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We compared the efficacy of articaine encapsulated in multilamellar and unilamellar liposomes with that of articaine with epinephrine, after infiltration into inflamed and uninflamed tissue in rats. We encapsulated 4% articaine in multilamellar (articaine:multi) and unilamellar (articaine:uni) liposomes and compared them with 4% articaine with 1:100 000 epinephrine (articaine:epinephrine), in inflamed (plantar incision into the hind paw) and uninflamed (infraorbital nerve block) tissue in rats. Anaesthetic formulations (0.1ml) were injected near the right infraorbital foramen in uninflamed tissue, where success and duration of anaesthesia were assessed by pinching the upper lip every 5 minutes. For inflamed tissue the anaesthetic formulations (0.1ml) were injected laterally into a surgical wound made 24 hours earlier in the plantar region of the rat's right hind paw. The degree of anaesthesia was assessed by application of forces laterally to the wound with electronic von Frey filaments. Articaine:uni resulted in less successful anaesthesia than both articaine:multi (p=1.1x10(-5)) and articaine:epinephrine (p=4.3x10(-8)) in uninflamed tissue, but there were no differences in duration or success of anaesthesia between articaine:epinephrine and articaine:multi. In inflamed tissue articaine:epinephrine gave significantly more effective anaesthesia for longer than articaine:uni (p=2.3x10(-6)), and articaine:epinephrine (p=1.8x10(-6)) formulations, which did not differ from each other. Multilamellar liposomal articaine could be an option for local anaesthesia in uninflamed tissues. However, articaine with epinephrine gave better results than liposomal formulations in inflamed tissue.

The supervised traineeship is a law object in the evaluation of Dental undergraduate courses in Brazil, by the country's Ministry of Education. The regulation of this curricular component exists in several documents provided by different segments of regulating the training of dentists. The Brazilian Association of Dental Education (Associacao Brasileira de Ensino Odontologico - ABENO), through its Education Commission, issued the first guidelines on this subject in 2002, and presents a review of these guidelines in the light of current legislation and best educational practices to meet the profile of the recommended egress by the Guidelines National curriculum for undergraduate Dental course. Thus, they present 12 ABENO guidelines for the definition of curricular supervised training in undergraduate courses in dentistry.

Objective The aim of this study was to compare the cardiovascular effects and the anesthetic efficacy of intraosseous injections of 4% articaine with 1:100,000 epinephrine (EPI100) or 4% articaine with 1:200,000 epinephrine (EPI200). Study Design In this prospective, randomized, double-blind study, 0.9 mL EPI100 and EPI200 solutions were administered for endodontic treatment of mandibular molars with symptomatic irreversible pulpitis in 60 patients. The anesthetic success and pain during anesthesia were evaluated by visual analog scale. The cardiovascular parameters evaluated were heart rate, diastolic/systolic blood pressure, pulse oximetry, and electrocardiogram changes. Results Both solutions provided high anesthetic efficacy (96.8% and 93.1% for EPI100 and EPI200, respectively; P > .05), and the cardiovascular parameters showed minimal incidences of significant differences throughout the clinical procedure. Conclusions The epinephrine concentration did not affect the efficacy of 4% articaine, and both solutions produced a high success level of pulpal anesthesia. Intraosseous delivery by slow speed of injection did not induce significant clinical changes in cardiovascular parameters.

One of the most common strategies for pain control during and after surgical procedures is the use of local anesthetics. Prolonged analgesia can be safely achieved with drug delivery systems suitably chosen for each local anesthetic agent.This review considers drug delivery formulations of local anesthetics designed to prolong the anesthetic effect and decrease toxicity. The topics comprise the main drug delivery carrier systems (liposomes, biopolymers, and cyclodextrins) for infiltrative administration of local anesthetics. A chronological review of the literature is presented, including details of formulations as well as the advantages and pitfalls of each carrier system. The review also highlights pharmacokinetic data on such formulations, and gives an overview of the clinical studies published so far concerning pain control in medicine and dentistry.The design of novel drug delivery systems for local anesthetics must focus on how to achieve higher uploads of the anesthetic into the carrier, and how to sustain its release. This comprehensive review should be useful to provide the reader with the current state-of-art regarding drug delivery formulations for local anesthetics and their possible clinical applications.

