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      Alternative practices of achieving anaesthesia for dental procedures: a review

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          Abstract

          Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations.

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          Most cited references53

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          Childhood dental fear in the Netherlands: prevalence and normative data.

          This study aimed to present normative data on dental fear for the Dutch child population, by identifying not only highly fearful children but also children at risk for developing this high dental fear. Fear distribution of samples of high and low fearful children was studied, using the Dutch parent's version of the Dental Subscale of the Children's Fear Survey Schedule (CFSS-DS). Total fear scores were calculated for both samples, for different age levels and for boys and girls separately. To establish cut-off scores, mean CFSS-DS scores were associated with dentists' clinical fear ratings and, in addition, were transformed into stanines. Scores between 32 and 38 were found to represent a borderline area for dental fear, and scores of 39 and higher to represent high dental fear. The results have shown 6% of the Dutch child population to be highly fearful, while another 8% may be at risk to develop high dental fear. By providing extra attention for these children, the development of high dental fear or phobia may be prevented.
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            Four dimensions of fear of dental injections.

            In 1995, students and staff at the University of Washington were surveyed regarding avoidance of dental care and fear of dental injections. More than 25 percent of adults surveyed expressed at least one clinically significant fear of injections. Almost one in 20 respondents indicated avoiding, cancelling or not appearing for dental appointments because of fear of dental injections. Fear of dental injections consists of four dimensions. General fear of dental injections including pain of injection and of bodily injury from injection are the two most common dimensions of dental injection fear. Many people also express fears of acquired disease. Fear related to local anesthetic (such as side effects, inadequate anesthesia) is less frequent. Some respondents have fears that must be categorized using more than one of these dimensions. Understanding the nature of a patient's fear of injection may suggest strategies to address his or her concerns.
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              Supplementary routes to local anaesthesia.

              J Meechan (2002)
              The satisfactory provision of many dental treatments, particularly endodontics, relies on achieving excellent pain control. Unfortunately, the administration of a local anaesthetic solution does not always produce satisfactory anaesthesia of the dental pulp. This may be distressing for both patient and operator. Fortunately, failure of local anaesthetic injections can be overcome. This is often achieved by using alternative routes of approach for subsequent injections. Nerves such as the inferior alveolar nerve can be anaesthetized by a variety of block methods. However, techniques of anaesthesia other than the standard infiltration and regional block injections may be employed successfully when these former methods have failed to produce adequate pain control. This paper describes some supplementary local anaesthetic techniques that may be used to achieve pulpal anaesthesia for endodontic procedures when conventional approaches have failed. Although some of these techniques can be used as the primary form of anaesthesia, these are normally employed as 'back-up'. The methods described are intraligamentary (periodontal ligament) injections, intraosseous anaesthesia and the intrapulpal approach. The factors that influence the success of these methods and the advantages and disadvantages of each technique are discussed. The advent of new instrumentation, which permits the slow delivery of local anaesthetic solution has led to the development of novel methods of anaesthesia in dentistry. These new approaches are discussed.
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                Author and article information

                Journal
                J Dent Anesth Pain Med
                J Dent Anesth Pain Med
                JDAPM
                Journal of Dental Anesthesia and Pain Medicine
                The Korean Dental Society of Anesthsiology
                2383-9309
                2383-9317
                April 2018
                27 April 2018
                : 18
                : 2
                : 79-88
                Affiliations
                Department of Restorative Dentistry, Cardiff University Dental Hospital, Cardiff, United Kingdom of Great Britain and Northern Ireland.
                Author notes
                Corresponding Author: Zavattini Angelo, Cardiff University, School of Dentistry, Department of Restorative Dentistry, Heath Park CF14 4XY Cardiff CF14 4XY, United Kingdom of Great Britain and Northern Ireland. Tel: +44-29207-44665, ZavattiniA@ 123456cardiff.ac.uk
                Author information
                https://orcid.org/0000-0002-6176-2688
                https://orcid.org/0000-0003-4289-157X
                Article
                10.17245/jdapm.2018.18.2.79
                5932994
                29744382
                25edd1ba-4957-4a85-9883-d8eb172c2b3e
                Copyright © 2018 Journal of Dental Anesthesia and Pain Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 March 2018
                : 11 April 2018
                : 14 April 2018
                Categories
                Review Article

                electronic dental anesthesia,local anesthesia,needleless anesthesia,needle-free anesthesia

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