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Compendium
September 2014
Volume 35, Issue 8
Peer-Reviewed

Dental trauma related to general anesthesia: should the anesthesiologist perform a preanesthetic dental evaluation?

Idrees SR, Fujimura K, Bessho K. Oral Health Dent Manag. 2014;13(2):271-274.

ABSTRACT: Perioperative dental damage is a common anesthesia-related adverse event and is responsible for the greatest number of malpractice claims against anesthesiologists. A preanesthetic assessment may be necessary but is frequently overlooked by surgeons and anesthesiologists. The present study aimed to investigate, for both dentists and anesthesiologists, how often and under what circumstances dental trauma occurs during general anesthesia as well as isolate possible anatomical, dental, and anesthesiological risk factors, based on which suggestions for preventive measures could be made. Anesthesiologists must perform a thorough preoperative oral evaluation to help identify the dentition at risk; the evaluation should include the patient’s dental history, an oral/dental examination, and a specific discussion with the patient about any existing dentures or crowns. The dental examination should especially include an assessment of the patient’s upper incisors—the teeth most likely to be injured during the perioperative period—for pre-existing damage. Preoperative notes and adequate intraprocedure precautions should be taken to prevent/minimize iatrogenic dental injury.

Applied anatomy of the lingual nerve: Relevance to dental anaesthesia

Tan VL, Andrawos A, Ghabriel MN, Townsend GC. Arch Oral Biol. 2014;59(3):324-335.

ABSTRACT: This study’s objectives were to: 1) classify the external morphology of the lingual nerve and investigate any relationship between its external and internal morphology; 2) explore the fascicular structure, nerve tissue density, and capillary density of the lingual nerve; and 3) provide an anatomical explanation as to why adverse clinical outcomes more commonly affect the lingual nerve following local dental anesthesia. Where possible, comparisons were made between the lingual and inferior alveolar nerves. The lingual and inferior alveolar nerves were examined in 23 hemi-sectioned heads macroscopically and microscopically 2 mm above the lingula. Specimens underwent histological processing and staining. RESULTS: The lingual nerve became flatter as it traversed through the pterygomandibular space. There was an increase in the connective tissue and a decrease in nerve tissue density along the lingual nerve (P < 0.001). At 2 mm above the lingula, the lingual nerve was uni-fascicular in 39% of cases, while the inferior alveolar nerve consistently had more fascicles (P < 0.001). The lingual nerve fascicles had thicker perineurium but the endoneurial vascular density was not significantly different in the two nerves.

Efficacy of an anesthetic gel in the reduction of pain during impression making

Bressan E, Paniz G, Gobbato L, et al. Oper Dent. 2014;39(4):361-366.

ABSTRACT: Gingival tissue displacement can be an uncomfortable procedure, often performed without injectable local anesthesia. The present study evaluated the efficacy of an anesthetic gel in reducing pain during this procedure. A total of 30 patients undergoing definitive dental impression, for fabricating full-coverage restorations, were evaluated for pain perception on displacement of the surrounding gingival tissues. All of the participants were randomly divided into two groups. Five minutes before the insertion of the displacement cord, the anesthetic gel, a mixture of 5% lidocaine and 5% prilocaine, was applied in the sulcus of test group patients. Each patient was asked to complete the Visual Analogue Scale (VAS) and the Verbal Rating Scale (VRS). RESULTS: In the two scales considered, test group patients showed a statistically significant pain reduction (VAS P = 0.0002, VRS P = 0.01054) compared to control group patients. Within the limitations of this study, a clinically significant efficacy of the anesthetic gel was noticed during gingival displacement procedures.

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