OBJECTIVE: To detect the presence and concentration of methylparaben in cartridges of commercial Brazilian local anesthetics. MATERIAL AND METHODS: Twelve commercial brands (4 in glass and 8 in plastic cartridges) of local anesthetic solutions for use in dentistry were purchased from the Brazilian market and analyzed. Different lots of the commercial brands were obtained in different Brazilian cities (Piracicaba, Campinas and São Paulo). Separation was performed using high performance liquid chromatography (HPLC) with UV-Vis detector. The mobile phase used was acetonitrile:water (75:25 - v/v), pH 4.5, adjusted with acetic acid at a flow rate of 1.0 ml.min-1. RESULTS: When detected in the solutions, the methylparaben concentration ranged from 0.01% (m/v) to 0.16% (m/v). One glass and all plastic cartridges presented methylparaben. CONCLUSION: 1. Methylparaben concentration varied among solutions from different manufacturers, and it was not indicated in the drug package inserts; 2. Since the presence of methylparaben in dental anesthetics is not regulated by the Brazilian National Health Surveillance Agency (ANVISA) and this substance could cause allergic reactions, it is important to alert dentists about its possible presence.

An effective topical agent to reduce pain during local anaesthesia of the palate is not yet available. The aim of the present study was to evaluate the efficiency of liposome-encapsulated ropivacaine in different concentrations for topical anaesthesia of the palatal mucosa. In this single-blinded, placebo-controlled, crossover study 40 (20 male) healthy volunteers were randomised to be given: liposome-encapsulated 2% ropivacaine, liposome-encapsulated 1% ropivacaine, a eutectic mixture of 2.5% lidocaine and 2.5% prilocaine (EMLA), and liposomal placebo gel, topically on to the palatal mucosa of the right canine region for 5 min each, at four different sessions. Pain associated with insertion of a 30G needle, and with injection of a local anaesthetic, was rated on a visual analogue scale (VAS). The effect of liposomal ropivacaine 1% and 2% did not differ from that of placebo (p=0.3 and p=0.1, respectively) in reducing pain during insertion of the needle. Lower VAS were obtained with EMLA. In this group VAS were lower in women than men (p=0.007). There was no difference in VAS among groups (p=0.3) as far as injection of the local anaesthetic was concerned. In conclusion, liposomal-encapsulated ropivacaine formulations did not reduce the pain of insertion of a needle into the palatal mucosa. None of the anaesthetic formulations tested, including the positive control (EMLA), were effective in reducing the pain of an injection of local anaesthetic compared with placebo.

Objectives This study evaluated the efficacy of liposome-encapsulated 2% ropivacaine in topical anesthesia and its influence on pulpal response. Study design Forty volunteers received the following topical formulations in the buccal fold of the maxillary lateral incisors region (bilaterally): liposome-encapsulated 2% ropivacaine gel (RL2); 20% benzocaine gel (B20); liposomal placebo gel (LP); and placebo gel (P). Formulations were kept in place for 30 minutes, during which time the teeth were electric pulp tested every 10 minutes. After this procedure, a dental needle was inserted until periosteum contact in the same site of topical application and pain was rated by a visual analog scale. Duration of soft tissue anesthesia was assessed by pinprick test. Results RL2 and B20 showed lower pain response to needle insertion and longer soft tissue anesthesia then P and LP ( P = .0003 and P P > .05) regarding those parameters. None of the formulations was able to induce pulpal anesthesia. Conclusion RL2 was as effective as B20 in reducing pain during needle insertion and inducing soft tissue anesthesia; however, neither one was able to induce pulpal anesthesia after a 30-min application.

