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The palatal injection is among the most feared by patients and causes more pain than injections in less dense soft tissues of the mucosa. A study was published in the March issue of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology & Endodontics entitled “Comparison of the Efficiencies of Permanent Maxillary Tooth Removal Performed With Single Buccal Infiltration Versus Routine Buccal and Palatal Injection.”
A prospective, blinded, randomized, controlled trial compared the efficacy of a buccal injection of articaine/hydrochloric acid (HCl) with that of a buccal and palatal injection for the extraction of maxillary teeth. The 38 men and 33 women (mean age; 25.37 years) underwent tooth extraction that included partly or fully erupted wisdom teeth and anterior to posterior maxillary teeth, including premolars and molars. Each patient had a control side and an experimental side. Patients rated pain on a 100-point Visual Analogue Scale (VAS); zero points represented “no pain” and 100 points represented “worst pain.” Patients were also asked to answer the question, “Is the extraction acceptable or unacceptable?” On the experimental side, a buccal injection of 1.7 mL of 4% articaine/HCl with epinephrine 1:100,000 was delivered over one minute. On the control side, the same buccal injection was administered plus an injection of 0.4 mL was given on the palatal side. There was a 5-minute delay prior to the procedure, during which the patient was asked to complete the VAS regarding the pain on injection. The surgeon extracting the teeth was not informed of the control and experimental sides to ensure blinding. The study found that the VAS score was 37.70 for injection on the control side and was 25.73 for the experimental side, which was a statistically significant difference. The mean VAS score was 14.68 for extraction using only buccal infiltration and was 12.82 for bilateral injection, which was not statistically significant. All patients rated the procedure as acceptable. The pain was less than expected on the experimental side for 90.1% of patients and was less than expected on the control side for 94.4% of patients. Although patients experienced greater discomfort when only a buccal injection was administered versus both buccal and palatal injection, they did not experience statistically significant greater discomfort on extraction of teeth from either side. The study concludes that injection of 1.7 mL of 4% articaine/HCl into the buccal vestibule provides similar clinical efficacy to the routine type of anesthesia which includes a palatal injection.
(Source: Oakstone Review, March 31, 2009)
