The Journal of the American Dental Association
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Local anesthetic needle fractures occur rarely. Since reports are uncommon, the mechanism and optimal treatment remain controversial. ⋯ Most needle fractures occur during the administration of inferior alveolar nerve blocks, often with 30-gauge needles and in children who are reported to have moved suddenly and violently as the dentist gave the injection. Dentists should avoid burying any needle up to the hub (so as to ensure the possibility of immediately retrieving the needle intraorally), avoid using 30-gauge needles to administer inferior alveolar nerve blocks and avoid bending the needle before inserting it.
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Randomized Controlled Trial Comparative Study
The efficacy of six local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia.
The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine. ⋯ The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.
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Red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with naturally red hair are resistant to subcutaneous local anesthetics and, therefore, may experience increased anxiety regarding dental care. The authors tested the hypothesis that having natural red hair color, a MC1R gene variant or both could predict a patient's experiencing dental care-related anxiety and dental care avoidance. ⋯ Dentists should evaluate all patients, but especially those with naturally red hair, for dental care-related anxiety and use appropriate modalities to manage the patients' anxiety.
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The dental literature suggests that a patient's antiplatelet medication schedule should not be altered before invasive dental procedures. The authors conducted a study to examine the frequency of bleeding complications after invasive dental procedures in patients taking antiplatelet medications. ⋯ The risks of altering or discontinuing use of antiplatelet medications far outweigh the low risk of postoperative oral bleeding complications resulting from dental procedures.
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Randomized Controlled Trial Comparative Study
Flumazenil reversal of sublingual triazolam: a randomized controlled clinical trial.
Incremental sublingual (SL) dosing of triazolam has emerged as a popular sedation technique. Nevertheless, few studies have evaluated the technique's safety or efficacy. Given its popularity, an easily administered rescue strategy is needed. ⋯ A single intraoral injection of flumazenil (0.2 mg) cannot immediately reverse oversedation with triazolam. A higher dose might be effective. Reversal for the purpose of discharging the patient early is neither appropriate nor safe.