The incisive/mental nerve block (IMNB) could be an alternative to the inferior alveolar nerve block in the mandibular anterior teeth. The effectiveness of articaine has not been tested in IMNB.This prospective randomized double-blind crossover study compared the anesthetic efficacy of 0.6 mL 4% articaine and 2% lidocaine, both with 1:100.000 epinephrine administered as IMNB to 40 volunteers in two sessions. Pulpal anesthesia of lateral incisor through premolars was tested with an electric pulp tester. The injection and postoperative pain were evaluated by using visual analog scales. The onset (time from the end of injection to the absence of pulpal response) and duration of pulpal anesthesia (time recorded before two positive responses to the pulp tester) and the anesthesia success (two consecutive readings of 80 without response and onsetor=10 minutes) were measured.Articaine provided a higher success rate (p0.001) of anesthesia than lidocaine for the lateral incisor (32.5%), the canine (55%), and the first (72.5%) and second (80%) premolars and a faster onset (p0.05) for canine and increased duration (p0.05) of anesthesia for premolars. The median duration of premolars anesthesia was 10 and 20 minutes, respectively, with lidocaine and articaine. There were no differences in pain scores between the solutions (p0.05).Articaine promoted higher anesthesia success and longer duration of anesthesia than lidocaine for most of the teeth after IMNB although anesthesia success could be considered clinically appropriated only for premolars. The volume of local anesthetic used in the present study may not be appropriate for procedures lasting longer than 10 minutes.

The objective of this randomized double-blind investigation was to compare the anesthetic efficacy and injection discomfort of 3 volumes of 2% lidocaine with 1∶100,000 epinephrine for maxillary infiltration anesthesia. A total of 25 subjects received 0.6, 0.9, and 1.2 mL of the anesthetic buccal to an upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia; soft tissue anesthesia and injection discomfort were assessed by pin-prick test and visual analog scale (VAS). Data were analyzed by 2-way analysis of variance (ANOVA), Friedman, and chi-square tests (α = 5%). The 1.2 mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than were achieved with the other doses (P < .05). No differences in injection discomfort were observed between treatments. It is concluded that maxillary infiltration anesthesia with lidocaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2 mL is used than when volumes less than 1.0 mL are used.

Cardiovascular effects of felypressin (FEL) were studied in Wistar rats. Heart rate and mean arterial pressure measurements were taken in awake rats treated with vasopressin (AVP), FEL, or epinephrine (EPI). Each group received either an intravenous (IV) or an intracerebroventricular V1 receptor antagonist, saline, area postrema removal, or sham surgery. Analysis of variance and Student-Newman-Keuls (P < .05) were applied. Felypressin and AVP induced a pressor effect, and bradycardia was inhibited by IV V1 antagonist. Intracerebroventricular V1 antagonist and area postrema removal enhanced their pressor effects. Epinephrine induced a higher pressor effect and a similar bradycardia that was not affected by the treatments. It was concluded that FEL depends on V1 receptors to induce pressor and bradycardic effects, and that it produces a high relationship between bradycardia and mean arterial pressure variation depending on area postrema and central V1 receptors. These effects are potentially less harmful to the cardiovascular system than the effects of EPI.

The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular pre-molar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P > .05). It was concluded that the solutions have similar anesthetic efficacy.

