Purpose: The purposes of this study were four-fold: 1) to determine the types and effectiveness of various topical anesthetics being used among dentists currently treating children, 2) to determine the types of procedures for which topical anesthetics are being used among children, 3) to understand the awareness and use of a relatively newer compounded topical gel Oraqix (Dentsply Caulk) among children, 4) to understand the adverse reactions to topical anesthesia that are seen among children. Methods: A cross sectional survey was designed, regarding the type, procedural use, effectiveness, and adverse reactions noted among children to various topical anesthetics. The survey sampled n=4933 actively practicing member dentists from a database of willing survey participants obtained from the American Academy of Pediatric Dentistry. The survey consisted of 14-items in multiple choice/answer format. The survey was pilot tested by a committee of faculty, and attached via e-mail with a cover letter containing a direct survey link for the study participants. Surveys were collected, posted, and managed through www.surveymonkey.com. Results: The study received 1255 responses from practitioners who are actively treating children giving an effective response rate of 25%. Of those that participated 94% are Pediatric dentists, 6% General dentists or “Other” specialists who treat children. The majority of respondents (95%) routinely use topical anesthetic, rating it as effective or very effective clinically. The most commonly used topical was 20%-Benzocaine gel with a reported 96% effective rate. The most common procedures topical anesthetics are being used for are pre-injection of local anesthetic and extraction of exfoliating deciduous teeth. Very few of the responding practitioners have ever heard of or used Oraqix gel prior to this survey. Many though, would consider using Oraqix if proven effective. Only 10% of respondents reported an adverse reaction to topical anesthetics, the most common being contact dermatitis or tissue sloughing from prolonged contact, followed by an allergic or aversive reaction to the dyes or flavoring in the topical anesthetic. Conclusions: The overwhelming majority of dentists treating children routinely use topical anesthetics to reduce pain response among children. 20%-Benzocaine gel is the most widely used topical anesthetic being used for dental procedures on children. Adverse reactions to topical anesthetic noted among practitioners treating children are very low but must still be strongly considered as potential life threatening risks if not used appropriately. Many practitioners treating children are still looking for the “ideal” topical anesthetic with improvements in taste, the ability to stay localized, the method of delivery, and improved effectiveness being key areas for future research.

Made available in DSpace on 2017-07-24T19:22:14Z (GMT). No. of bitstreams: 1 Jose Laufer.pdf: 1246261 bytes, checksum: 67bab31b5ee267fca6c8c43076e3729b (MD5) Previous issue date: 2006-02-22 / The no invasive anesthesia by application of an anesthetic gel in the interior of the periodontal pocket appears as an alternative in the periodontal treatment. The objective of this study was to manipulate, to test the physical-chemical properties, the percutaneous absorption of a gel thermosetting topical anesthetic lidocaine/prilocaine 5 Test) and evaluates its biocompatibility. Preformulation studies, microbiological and percutaneous absorption (PA) in vitro and in vivo, has been done. To evaluate aspects of biocompatibility 2 techniques had been done: vascular permeability (VP) and descriptive histological analyses (HA). In the PV, 60 rats and 3 periods of observation had been used (3, 6, 9 hours) and were evaluated,visually, for the area of the inflammation and for dye concentration applied, by spectrophotometric analysis, after mplantation of 0,1 mL of the substances: G1- Teste; G2-Emla; G3-Poloxamer; G4-Controle. In AH, 60 rats, were divided in 4 groups (in the same way cited before) with subcutaneous implantation of polyethylene tubes with substances had been used, in periods of 2, 5 and 15 days. The pharmacotechnical results had shown values of pH 7,71, density (gel 1,020),not occurring microorganisms growth (gram+, gram- and fungi) in the substance Test and showing a good viscosity, adjusted for use in oral cavity. AP did not show significant differences between the GI and GII, with p>0,05 (Mann-Whitney) for the experiments in vitro and in vivo. In the PV, G1 and G2 had bigger values (p< 0,05) than G3 and G4. The histological analysis did not show areas of necrosis, nor severe inflammatory response. It is concluded that the gel Test presents adequate properties and showed not to induce severe inflammatory response in the subcutaneous, showing biocompatibility when compared with the control group. / A anestesia não invasiva com a aplicação de gel anestésico no interior da bolsa periodontal surge como uma alternativa no tratamento periodontal. Esse estudo teve como objetivo manipular, testar as propriedades físico-químicas, de absorção percutânea de um gel anestésico tópico termosensível (lidocaína/prilocaína 5 - Teste) e avaliar a sua biocompatibilidade. Foram realizados estudos de préformulação, microbiológicos e absorção percutânea (AP) in vitro e in vivo do fármaco. Para biocompatibilidade foram utilizadas 2 técnicas: permeabilidade vascular (PV) e análise histológica descritiva (AH). Na PV foram utilizados 60 ratos e 3 períodos de observação (3, 6, 9 horas) em que avaliou-se a área da inflamação visualmente e por quantificação do corante aplicado sob análise de espectrofotometria após implantação de 0,1 mL das substâncias sendo: G1-Teste; G2-EMLA; G3-Poloxamer; G4-Controle. Na AH foram utilizados 60 ratos divididos em 4 grupos (os mesmos supra citados) com implantação subcutânea de tubos de polietileno preenchidos com as substâncias, em períodos de 2, 5 e 15 dias. Os resultados de farmacotécnica mostraram valores de pH 7,71, densidade (gel 1,020), não ocorrendo crescimento microbiano (gram+, gram- e fungos) na substância Teste e mostrando uma boa viscosidade, adequada para uo em cavidade bucal. A AP não mostrou diferenças significativas entre o GI e GII com p>0,05 (Mann-Whitney) para os experimentos in vitro e in vivo. Na PV G1 e G2 tiveram valores maiores (p< 0,05) que G3 e G4. A análise histológica não mostrou áreas de necrose, nem resposta inflamatória severa. Conclui-se que o gel Teste apresenta propriedades adequadas e mostrou não induzir resposta inflamatória severa no subcutâneo de ratos, mostrando-se biocompatível quando comparado com o grupo controle .

