Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Thesis (M.S.)--University of Michigan, 2006. / Includes bibliographical references (leaves 116-122).

Diss. med. dent. Zürich. / Literaturverz.

Thesis (M.S.)--University of Michigan, 1997. / Includes bibliographical references.

Indiana University-Purdue University Indianapolis (IUPUI) / The pain-controlling effects of a recently introduced electronic dental anesthesia device (CEDETA) were compared with those of local anesthesia in this study. Procedures performed involved full-coverage stainless steel crowns on maxillary primary molars, some of which required indirect pulp therapy and pulpotomies. A total of 55 children, aged 6 years to 10 1/2 years, were randomly selected to have treatment done with CEDETA or local anesthetic. Eight of these patients were treated with both CEDETA and local anesthetic at different appointments. At various times during each procedure, the patient and operator rated the patient's level of discomfort using a 6-point Visual Analog Scale. For each of the five evaluation steps, no significant differences existed in discomfort ratings between the CEDETA and local anesthetic methods for the group of eight patients or for the entire group. Operator ratings of patient discomfort did not vary significantly between the two methods of anesthesia for each of the evaluation steps, except at the step of maximum output or after injection, when the CEDETA group as a whole had significantly lower operator-rated pain. In general, patients tended to rate their perceptions of pain higher than those of the operator. Although the operator and patients in this study found CEDETA to be as effective as local anesthetic for controlling dental operative pain, a number of factors must be considered when deciding to use this type of electronic dental anesthesia. A substantial monetary investment is required to purchase the CEDETA device and the disposable electrodes and batteries to power the unit. There is an increased operating expense for each procedure done when using CEDETA, because of the additional time needed for the operator, staff, and patients to become familiar with the use of the device. Additional setup and break-down time is also needed when using CEDETA as opposed to local anesthetic.

Submitted by Eunice Novais (enovais@uepg.br) on 2017-09-01T18:47:07Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Leticia Maira Wambier.pdf: 16422117 bytes, checksum: a3982694093e88d3d304fecbb64368a8 (MD5) / Made available in DSpace on 2017-09-01T18:47:07Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Leticia Maira Wambier.pdf: 16422117 bytes, checksum: a3982694093e88d3d304fecbb64368a8 (MD5) Previous issue date: 2017-06-30 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O objetivo deste trabalho foi realizar revisões sistemáticas e estudos clínicos randomizados para avaliar a efetividade dos anestésicos tópicos, para reduzir o risco e a intensidade de dor durante procedimentos odontológicos em crianças e adultos. Nos experimentos 1 e 2, revisões sistemáticas foram conduzidas para responder as perguntas PICO: “A anestesia tópica exerce influência na dor durante a raspagem radicular (RAP) em pacientes adultos?” e “A anestesia infiltrativa exerce influência na dor durante a raspagem radicular (RAP) em pacientes adultos?” A patente foi obtida com o gel anestésico fotoativado. Nos estudos 3 e 4, um dos géis anestésicos (lipossomal termossensível ou fotoativado versus placebo) foi aplicado ao redor da gengiva de primeiros molares permanentes inferiores para adaptação do grampo # 26, colocação do dique de borracha e aplicação de selante resinoso. No estudo 5, participaram adultos com lesões cervicais não cariosas, cujo tratamento foi realizado com o gel anestésico fotoativado versus placebo para a adaptação do grampo # 212. Os dados do estudo 1 evidenciaram que a anestesia tópica diminuiu o risco (p= 0,002), a intensidade da dor (VAS e Heft Parker, p= 0,002; VRS, p= 0,023) e a necessidade de anestesia resgate (p= 0,005) durante a sondagem e RAP comparada ao uso de um placebo. O estudo 2 mostrou que a anestesia infiltrativa foi melhor somente na avaliação da intensidade de dor (p = 0,03) comparada a anestesia tópica, sem diferença estatística para o risco de dor (p = 0,58), necessidade de anestesia de resgate (p < 0,0001) e preferência dos pacientes (p = 0,09). No estudo 3 não foram detectadas diferenças estatísticas para o risco de dor (p = 0,52) entre o gel anestésico lipossomal termossensível e o gel placebo em crianças, havendo diferenças para a intensidade de dor com resultados positivos para o gel anestésico (p= 0,023 para escala numérica e p= 0,013 para escala facial). O estudo 4 mostrou resultados positivos para o gel anestésico fotoativado versus placebo, com diferenças significativas para o risco de dor (p= 0,0002) e intensidade da dor nas diferentes escalas (P<0,001). Dados semelhantes foram observados no estudo 5, com resultados também favoráveis para o gel anestésico fotoativado versus placebo aplicado em adultos, sendo detectadas diferenças estatísticas para o risco de dor (p= 0,0339) e intensidade da dor nas diferentes escalas empregadas (VAS, p=0,005 e VRS, p=0,015). As revisões sistemáticas demonstraram que a anestesia tópica pode ser uma alternativa para substituir a infiltrativa na RAP, enquanto que os ensaios clínicos randomizados demonstraram que os anestésicos tópicos lipossomal termossensível e fotoativado são efetivos para diminuir a intensidade de dor em crianças e adultos, e são uma alternativa de trabalho para procedimentos odontológicos menos invasivos. / The objective of these researche was to conduct systematic reviews and randomized clinical trials to evaluate the effectiveness of topical anesthetics to reduce the risk and intensity of pain during dental procedures in children and adults. In the experiments, 1 and 2, systematic reviews were conducted to answer the PICO questions: "Does topical anesthesia influence pain during scaling and root planing (SRP) in adult patients?" and "Does infiltrative anesthesia influence pain during scaling and root planing (SRP) in adult patients?" The patent was obtained with the light-curred anesthetic gel. In the studies 3 and 4, one of the anesthetic gels (thermosensitive liposomal or light-curred gel versus placebo) was applied around the lower permanent first molars gingiva to adapted the clamp # 26, placement of the rubber dam and application of resin sealant. In the study 5, adults with non-carious cervical lesions, whose treatment was performed with the light-curred anesthetic gel versus placebo for the clamp # 212 adaptation,were enrolled.The data from study 1 showed that topical anesthesia reduced risk (p = 0.002), pain intensity (VAS and Heft Parker, p = 0.002; VRS, p = 0.023) and need for rescue anesthesia (p = 0.005) during the probing and RAP compared to the placebo. Study 2 showed that infiltrative anesthesia was better only in the assessment of pain intensity (p = 0.03) compared to topical anesthesia, with no statistical difference for pain risk (p = 0.58), need for rescue anesthesia (p<0.0001) and patients' preference (p = 0.09). In the study 3, no statistical differences were detected for the risk of pain (p = 0.52) between thermosensitive liposomal anesthetic and placebo gel in children, with differences for pain intensity with positive results for the anesthetic gel (p = 0.023 for numerical scale and = 0.013 for facial scale). Study 4 showed positive results for the light-curred anesthetic gel versus placebo, with significant differences for the risk of pain (p = 0.0002) and pain intensity at the different scales (p<0.001). Similar data were observed in study 5, with favorable results for light-curred anesthetic gel versus placebo applied in adults. Statistical differences were found for the risk of pain (p = 0.0339) and pain intensity in the different scales used (VAS, p = 0.005 and VRS, p = 0.015). Systematic reviews have demonstrated that topical anesthesia may be an alternative to replace infiltrative anesthesia in SRP, where as randomized clinical trials have demonstrated that thermosensitive liposomal and light-curred anesthetics gels are effective in reducing pain intensity in children and adults, and are an alternative for less invasive dental procedures.