Foram avaliadas neste trabalho agulhas anestésicas odontológicas descartáveis, comercializadas no Brasil no segundo semestre de 1997, quanto às medidas: comprimento da cânula, da porção que perfura o tubete e da porção que permanece no interior do adaptador plástico e diâmetros externo e interno. A resistência à corrosão da cânula e as informações da embalagem (caixa e protetor) também foram avaliadas. Os resultados foram comparados com as normas Internacional (ISO)8, Americana (ANSI/ADA)¹ e Francesa (NF). Foram observadas variações, não havendo uma só marca que estivesse de acordo com qualquer das normas, para todas as medidas. Todas as agulhas atingiram as especificações do teste de corrosão. Algumas embalagens mostraram conteúdo de informação incompleto e uma marca estava sendo vendida sem prazo de validade. Alguns protetores não permitiam identificar a violação do lacre, quando isto ocorria. Estes resultados demonstram a necessidade de se estabelecerem normas brasileiras, para regulamentar a produção e venda de agulhas odontológicas no país.The standardization of sterile, single-use dental injection needles marketed in Brazil in 1997 was evaluated. The effective needle length (L1), butt end length (L2), socket depth (L3), external (ED) and internal (ID) diameters, corrosion resistance of the cannula, and the information printed on the package (unitary protector and box) were evaluated. The data were compared with the International Standard (ISO), American specification no. 54 (ANSI/ADA) and French Standard (FS). There were great variations for L1, L2, L3 and ID, and no trade mark fitted in any of the standards for all the dimensions. The external diameter showed very little variation in all the trade marks according to the ANSI/ADA and FS. All of the needles withstood the corrosion test. Some trade marks had incomplete information in their package and one of them had no expiration date. Some of the unitary protectors, once opened, did not show clear evidence of having been violated. These results show the need for a Brazilian specification to regulate the manufacturing of single-use dental injection needles.

O uso dos antimicrobianos para a profilaxia e tratamento de infecções orais é uma prática comum em odontologia. Sendo assim, é importante que o dentista conheça os riscos potenciais de seu uso, como reações adversas e interações medicamentosas. Uma importante interação envolve o uso concomitante de antimicrobianos e contraceptivos orais, podendo resultar em perda da eficácia contraceptiva e gravidez inesperada. Este artigo faz uma revisão sobre os principais antimicrobianos e possíveis mecanismos envolvidos no processo, assim como analisa a responsabilidade do dentista e os meios de se prevenir tal complicação. The use of antibiotics for prophylaxis and treatment of oral infections is a normal practice in Dentistry. So, it is important that dentists be aware of the potential risks of their use such as adverse reactions and drug interactions. An important interaction involves the concomitant use of antibiotics and oral contraceptives, resulting in reduced contraceptive effectiveness and unexpected pregnancy. This paper reviews the antibiotics most often associated with this problem and possible mechanisms involved in causing failure of contraception. It also examines the dentist's responsibility and the means of preventing such complications.

O uso dos antimicrobianos para a profilaxia e tratamento de infecções orais é uma prática comum em odontologia. Sendo assim, é importante que o dentista conheça os riscos potenciais de seu uso, como reações adversas e interações medicamentosas. Uma importante interação envolve o uso concomitante de antimicrobianos e contraceptivos orais, podendo resultar em perda da eficácia contraceptiva e gravidez inesperada. Este artigo faz uma revisão sobre os principais antimicrobianos e possíveis mecanismos envolvidos no processo, assim como analisa a responsabilidade do dentista e os meios de se prevenir tal complicação.The use of antibiotics for prophylaxis and treatment of oral infections is a normal practice in Dentistry. So, it is important that dentists be aware of the potential risks of their use such as adverse reactions and drug interactions. An important interaction involves the concomitant use of antibiotics and oral contraceptives, resulting in reduced contraceptive effectiveness and unexpected pregnancy. This paper reviews the antibiotics most often associated with this problem and possible mechanisms involved in causing failure of contraception. It also examines the dentist's responsibility and the means of preventing such complications.

