Background:Effective pain control is central to the pediatric dental practice. Buffering local anesthetics with sodium bicarbonate raises the solution pH to physiological levels, theoretically accelerating the onset and reducing injection discomfort. Although buffered lidocaine has been studied in children, direct evidence comparing buffered 4% articaine with the most widely used clinical alternative (non-buffered 2% lidocaine) in a pediatric outpatient setting with a comprehensive outcome assessment remains scarce. This study aimed to compare buffered 4% articaine with 1:100,000 epinephrine and non-buffered 2% lidocaine with 1:100,000 epinephrine in children aged 6-12 years requiring single-tooth dental procedures and evaluate multiple clinically relevant outcomes, including pain, anesthetic onset, operator experience, and postoperative safety. Methods:This parallel-group, double-blind, randomized controlled trial enrolled 100 healthy children (American Society of Anesthesiologists (ASA) Physical Status I, aged 6-12 years). The participants were randomly allocated in a 1:1 ratio to receive either buffered 4% articaine (n = 50) or non-buffered 2% lidocaine (n = 50). The primary outcomes were injection pain (visual analog scale [VAS] score), anesthetic onset time (s), and operator-rated difficulty (VAS). Secondary outcomes included intraoperative pain, duration of soft tissue anesthesia, cardiovascular response (heart rate), behavioral cooperation (Frankl scale), pulpal success, need for reinjection, lip or cheek biting, and delayed adverse events at one week. Results:Buffered articaine produced significantly lower injection pain (2.25 ± 0.94 vs. 3.93 ± 0.90; P < 0.001), faster anesthetic onset (71.98 ± 15.24 vs. 115.28 ± 20.04 s; P < 0.001), lower operator difficulty scores (2.27 ± 0.99 vs. 4.22 ± 0.98; P < 0.001), and reduced procedure pain (2.15 ± 0.99 vs. 3.56 ± 1.05; P < 0.001). Soft tissue anesthesia lasted significantly longer with buffered articaine (159.02 ± 19.10 vs. 137.84 ± 17.54 min; P < 0.001). Heart rate elevation during the injection was significantly attenuated in the articaine group (P = 0.0003). Pulpal success rates were comparable (84% vs. 82%; P = 1.000), and no significant between-group differences were observed in the reinjection rate, lip or cheek biting, or delayed adverse events. Conclusion:Buffered 4% articaine provides clinically superior injection comfort, faster onset, and better behavioral cooperation than non-buffered 2% lidocaine in the pediatric dental practice, with a comparable safety profile.
Dental dislodgement during oral and maxillofacial surgery is an uncommon, but potentially serious complication. We report a case of intraoperative tooth loss with asymptomatic supraglottic retention during oral surgery under general anesthesia. A 55-year-old man underwent bilateral maxillary endoscopic sinus surgery (MESS) under general anesthesia. A severely mobile mandibular tooth was missing during surgery, although the ventilation and hemodynamic parameters remained stable. As the patient showed no evidence of airway compromise and the location of the tooth was uncertain, radiographic localization was performed after completion of the procedure. Portable radiograph revealed a tooth-shaped foreign body in the laryngeal region. Subsequent videolaryngoscopic examination revealed a tooth lodged beneath the epiglottis and above the vocal cord. The tooth was successfully removed using Magill forceps and the patient recovered without any respiratory complications. This case highlights that a dislodged tooth may remain undetected in the supraglottic airway despite stable respiratory parameters. Radiographic localization, followed by targeted video laryngoscopic retrieval, has enabled successful management.
Oral mucosal diseases, such as burning mouth syndrome, oral lichen planus, oral mucositis, and recurrent aphthous stomatitis, frequently present with altered sensory functions, including pain, dysesthesia, and changes in thermal and mechanical sensitivity. Accurate assessment of these sensory changes is essential for understanding disease mechanisms, evaluating treatment efficacy, and improving patient outcomes. This review summarizes current evidence on sensory measurement methods used in clinical trials involving patients with oral mucosal diseases, with a particular focus on quantitative sensory testing techniques.
