The Journal of the American Dental Association
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Randomized Controlled Trial Comparative Study Clinical Trial
Anesthetic efficacy of the palatal-anterior superior alveolar injection.
A single palatal-anterior superior alveolar, or P-ASA, injection has been reported to provide pulpal anesthesia of the four maxillary incisors and usually the canines. The authors conducted a prospective, randomized, double-blind study to compare the anesthetic efficacy of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine using a computer-assisted injection system to administer the P-ASA injection. ⋯ Using the computer-assisted injection system for the P-ASA injection, we concluded that the rather modest-to-low success rates of the lidocaine and mepivacaine solutions would not ensure predictable pulpal anesthesia of the four maxillary incisors and the canines.
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The authors conducted a study that considered family physicians' and dentists' knowledge and application of techniques to reduce the pain associated with anesthetic injections. They also assessed practitioners' discomfort with patients' injection pain and needle anxiety/phobia. ⋯ Pain reduction techniques for anesthetic injection cost little to implement, are not time liabilities, and can lessen avoidable pain and reduce the incidence of needle phobia.
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Licensure examinations in dentistry have become an increasing concern, owing to ethical issues in the use of patients, difficulties in seeing relationships between outcomes of licensure examinations and performance in educational programs, and questions on the reliability of "one-shot" clinical examinations. Using data from a nine-year period, the authors compared the results of clinical licensing tests and the academic class ranks of the candidates. ⋯ If the results of this study can be generalized to all U.S. licensure examinations, basing licensing decisions on clinical licensure examination alone risks licensure decisions of low validity. Use of patients in examinations of questionable validity may be unethical because they may have been subjected to risk of irreversible damage without contribution to a valid decision-making process by the licensing authority.
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High-quality systematic reviews are the basis of valid, reliable clinical practice guidelines, or CPGs. In 1999, a Canadian collaboration of dentists embarked on the process of developing guidelines. ⋯ Systematic reviews and the development of CPGs require rigorous methodology, as well as input from content experts and clinicians, to ensure validity and relevance. The processes are costly and time-intensive, but the anticipated outcome is enhanced clinical decision making and improved oral health.