The aim of this study was to evaluate the effectiveness of liposome-encapsulated ropivacaine (0.5%) in dental anaesthesia. This randomised, double-blind, crossover, four-period treatment study included 40 volunteers who were given 1.8 ml of the following local anaesthetics into the buccal sulcus at the right level of the upper canine: 0.5% ropivacaine; 0.5% ropivacaine with 1:200,000 adrenaline; liposome-encapsulated 0.5% ropivacaine; and 2% lignocaine with 1:100,000 adrenaline. Onset of pulpal anaesthesia; the success of anaesthesia; and the duration of labial, gingival, and pulpal anaesthesia involving the upper right canine and first premolar were evaluated. At the end of each injection, volunteers rated the pain on injection on a visual analogue scale (VAS). Both ropivacaine and adrenaline, and lignocaine with adrenaline, were more successful anaesthetic agents than liposome-encapsulated ropivacaine or plain ropivacaine (p0.05). There were no significant differences among the anaesthetic preparations in the onset of pulpal anaesthesia. Ropivacaine and adrenaline and lignocaine and adrenaline gave a significantly longer duration of pulpal anaesthesia. VAS showed no significant differences among the groups tested. The results showed that encapsulation of liposome did not improve the anaesthetic efficacy of ropivacaine.

Objective: This study aimed to analyze the influence of storage conditions of local anesthetic solutions in the inflammatory reaction after injection in rats. Study design: Twenty-four rats received in their oral mucosa the injection of 2% lidocaine with epinephrine 1:100.000 solutions (LA) submitted to the following storage conditions during a twelve-month period: G1 - inside the original packaging, in refrigerator (5±1°C); G2 - inside the original box, under light shelter, at room temperature; G3 - outside the original box at room temperature (exposed to artificial light for 12 hours/day) and G4 - brand new solution. For the controls tests, 0.9% sodium chloride solution was injected in the opposite side. After 6 and 24 hours, three animals of each group were sacrificed and their maxilla along with the soft tissue were removed and submitted to histological analysis (HE). Results: The pH of LA was measured before and after the storage period and no statistically differences were observed between G1 and G4, but both were different from G2 and G3. All the scores of the testing solutions were higher than their respective negative controls, except for G1 at 6 hours. The order of the scores of inflammation after 6 hours was G3>G4>G2=G1. After 24 hours the order was G3>G2>G1>G4. Conclusion: The study showed that the method of storage can influence the pH and the level of inflammatory reaction after the injection of 2% lidocaine with epinephrine 1:100.000.

O objetivo do trabalho foi avaliar a influência da dor e ansiedade sobre a freqüência cardíaca (FC) e pressão arterial (PA) de 275 voluntários em situações de urgências endodônticas, selecionados de forma aleatória, entre os pacientes que procuraram o serviço do Pronto Socorro Odontológico da Faculdade de Odontologia da Universidade Federal de Uberlândia (FOUFU). Os voluntários responderam a ficha de anamnese e a Escala de Ansiedade Dental de Corah ainda na sala de espera. A Escala de 11 Pontos em Caixa foi usada para avaliar a sensação dolorosa dos voluntários, em dois momentos: antes do atendimento, para determinar a dor com que chegaram para atendimento e, após o tratamento, para determinar se houve alteração na sensação dolorosa. A PA e FC foram avaliadas através de esfingnomanômetro com coluna de mercúrio, também em dois momentos; inicialmente, com o paciente na sala de espera e, imediatamente ao término do atendimento, com o objetivo de correlacionar o controle eficaz da dor com a variação dos parâmetros cardiovasculares avaliados. De acordo com os resultados obtidos concluímos que a dor e a ansiedade não foram capazes de alterar significativamente a pressão arterial e freqüência cardíaca.

