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PHYSICAL DISORDERS

DENTAL ANESTHESIA

6. Clark, Morris S., Silverstone, Lwon, M., Lindenmuth, James et al. An evaluation of the clinical analgesia/anesthesia efficacy on acute pain using the high frequency neural modulator in various dental settings. Oral Surgery, Oral Medicine, Oral Pathology. 63(4):501-505, 1987

Device: high frequency neural modulator, 15 Hz, 4 mA, temporal electrodes, and introral to

hand electrodes

50 healthy, nonpregnant dental pts from 16 to 60 years old were separated into an experimental group (N=30), and placebo group (N=20) in this double-blind study to evaluate the effectiveness of CES and peripheral stimulation as a substitute for local anesthesia in various dental procedures, including oral surgery, restorations, tooth extractions, root planing, pulp extirpation, and temporomandibular joint therapy. The degree of pt comfort and satisfaction, their request for local anesthetics, as well as manageability of pain control by the dentist was evaluated. In the experimental group, favorable responses ranged from 0.0% to 92.8%, depending on the procedures. 24 of 30 (80%) CES pts were able to undergo dental procedures without anesthesia. 15 of 20 (75%) of the placebo group required anesthesia. In the operative group, 13 of 14 pts were treated successfully with CES, whereas only 3 of 7 placebo CES pts did well, which is significant at the 0.05 level. All 3 of the CES pts and all 3 placebo CES pts required anesthesia for endodontic procedures. An overall favorable rating of 71.8% was given by the experimental group, whereas an overall favorable response of 8.5% was given by the placebo group. Pts gave favorable comments and all stated that this procedure would be their first choice in future visits. No side effects were reported.

22. Hochman, Richard. Neurotransmitter modulation (TENS) for control of dental operative pain. Journal of the American Dental Association. 116:208-212, 1988.

Device: Neurotransmitter Modulator, electrodes across temples

This is an unblind study of 600 dental procedures over a 1 year period. Although the author refers to the device as a TENS, electrodes were placed across the temples for 10 minutes prior to each procedure which makes the treatment CES by definition. The procedures ranged from vigorous subgingival scaling to endodontic. Results were evaluated for pain control related to procedure type, and the patients' skepticism about the procedure. Results were considered positive if the patient reported greater than 90% reduction in pain and did not request the additional administration of local anesthetic. More than 76% of the pts in all procedures reported 90% or greater success using CES for dental analgesia. For the 71 scaling and prophylactic procedures, more than 83% reported successful pain reduction, and for the 473 restorative procedures, more than 76% reported pain reduction success. For 29 crown preparations, "only" 55% reported success. The majority of pts were skeptical about the procedure but after experiencing CES they were more comfortable with CES than they were with previous dental experiences. The author concluded that from the results obtained during 1 year of treating a variety of pts requiring a broad scope of dental treatments, CES was found to provide a safe, noninvasive, readily acceptable, adjunctive analgesic modality to maintain pt comfort through the majority of dental procedures for most pts. Additional, unexpected positive results were found when the pts reported "feeling more relaxed than usual." No side effects were reported.

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