The Journal of the American Dental Association
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Tramadol hydrochloride is a novel, centrally acting analgesic with two complementary mechanisms of action: opioid and aminergic. First marketed in 1994, tramadol is frequently prescribed by physicians for the management of moderate-to-moderately severe chronic pain. The author evaluates its unique analgesic pharmacology and limited clinical utility for managing acute pain in dentistry. ⋯ Tramadol has limited indication for management of acute pain in dentistry, possibly as an alternative analgesic when gastrointestinal side effects contraindicate the use of nonsteroidal anti-inflammatory drugs and when codeine/acetaminophen combination analgesics are not well-tolerated or are contraindicated.
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The authors conducted literature review to create a heightened awareness of the potential for developing toxic methemoglobinemia from local anesthetics. Methemoglobin normally is present in the blood at levels less than 1 percent. Levels may become toxic as hemoglobin is oxidized to methemoglobin after local anesthetics such as benzocaine and prilocaine are administered. ⋯ Dentists should identify patients who are at increased risk of developing methemoglobinemia before administering local anesthetics. They also should follow new recommended dosing guidelines for prilocaine and be aware of symptoms of this adverse reaction.
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Although periodontal scaling and root planing, or SRP, is one of the most common procedures used in dental practice, there is little information available about the degree of postprocedural pain associated with it. The authors undertook this study to document the intensity and duration of pain after SRP with a view toward helping practitioners and their patients manage postprocedural discomfort. ⋯ Practitioners should consider using appropriate analgesic drugs to alleviate mild-to-moderate pain after SRP. On the basis of this study, it would appear that an analgesic that has a peak effect two to eight hours after the completion of SRP would be the most appropriate medication. Moreover, it is unlikely that analgesic medication would be needed by most patients beyond the day on which SRP was performed.
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More than 350,000 adult Americans die each year of sudden cardiac arrest, or SCA. The event is unpredictable and can occur in patients with no history of cardiac disease or cardiac symptoms. Drugs and cardiopulmonary resuscitation, or CPR, save only a small percentage of victims. The necessary response is rapid application of electrical shock, and the chances of success are reduced 10 percent for every minute of delay. ⋯ AEDs are being installed in more public locations, including some dental offices. As costs decrease and availability increases, there is significant potential use for AEDs in managing SCAs in dental offices.
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Randomized Controlled Trial Clinical Trial
Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine.
Because a number of patients have reported an increase in heart rate with the intraosseous, or i.o., injection, it is important to evaluate changes in the cardiovascular system with this injection technique. The purpose of this study was to determine the cardiovascular effects of an i.o. injection of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. ⋯ While patients would likely notice the heart rate increase with the lidocaine-epinephrine solution, it would not be clinically significant in most healthy patients. In patients whose medical condition, drug therapies or epinephrine sensitivity suggests caution, 3 percent mepivacaine is a good alternative for i.o. injections.