Advanced polymeric drug delivery systems, particularly electrospun nanofibers and mucoadhesive patches, are promising platforms for the local treatment of periodontal and oral mucosal diseases. However, evidence regarding fabrication reproducibility, mucosal interactions, therapeutic efficacy, and stability has not been systematically synthesized. This systematic review evaluated novel polymeric carriers for dental and oral applications, with emphasis on fabrication parameters, drug loading, mucoadhesion, release behavior, immunomodulatory effects, clinical outcomes, and safety. Following PRISMA guidelines and the PICO framework, two independent reviewers searched PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for English-language studies published between 2015 and 2025. Eligible studies investigated novel polymeric carriers, primarily electrospun or composite systems, and reported fabrication parameters, including polymer type, preparation method, and drug loading, along with relevant biological or clinical outcomes. Risk of bias was assessed using SYRCLE/OHAT tools for original studies and AMSTAR-2 for review articles. Eight studies (four original research studies and four review articles) met the inclusion criteria. The included studies evaluated polymers, such as PLA/nano-HAP, chitosan/PVA/PCL, and PLLA/PEO, in combination with active agents including doxycycline, neem extract, curcumin, diclofenac sodium, and binahong extract. Electrospinning consistently generated porous, uniform carriers with fiber diameters of approximately 250-500 nm, sustained release ranging from 82% over 8 h to 60-80% over 7 days, mucoadhesive strength up to 0.34 N, immunomodulatory effects reflected by reduced IL-1, TNF-α, and MMP-8 levels, and antibacterial efficacy up to 98%. These systems also maintained mucosa-compatible pH values (6.5-7.0) and showed no evidence of irritation or toxicity. Needleless electrospinning variants further improved scalability. However, heterogeneity in fabrication parameters and moderate overall risk of bias, mainly from review-based evidence, limited direct comparisons across studies. Overall, electrospun nanofibers and mucoadhesive patches demonstrated promising potential as biocompatible platforms for targeted local drug delivery in dentistry, with the capacity to enhance immunomodulatory and antimicrobial effects in periodontitis, aphthous stomatitis, and oral ulcers. Further studies incorporating standardized fabrication validation and long-term stability testing are recommended to support clinical translation.
Acute exacerbation of idiopathic interstitial pneumonia (AE-IIP) can be triggered by invasive procedures and carries a mortality rate of approximately 50%. We report a case of a 73-year-old man who presented to a dental emergency room with maxillary swelling and a fever of 39.0℃. Initially, the patient was prescribed analgesics and antibiotics. The following day, because of an elevated C-reactive protein (CRP) level (18.0 mg/dL), emergency incision and drainage were performed. During the procedure, he developed tachypnea, dry cough, and hypoxia (SpO2, 85-90%). The patient was immediately transferred to a medical emergency hospital, where chest computed tomography confirmed the diagnosis of IIP. The patient was admitted to the respiratory care unit and was treated with corticosteroid pulse therapy and antibiotics. The patient was discharged on day 39 with ambulatory oxygen therapy. High CRP levels and acute hypoxia may be critical early indicators of AE-IIP. Dental anesthesiologists must recognize that oral infections can trigger severe and potentially fatal systemic inflammatory responses, including AE-IIP.
Anaphylaxis is a severe, potentially life-threatening hypersensitivity reaction. Although anaphylaxis rarely occurs during dental anesthesia, preparation for a prompt and appropriate response is crucial. Severe anaphylaxis may occur in the absence of typical skin manifestations. We encountered anaphylaxis approximately 15 min after induction of general anesthesia, presenting with a gradual decrease in SpO2, acute hypotension, and tachycardia without skin manifestations. After administration of epinephrine, the patient's hemodynamic status improved rapidly. Elevated serum tryptase and plasma histamine levels supported this diagnosis. This case highlights the diagnostic challenges of perioperative anaphylaxis during general anesthesia because cutaneous manifestations may be absent and alternative causes of hypoxemia or circulatory collapse must also be considered. Perioperative anaphylaxis remains an important differential diagnosis, even in the absence of skin symptoms. Prompt exclusion of alternative causes and early epinephrine administration are essential for successful management. Postoperative allergological evaluation, patient education, and institutional preparedness are important for reducing the risk of recurrence and improving patient safety.
Background:Ultrasound-guided lateral pterygoid muscle (LPM) block, a single-intramuscular-injection technique originally described for sagittal split ramus osteotomy, may offer a simplified regional analgesic option for dental surgery. However, its application as an adjunct to wound infiltration in impacted third molar extraction has not been reported. Methods:This retrospective two-center exploratory study included 48 consecutive patients who underwent impacted third molar extraction under general anesthesia between September and November 2025. All patients received standardized intraoperative multimodal analgesia (intravenous acetaminophen and dexamethasone) and wound local infiltration; the LPM group (n = 27) additionally received an ultrasound-guided LPM block with 10 ml of 0.25% levobupivacaine, whereas the NE group (n = 21) received wound infiltration alone. The primary outcome was the Numeric Rating Scale (NRS) score at rest 6 h postoperatively. Institutional and extraction-pattern imbalances were addressed using adjusted ordinal logistic regression sensitivity analyses. Results:The median NRS score at rest 6 h postoperatively was lower in the LPM group than in the NE group (0 [0, 2] vs. 3 [1.5, 4.0], P < 0.001). The institution- and extraction-pattern-adjusted ordinal logistic regression preserved the direction of the association (adjusted odds ratio 0.14, 95% confidence interval 0.04-0.48, P = 0.002). The recorded total volume of wound local anesthetic was similar between the groups (LPM 9.0 ml vs. NE 8.4 ml, P = 0.729). Lower NRS scores were also observed at 2 h and 21:00; differences resolved by the following morning. The median time to first rescue analgesia was 10 h in the LPM group versus 7 h in the NE group (log-rank P = 0.294). No complications directly attributable to the LPM block were documented during the recorded early postoperative observation window. Conclusion:An adjunctive ultrasound-guided LPM block was associated with lower recorded early postoperative pain scores after impacted third molar extraction. These hypothesis-generating findings require confirmation in the ongoing ALPINE randomized controlled trial (jRCT1031250592).
