Pulsed electromagnetic fields for postoperative pain: a randomized controlled clinical trial in patients undergoing mandibular third molar extraction
ABSTRACT:
The clinical efficacy of a wearable pulsed electromagnetic field (PEMF) therapy device was assessed in terms of pain and quality of healing after tooth extraction. This randomized, parallel-design, placebo-controlled study involved 120 patients undergoing unilateral mandibular third molar extraction and assigned to three groups after surgery. Test and placebo patients wore enabled or disabled PEMF devices, respectively, and controls wore no device. Patients recorded pain (on the visual analog scale) and analgesic use for a week, after which healing complications were assessed. RESULTS: Test patients had only slightly lower visual analog scale scores and analgesic use, but significantly fewer cases of dehiscence than placebo patients. The authors concluded that PEMF therapy delivered by a wearable device improved soft-tissue healing and may be a useful adjunct for pain management after oral surgery.
Noise level measurement, a new method to evaluate effectiveness of sedation in pediatric dentistry
ABSTRACT:
The authors aimed to determine if the level of noise created by children who are undergoing moderate sedation during dental procedures could be used as a nonsubjective measurement of the depth of sedation and compare it to the Ohio State Behavior Rating Score (OSBRS). Following Institutional Review Board approval and after receiving informed consent, 51 children with a mean age of 4.2 years and average weight of 18.5 kg were studied; they were undergoing restorative or extractive dental procedures, requiring moderate sedation. Sedation efficacy was assessed using OSBRS at several stages of the procedure. The noise level was measured by using a NoisePRO logging device. RESULTS: The depth of sedation assessed by OSBRS during the operative procedure was significantly correlated with noise level. Administering the local anesthesia and the operative procedure itself were two phases of the encounter that were significantly associated with higher OSBRS as well as noise levels. Measurement of noise level can be used as an effective guide to quantify the depth of sedation at different stages of the dental procedure. It is a nonsubjective and continuous measurement, which could be useful in clinical practice for the administration of moderate sedation during dental procedures. By using noise level analysis the authors were able to determine successful, poor, and failed sedation outcome.
A prospective randomized controlled trial of two different sedation sequences for third molar removal in adults
ABSTRACT:
In oral and maxillofacial outpatient surgery, sedation techniques are an important component in patient management for a wide variety of surgical procedures. Fentanyl and midazolam are commonly used sedatives with different mechanisms of action and specific analgesic or amnestic properties. This study examined whether the order of their administration would affect a patient’s pain perception or procedural vital signs. After institutional review board approval and written informed consent, a prospective, randomized, parallel-group clinical trial was conducted in patients who planned to undergo removal of at least two (2) third molars under intravenous moderate sedation. Patients were randomly assigned to one of two groups. The fentanyl-first group received fentanyl and then midazolam; the midazolam-first group received midazolam and then fentanyl. Recollection of the intraoperative pain score was assessed 24 hours after surgery using the Wong-Baker FACES pain scale. CONCLUSIONS: In this study, selective sequencing of midazolam or fentanyl during an intravenous moderate-sedation procedure did not result in a measurable difference of recollected procedural pain scores at 24 hours after third molar extraction. The choice of the sedation agents and the order of their administration should be tailored to the patient’s needs, type of surgical procedure, and surgeon preference.