Made available in DSpace on 2017-07-24T19:22:34Z (GMT). No. of bitstreams: 1 LETICIA MAIRA WAMBIER.pdf: 1876181 bytes, checksum: bd12d925a7b8bc206eb9be1d465c2fe8 (MD5) Previous issue date: 2014-02-21 / This study evaluated the effect of a thermosensitive liposomal anesthetic gel on pain and anxiety during nonsurgical periodontal treatment in patients with special needs. Material and Methods: This study was designed as a split mouth randomized bind clinical trial. Thirty-two young subjects (17.4 ± 5.6) of both genders were selected according to the inclusion criteria: moderate intellectual disability, minimum of 16 teeth, at least one tooth in each sextant with probing depth ≥ 4 mm. Prior periodontal treatment, the index of plaque, marginal bleeding, probing pocket depth and bleeding were obtained. The experimental gel tested was composed of 5% prilocaine/lidocaine, microemulsion thermosensitive liposomal phospholipid gel. It was compared to a commercially available gel Oraqix (5% prilocaine/lidocaine-thermosensitive gel).The negative controls for both gels were periodontal treatment without anesthesia and the rescue drug used was EMLA cream (5% prilocaine/lidocaine), applied in the periodontal pocket if there was discomfort during scaling and root planning (SRP). The parameters used to assess pain intensity and dental anxiety during periodontal treatment were: Hannallah pain scale; Wong-Baker faces pain rating scale and 11-point numerical rating scale, blood pressure and oxygen saturation. All data were compared with ANOVA and chi-square tests. Results: Hannallah pain scale showed significant difference (p<0.05) during SRP. Wong-Baker faces pain rating scale and 11-point numerical rating scale, blood pressure and oxygen saturation did not have significant difference among groups (p>0.05). The anesthetic gel preference between male and female showed significant difference (p<0.0001). Conclusion: Most of the handicapped patients did not require anesthesia to control pain and anxiety during non-surgical periodontal treatment (SRP). Therefore, the non-invasive topical anesthesia could be indicated for anxious patients. / Esta pesquisa avaliou a ação de um gel anestésico lipossomal termossensível na dor e ansiedade durante o tratamento periodontal não cirúrgico em pacientes com necessidades especiais. Material e Método: Este estudo foi clínico, randomizado, boca dividida. Foram selecionados 32 indivíduos jovens (17,4 5,6) de ambos os gêneros conforme critérios de inclusão: deficiência intelectual moderada, mínimo de 16 dentes, com pelo menos um dente em cada sextante com profundidade clínica de sondagem ≥ 4 mm. Antes do tratamento foram obtidos o índice de placa, sangramento marginal, profundidade clínica de sondagem e sangramento. O gel experimental testado era composto de 5 % de prilocaina / lidocaína em microemulsão lipossomal fosfolipídica termossensível. Foi comparado com um gel disponível comercialmente Oraqix (gel de 5 % de prilocaina / lidocaína - termossensível). Os controles negativos para os dois géis foram o tratamento periodontal sem anestesia, e o medicamento de resgate utilizado foi o EMLA creme (5 % de prilocaina / lidocaína), aplicada na bolsa periodontal se houvesse desconforto durante a raspagem e alisamento radicular (RAP). Os parâmetros utilizados para avaliar a intensidade da dor e da ansiedade no tratamento periodontal foram: Escala Comportamental de Hannallah; Escala de Face de Wong-Baker e Escala Numérica de 11 pontos, pressão arterial e saturação de oxigênio. Os dados foram comparados com os testes ANOVA e Qui-quadrado. Resultados: Para a Escala de dor Hannallah houve diferenças significantes (p<0,05) durante a RAP. Para a Escala de Face Wong-Baker, Escala Numérica de 11 pontos, pressão arterial e saturação de oxigênio não foram observadas diferenças significativas entre os grupos (p>0,05). As diferenças foram significativas quanto à preferência pelo tratamento considerando os gêneros masculino e feminino (p<0,0001). Conclusão: A maioria dos pacientes com necessidade especial não precisaram de anestesia para o controle da dor e ansiedade no tratamento periodontal não-cirúrgico (RAP). Portanto, a anestesia tópica não invasiva pode ser indicada para pacientes ansiosos.