Background:Local anesthetic systemic toxicity (LAST) is a preventable complication associated with regional anesthesia. When multiple local anesthetic (LA) agents are administered during dental procedures, calculating the cumulative fractional toxicity is cognitively demanding and error-prone. Studies have demonstrated that up to 87% of dental practitioners cannot correctly calculate the LA doses. The risk is amplified in pediatric patients, where fatal overdoses have been reported from dosing calculation errors. Despite the clinical importance of accurate dosing, no freely available peer-reviewed tool combines cartridge-based input, cumulative fractional toxicity calculations, and epinephrine dose tracking in dental practice. Methods:MaxSafe is a free open-source web application. The tool accepts patient weight, age (less than 1 year through 17 years or adult), and status (with independent cardiac and pregnant toggles). It provides five common dental LA formulations with multiple epinephrine concentration options, and uses dental cartridge counts as the input. It calculates the cumulative fractional toxicity in real-time and independently tracks the epinephrine dose against patient-specific limits. In the pediatric mode, the tool applies the American Academy of Pediatric Dentistry (AAPD) Conservative maximum recommended doses and visually restricts age-inappropriate drugs. Additional features include multi-concentration tracking per drug, advisory warnings for hepatic and renal impairments, and a verification summary panel to mitigate automation bias. The accuracy was validated against 23 manually calculated clinical test scenarios, including adult dosing, pediatric dosing, and alternative epinephrine concentration calculations. Results:The app-calculated values matched the manual calculations exactly across all 23 test scenarios. In pediatric scenarios, the AAPD Conservative maximum recommended doses were substantially more restrictive than the Food and Drug Administration-labeled values; a single cartridge of lidocaine in an 8-kg infant produced 96.6% cumulative LA toxicity, and two cartridges of mepivacaine in an 18-kg child exceeded the safe threshold at 128.8%. Conclusion:MaxSafe is a validated, free, open-source clinical decision-support tool that automates fractional toxicity calculations and epinephrine dose tracking for multi-agent LA administration in both adult and pediatric dental practices. This tool is available as a progressive web application at https://thesorenc.github.io/maxsafe-local-anesthesia/.
Background: This study aimed to provide a comprehensive bibliometric overview of the research on computer-controlled local anesthesia in pediatric dentistry by analyzing publication trends, citation patterns, collaborative structures, and thematic evolution within the field. Methods: A bibliometric analysis was conducted on publications indexed in Scopus, Web of Science, and PubMed from 2000 to 2024. After excluding duplicates, 80 eligible documents were included. Descriptive indicators, such as annual scientific production, citation performance, authorship patterns, and core sources, were analyzed using the Bibliometrix package (Biblioshiny). Keyword co-occurrence and co-authorship network visualizations were generated using VOSviewer to explore thematic structures and collaboration patterns. Results: The findings revealed a gradual increase in scientific output over time, with a marked rise after 2014 and a peak in publication activity from 2018 to 2024. A limited number of core journals accounted for a substantial proportion of the publications, consistent with Bradford's law. Author productivity followed Lotka's law, with most authors contributing to a single publication. Keyword co-occurrence analysis identified major thematic clusters centered on local anesthesia, pain management, anxiety, pediatric dental procedures, and behavioral considerations. Co-authorship analysis demonstrated that research collaboration was concentrated within a small number of author groups. Conclusions: This bibliometric analysis demonstrates the increasing scientific interest in computer-controlled local anesthesia in pediatric dentistry and identifies the field's core journals, key research themes, and collaborative structures. These findings provide a concise reference framework for future clinical and research-oriented studies on pediatric dental anesthesia.
