The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study

Abstract

Background: The purpose of this study was to evaluate the anesthetic effectiveness of a buccal infiltration technique combined with local massage (using 2% lidocaine) in the extraction of mandibular premolars to be utilized as an alternative to the conventional inferior alveolar nerve block. Methods: Patients eligible included any subject with a clinical indication for tooth extraction of the mandibular 1st or 2nd premolars. All patients were anesthetized buccally by local infiltration technique followed by an external pressure applied for 1 min directly over the injection area. In each case, another local injection was given lingually. All operations were started at approximately 5 min after the buccal injection. The collected data included age, gender, pain perception and its intensity during treatment at three checkpoints, apical tenderness, and the type of extraction. Any associated complications or difficulties were also recorded. Then the results were analyzed and interpreted using appropriate statistical tests. The significance level was set at P ≤ 0.05. Results: A total of 247 cases (1st premolar, n = 119; 2nd premolar, n = 128), predominantly male, were included. In 95% of study sample, the patients were satisfied with the dental extraction without any pain. However, in 5% of cases, pain was reported at the stage of tooth removal. Apical tenderness was found to be present in 11% of the total cases. Three teeth required surgical removal. Upon analysis, no significant differences in the success rates were detected between the 2 premolar groups or amongst the various age groups. Minor and transient side effects were reported in this study. Conclusion: The technique is simple and effective as well. It might be considered as an alternative anesthetic injection to the inferior alveolar nerve block for dental extraction of the mandibular premolars.

Neurological Complications of Local Anesthesia in Dentistry: A Review

“…It is commonly administered by injection into the oral mucosa. Dental procedures such as tooth extraction, root canal treatment, dental fillings, and gingival treatments, including root planing and gingival grafts, often require the use of LA to ensure patient comfort [ 5 ].…”

“…Prompt recognition and appropriate management are crucial in minimizing the risks associated with vascular complications. Adherence to proper injection techniques, aspiration to rule out intravascular injection, and knowledge of anatomical landmarks help reduce vascular complications incidence during LA procedures [ 5 , 12 , 13 ].…”

“…There are many symptoms of neurological complications like agitation, restlessness, irritability, or a state of increased anxiety, confusion, difficulty in thinking, impaired judgment, disorientation, dizziness, a sensation of light-headedness, feeling faint, drowsiness, feeling excessively sleepy or fatigued, and a metallic taste in the mouth [ 5 , 73 ].…”

“…When LA affects the ophthalmic nerve or its branches, it can cause various effects on the eye and periorbital region. Some of these effects include direct effects on the eye and periorbital effects (Tables 1 , 2 ) [ 5 , 80 ].…”

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

“…Local anesthetic agents are weak bases, and are commonly synthesized in the form of hydrochloride salts in order to enhance their water solubility [2]. Inferior alveolar nerve block (IANB) is known to be the preferred method for mandibular molar anesthesia [3]. However, it has some shortcomings, such as a high rate of insufficient depth of anesthesia ranging from 15% to 20% due to lack of reliable anatomical landmarks and variations [4].…”