Local Anesthetics: A Century of Progress.

One century after the clinical introduction of cocaine, local anesthesia remains the most important method of pain control in dentistry. Many local anesthetics have been marketed since 1884, and it is likely that attempts to produce drugs that enhance anesthetic efficacy, reduce systemic and local toxicity, and increase nociceptive selectivity, will continue. In addition, new methods of drug administration have been and will be developed to achieve these goals.

Dentistry-based approaches to sleep-disordered breathing, algorithms, and multidisciplinary perspectives.

Sleep disorders affect more than 20 percent of the U.S. population, but less than 7 percent have been medically diagnosed.

What's new with phentolamine mesylate: a reversal agent for local anaesthesia?

Phentolamine mesylate (OraVerse), a nonselective a-adrenergic blocking drug, is the first therapeutic agent marketed for the reversal of soft-tissue anaesthesia and the associated functional deficits resulting from an intraoral submucosal injection of a local anaesthetic containing a vasoconstrictor. In clinical trials, phentolamine injected in doses of 0.2 to 0.

Advanced techniques and armamentarium for dental local anesthesia.

Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections.

Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients.

Background: The authors evaluated the safety and efficacy of a formulation of phentolamine mesylate (PM) as a local anesthesia reversal agent for pediatric patients.

Methods: A total of 152 pediatric subjects received injections of local anesthetic with 2 percent lidocaine and 1:100,000 epinephrine before undergoing dental procedures. The authors then randomized subjects to receive a PM injection or a control injection (sham injection in which a needle does not penetrate the tissue) in the same sites as the local anesthetic was administered in a 1:1 cartridge ratio after the procedure was completed.

Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults.

Background: The authors conducted two multicenter, randomized, double-blinded, controlled Phase III clinical trials to study the efficacy and safety of phentolamine mesylate (PM) in shortening the duration and burden of soft-tissue anesthesia. The study involved 484 subjects who received one of four commercially available local anesthetic solutions containing vasoconstrictors for restorative or scaling procedures.

Methods: On completion of the dental procedure, subjects randomly received a PM or a sham injection (an injection in which a needle does not penetrate the soft tissue) in the same site as the local anesthetic injection.

Randomized study of phentolamine mesylate for reversal of local anesthesia.

Local anesthetic solutions frequently contain vasoconstrictors to increase the depth and/or duration of anesthesia. Generally, the duration of soft-tissue anesthesia exceeds that of pulpal anesthesia. Negative consequences of soft-tissue anesthesia include accidental lip and tongue biting as well as difficulty in eating, drinking, speaking, and smiling.

Pharmacokinetics of lidocaine with epinephrine following local anesthesia reversal with phentolamine mesylate.

Phentolamine mesylate accelerates recovery from oral soft tissue anesthesia in patients who have received local anesthetic injections containing a vasoconstrictor. The proposed mechanism is that phentolamine, an alpha-adrenergic antagonist, blocks the vasoconstriction associated with the epinephrine used in dental anesthetic formulations, thus enhancing the systemic absorption of the local anesthetic from the injection site. Assessments of the pharmacokinetics of lidocaine and phentolamine, and the impact of phentolamine on the pharmacokinetics of lidocaine with epinephrine were performed to characterize this potentially valuable strategy.

The pathophysiology, medical management and dental implications of adult attention-deficit/hyperactivity disorder.

Background: Few published reports in the dental literature have focused on adult attention-deficit/hyperactivity disorder (ADHD) and its dental implications.

Types Of Studies Reviewed: The authors conducted a MEDLINE search for the period 2000 through 2005 using the terms "adult" and "attention-deficit" to define ADHD's pathology, medical treatment and dental implications.

Results: ADHD is a developmental condition that affects slightly more than 4 percent of the adult U.

Metabolic syndrome: pathogenesis, medical care and dental implications.

Background: The dental literature contains little information about metabolic syndrome (MetS) and its dental implications.

Types Of Studies Reviewed: The authors conducted a MEDLINE search for the period 2000 through 2005, using the term "metabolic syndrome" to define its pathophysiology, medical treatment and dental implications.

Results: MetS is the co-occurrence of abdominal obesity, hyper-triglyceridemia, reduced high-density lipoprotein cholesterol levels, hypertension and impaired fasting glucose, which results from consumption of a high-calorie diet and decreased levels of physical activity superimposed on the appropriate genetic setting.

Management of the hypertensive dental patient.

Hypertension is a common malady and a harbinger of such diseases as heart attack and stroke. Because millions of Americans are not aware they are hypertensive or it is not adequately controlled, dentists can contribute significantly to national health by screening their patients. Dentists must also be cognizant of the implications high blood pressure has for dental practice.

Obesity: a complicating factor for sedation in children.

The purpose of this review was to describe the potential influence of childhood obesity on pharmacosedation in pediatric dentistry and provide specific recommendations for managing obese patients. Increasingly common in the United States, childhood obesity poses specific challenges to the dentist. The greatest of these involve the increased potential for respiratory complications because of fat-induced restrictive lung disease and obstructive sleep apnea.

The neuropathology, medical management and dental implications of autism.

Background: A paucity of information exists in the dental literature about autism and its dental implications.

Types Of Studies Reviewed: The authors conducted a MEDLINE search for the period 2000 through 2006, using the term "autism," with the aim of defining the condition's clinical manifestations, dental and medical treatment and dental implications.