This blinded crossover study evaluated the efficacy and pain sensitivity evoked by a previously reported liposome-encapsulated mepivacaine formulation (Araujo et al., 2004). Thirty healthy volunteers received an intraoral injection (1.8 mL), at four different sessions, of the following formulations: 2% mepivacaine with 1:100,000 epinephrine (MVC(2%EPI)), 3% mepivacaine (MVC(3%)), and 2 and 3% liposome-encapsulated mepivacaine (MVC(2%LUV) and MVC(3%LUV)). Latency period and duration of anesthesia were assessed by an electrical pulp tester and injection discomfort by a visual analog scale (VAS). Data were analyzed with Tukey-Kramer and Friedman tests (P 0.05). No significant difference was found regarding latency period (in minutes) among the formulations (P 0.05). The duration of anesthesia after the injection of MVC(3%LUV) was higher than the one obtained after the infiltration of MVC(2%LUV) and of MVC(3%) (P 0.05). However, the duration of anesthesia obtained with MVC(3%) did not differ from the one obtained with MVC(2%LUV) (P 0.05). MVC(3%LUV) showed lower VAS median values than MVC(2%EPI) (P 0.05), and there were no significant differences among the others formulations. Liposome-encapsulated 3% mepivacaine showed longer duration of anesthesia, in comparison to the commercial formulation of MVC(3%). MVC(2%LUV) was able to produce a similar duration of anesthesia as the 3% commercial formulation, despite the 50% decrease in the anesthetic concentration. Thus, the encapsulation of mepivacaine increased the duration of anesthesia and reduced the injection discomfort caused by vasoconstrictor-associated formulations in healthy volunteers.

The pharmacokinetics and the local toxicity of commercial and liposome-encapsulated mepivacaine formulations injected intra-orally in rats were studied. Animals were divided in groups (n = 4-6) and treated with 0.1 mL of the formulations: 2% mepivacaine with 1:100,000 epinephrine (MVC(2%EPI)), 3% mepivacaine (MVC(3%)), and 2% liposome-encapsulated mepivacaine (MVC(LUV)). The results showed that the 2% liposome-encapsulated mepivacaine reduced C(max), prolonged AUC(0-infinity) and t(1/2) compared with 3% plain and 2% vasoconstritor-associated mepivacaine, after intraoral injection. In addition, it was also observed that liposomal mepivacaine might protect the tissue against local inflammation evoked by plain or vasoconstrictors-associated mepivacaine, giving supporting evidence for its safety and possible clinical use in dentistry.

The aim of this study was to determine the pharmacokinetic parameters of liposomal ropivacaine after dental anesthesia in 14 healthy volunteers. In this randomized, double-blind and crossover study, the volunteers received maxillary infiltration of liposome-encapsulated 0.5% ropivacaine and, 0.5% ropivacaine with 1:200,000 epinephrine in two different sessions. Blood samples were collected before and after (from 15 to 1440 min) the administration of either ropivacaine formulation. HPLC with UV detection was used to quantify plasma ropivacaine concentrations. The pharmacokinetic parameters AUC0-24 (area under the plasma concentration × time curve from baseline to 24 h), AUC0-∞ (area under the plasma concentration-time curve from baseline to infinity), Cmax (maximum drug concentration), CL (renal clearance), Tmax (maximum drug concentration time), t1/2 (elimination half-life) and Vd (volume of distribution) were analyzed using the Wilcoxon signed-rank test. No differences (p > 0.05) were observed between both formulations for any of the pharmacokinetic parameters evaluated and plasma ropivacaine concentrations, considering each period of time. Both formulations showed similar pharmacokinetic profiles, indicating that the liposomal formulation could be a safer option for use of this local anesthetic, due to the absence of a vasoconstrictor. O objetivo do presente estudo foi determinar os parâmetros farmacocinéticos da ropivacaína encapsulada em lipossomas após anestesia local em 14 voluntários sadios. Neste estudo randomizado, cruzado e duplo-cego, os voluntários receberam anestesia infiltrativa na maxila de ropivacaína a 0,5% encapsulada em lipossomas e ropivacaína 0,5% com epinefrina a 1:200.000 em duas sessões distintas. Amostras de sangue foram coletadas antes e após (de 15 a 1440 min) a administração das formulações de ropivacaína. A quantificação da concentração plasmática de ropivacaína foi feita por meio de HPLC com detecção por UV. Os parâmetros farmacocinéticos AUC0-24 (área sob a curva de concentração × tempo do tempo 0 até 24 horas) , AUC0-∞ (área sob a curva de concentração x tempo do tempo 0 até o infinito), Cmax (concentração máxima da droga), CL (clearance renal), Tmax (tempo em que ocorre a concentração máxima); t1/2 (meia vida de eliminação) e Vd (volume de distribuição) foram analisados pelo teste de Wilcoxon. Nenhuma diferença (p > 0,05) foi observada entre as duas formulações em cada parâmetro farmacocinético avaliado e as concentrações plasmáticas de ropivacaína, considerando cada período de tempo. Ambas as formulações apresentaram perfil farmacocinético semelhante, indicando que a formulação lipossomal poderia ser uma opção mais segura para o uso deste anestésico local, devido à ausência de vasoconstritor.