This review aimed to systematically evaluate whether rotary or reciprocating nickel-titanium instrumentation systems influence postoperative pain after nonsurgical endodontic retreatment. This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261325110). A comprehensive electronic search was conducted in the PubMed, Scopus, Web of Science, and Embase databases. Randomized clinical trials comparing rotary and reciprocating systems for nonsurgical endodontic retreatment and reporting postoperative pain outcomes were included. Risk of bias was assessed using the Modified Cochrane RoB-2 tool. Due to clinical and methodological heterogeneity, a qualitative synthesis was performed. A total of 194 records were identified through a database search, and five randomized clinical trials fulfilled the inclusion criteria. Most studies reported no statistically significant differences in the incidence or intensity of postoperative pain between the rotary and reciprocating retreatment systems at 24, 48, and 72 h. However, one randomized clinical trial reported significantly higher early postoperative pain associated with the reciprocating system than with the rotary system during the initial postoperative period, whereas no significant difference was observed at longer follow-up intervals. Furthermore, no statistically significant differences were observed between the rotary and reciprocating kinematics regarding analgesic intake following the retreatment procedures. Based on available randomized evidence, rotary and reciprocating instrumentation systems appear to produce comparable postoperative pain following nonsurgical endodontic retreatment. Postoperative discomfort is generally mild, decreases over time, and does not demonstrate a consistent dependence on instrumentation kinematics.
Background: Obesity is a known risk factor for the increased severity and persistence of postoperative pain; however, the underlying mechanisms remain incompletely understood. The primary objective of this study was to elucidate the peripheral mechanisms underlying obesity-related exacerbation and prolongation of postoperative pain. A comparative transcriptomic analysis of the spinal cord was performed as a secondary exploratory assessment. Methods: Male Wistar rats were fed a high-fat diet (HFD) or standard diet (SD) to induce obesity. Postoperative pain was modeled using the plantar incision (Brennan) model. Pain-related behaviors including spontaneous pain, mechanical withdrawal thresholds, and thermal withdrawal latencies were evaluated longitudinally. Electrophysiological recordings were performed to assess the mechanical sensitivity of primary afferent fibers in the tibial nerve-plantar skin preparation. Transcriptome analyses were conducted on the dorsal root ganglia (DRG) and spinal cord on postoperative day 4 to identify the differentially expressed genes (DEGs) associated with obesity-related pain modulation. Results: Rats fed an HFD exhibited increased body weight and body fat percentage compared with SD-fed rats. Following surgery, the HFD-fed rats showed significantly higher spontaneous pain scores and prolonged mechanical hypersensitivity than the SD-fed rats, whereas preoperative pain sensitivity did not differ between the groups. Electrophysiological analysis revealed no significant differences in the mechanical thresholds or stimulus-response relationship of mechanosensitive C-fibers between the groups. Transcriptome analysis identified 19 DEGs in the DRG of HFD-fed rats; however, no genes in the spinal cord dorsal horn met the statistical threshold for differential expression under the present analytical conditions. Pathway analysis indicated that the DRG DEGs were primarily associated with endocrine disorders and lipid metabolism. Conclusion: Diet-induced obesity exacerbated and prolonged postoperative pain in rats. This effect may be associated with peripheral molecular adaptations in primary sensory neurons, including changes in DRG gene expression related to metabolic and endocrine pathways. In contrast, no genes met the statistical threshold for differential expression in the spinal cord dorsal horn on postoperative day 4 under the present analytical conditions.
Background:Synthetic intraoral topical anesthetics, such as lignocaine and benzocaine can cause adverse effects in pediatric dentistry, creating a need for safer plant-based alternatives. Anacyclus pyrethrum (A. pyrethrum) and Commiphora myrrha (C. myrrha) have traditionally demonstrated anesthetic and analgesic properties. Therefore, we aimed to evaluate the phytochemical composition, cytotoxicity, and molecular docking interactions of A. pyrethrum and C. myrrha extracts for potential use as novel herbal topical anesthetic gels. Methods:Ethanolic extracts of A. pyrethrum roots and C. myrrha resin were prepared by Soxhlet extraction and maceration, respectively. Phytochemical profiling was performed using High-Performance Liquid Chromatography (HPLC), gas chromatography-mass spectrometry (GC-MS), and Fourier-Transform Infrared Spectroscopy (FTIR). Cytotoxicity was assessed in L929 fibroblasts and neural cells using the MTT assay. Molecular docking and codocking of pyrethrin and furanoeudesma-1,3-diene with neuronal sodium, potassium, and GABA-A receptors were performed. Results:HPLC and GC-MS confirmed the presence of bioactive compounds, including pyrethrin and furanoeudesma-1,3-diene, and the functional groups were validated by FTIR. Cytotoxicity assays revealed high biocompatibility, with half-maximal Inhibitory Concentration (IC50) values of 53 ± 0.21 µg/mL for A. pyrethrum and 54 µg/mL for C. myrrha. Molecular Docking studies showed strong binding affinities (-6.1 to -8.2 kcal/mol) across target receptors, and co-docking demonstrated synergistic ligand-receptor interactions. Conclusion:Phytochemical, cytotoxic, and molecular docking analyses confirmed the anesthetic potentials of A. pyrethrum and C. myrrha. These findings support their further development as safe plant-based topical anesthetic gels.