Results: Autism is a severe developmental brain disorder that appears in infancy, persists throughout life, and is characterized by impaired social interaction, abnormalities in communication (both verbal and nonverbal) and restricted interests.

Alzheimer's disease: psychopathology, medical management and dental implications.

Background: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with Alzheimer's disease (AD).

Studies Reviewed: The authors conducted MEDLINE searches for 2000 through 2005 using the terms "Alzheimer's disease," "geriatric," "epidemiology," "pathophysiology," "treatment" and "dentistry." Reports selected for further review included those published in English in peer-reviewed journals.

Restless legs syndrome: manifestations, treatment and dental implications.

Background: The authors reviewed the clinical features, epidemiology, pathogenesis and risk factors, medical management, dental findings and dental management of patients with restless legs syndrome (RLS).

Types Of Studies Reviewed: The authors conducted a MEDLINE search for the years 2000 through 2004 using the key terms "restless legs syndrome," "epidemiology," "pathophysiology," "treatment" and "dentistry." They selected articles published in English in peer-reviewed journals for further review, and they gave preference to articles reporting randomized controlled trials.

Anesthetic efficacy of different ropivacaine concentrations for inferior alveolar nerve block.

This study was conducted on 72 American Society of Anesthesiologists class 1 patients scheduled for extraction of a mandibular third molar after inferior alveolar nerve block. Each patient was randomly administered one of the following ropivacaine concentrations: 0.75%, 0.

Balancing efficacy and safety in the use of oral sedation in dental outpatients.

Background: Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations.

Overview: There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety.

Monitoring of vital signs during dental care.

Advances in medicine have greatly increased the survival of patients with severe health problems and have significantly prolonged life in elderly individuals with systemic disorders. Concomitant advances in dentistry and evolving societal expectations regarding dental health and function have likewise ensured that these patients are increasingly retaining their teeth and/or seeking dental care. The administration of local anaesthetics and the performance of extensive dental procedures may cause stress and systemic disturbances in such patients.

Recent developments in local anesthesia and oral sedation.

This article reviews 3 recent developments in anxiety and pain control with significant potential for altering dental practice. First is the introduction of articaine hydrochloride as an injectable local anesthetic. Although articaine is an amide, its unique structure allows the drug to be quickly metabolized, reducing toxicity associated with repeated injections over time.

Developmental stuttering: manifestations, treatment and dental implications.

Developmental stuttering (DS) is a disturbance in the normal fluency and time patterning of speech resulting in involuntary repetition, prolongation, or cessation of sound. The scientific literature has implicated the lack of strong left cerebral dominance and abnormal levels of the neurotransmitters dopamine and possibly serotonin in regions of the brain controlling the coordination of language processing and motor activity of the vocal apparatus as possible causative factors in DS. Speech-language therapy is the most common form of treatment, but antipsychotic, antidepressant, and anxiolytic medications may be prescribed for some children and adults with persistent stuttering.

Serum mepivacaine concentrations after intraoral injection in young children.

The authors measured plasma concentrations of mepivacaine in 36 children from the ages of 2 to 5 years who received dental care under light general anesthesia. The subjects were randomly assigned to receive either 2 percent mepivacaine hydrochloride with 1:20,000 levonordefrin or 3 percent mepivacaine hydrochloride without vasoconstrictor. The volume of anesthetic injected depended on the planned procedures for each patient.

The pathophysiology, medical management and dental implications of fragile X, Rett, and Prader-Willi syndromes.

Fragile X, Rett, and Prader-Willi syndromes are a group of inherited disorders that often present with varying degrees of mental retardation and challenging behaviors. Dentists caring for individuals with these disorders must be familiar with the manifestations of these diseases and their associated features so they can garner the maximum level of cooperation from the patient. They must also be familiar with the medications (anticonvulsants, antihypertensives, antidepressants, antipsychotics, and central nervous system stimulants) used to treat the associated behaviors, because many of these pharmaceuticals cause clinically evident orofacial and systemic reactions, and may precipitate adverse interactions with dental therapeutic agents.

The pathophysiology, medical management, and dental implications of autism.

Autism is a lifelong, severe, developmental disorder that appears initially in infancy and early childhood and impairs the acquisition of some of the most important skills in human life. The disease is characterized by impaired social interactions, verbal and nonverbal communication deficiencies, limited activities and interest, and repetitive behaviors. Often accompanying the disorder are behavioral disturbances, such as self-mutilation and aggression, psychiatric symptoms, and seizures, which necessitate the administration of multiple medications to help the affected individual participate effectively in the educational and rehabilitative process.

The pathophysiology, medical management, and dental implications of children and young adults having attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder is considered to be the most common neurobehavioral disorder among school-aged children. Children who have ADHD exhibit symptoms of inattention, hyperactivity, and impulsivity that are extreme for their age. These symptoms adversely affect academic performance, vocational success, and social-emotional development.

Alcohol abuse and dependence: psychopathology, medical management and dental implications.

Background: The authors review the clinical features, epidemiology, pathophysiology, medical management, dental findings and dental treatment of patients with alcoholism.

Literature Reviewed: The authors conducted a MEDLINE search for 1995 through 2001 using the key terms of alcoholism, epidemiology, pathophysiology, treatment and dentistry. Reports selected for further review included those published in English in peer-reviewed journals.