To compare the topical and the pulpal anesthesia efficacy of liposomal and plain benzocaine formulations.Double-blinded, randomized crossover study.University ambulatory dental center.30 ASA physical status I volunteers.Volunteers received, in three different sessions, topical application of liposome-encapsulated 10% benzocaine (LB10), 10% benzocaine gel (B10), and 20% benzocaine gel (B20) in the right maxillary canine mucobuccal fold.Pain associated with the needle insertion was rated by visual analog scale (VAS) and the duration of topical anesthesia was recorded. Pulpal anesthesia was evaluated using an electric pulp tester.VAS values (median, 1st - 3rd quartiles) were 17 cm (11 - 25), 14 cm (3 - 22), and 21 cm (9 - 21) for B10, LB10, and B20, respectively. No differences were noted among the groups (Friedman test; P = 0.58). Soft tissue anesthesia was also not different. The LB10 [10 (8 - 12) min] showed longer soft tissue anesthesia (Friedman test; P0.01) than the other agents [B10 = 8 (5 - 10) min, and B20 = 7 (6 - 9) min]. None of the topical benzocaine formulations tested induced pulpal anesthesia.The encapsulation of benzocaine into liposome increased the duration of soft tissue anesthesia. However, it did not induce pulpal anesthesia.

To evaluate the efficacy of 1% ropivacaine for topical anesthesia in dentistry.Thirty healthy volunteers randomly (blind crossover) received the following treatments: 20 mg of 1% ropivacaine gel (ropivacaine-20), 60 mg of 1% ropivacaine gel (ropivacaine-60), 20 mg of the eutectic mixture of local anesthetics 2.5% lidocaine and 2.5% prilocaine (EMLA cream, AstraZeneca; EMLA-20), 60 mg of EMLA (EMLA-60), 20 mg of 20% benzocaine gel (Benzotop, DFL; benzocaine-20), and 60 mg of 20% benzocaine gel (benzocaine-60), applied on the maxillary buccal fold of the right canine at different sessions. Pain was assessed by visual analog scale (VAS) and 11-point box scale (BS-11) after the insertion of 30-gauge needles. Soft tissue anesthesia was measured by pinprick test. Data were analyzed by Friedman and Pearson correlation tests.All the topical anesthetics evaluated showed similar performance in relation to the pain perceived after needle insertion (P.05), and there were no significant differences among groups considering VAS or BS-11 (P = .177 and P = .179, respectively). The duration of soft tissue anesthesia was not statistically significantly different for ropivacaine-20, EMLA-20, benzocaine-20, ropivacaine-60, EMLA-60, and benzocaine-60, but EMLA-60 showed significantly longer duration than the other agents (P.05).All topical anesthetics were similar in reducing pain to needle insertion. EMLA-60 promoted longer duration of soft tissue anesthesia.

The elimination of pain caused by needle insertion for local anesthesia would be a significant advance in dentistry.In this blinded cross-over study we evaluated the efficacy of liposome-encapsulated ropivacaine for topical anesthesia. Thirty healthy volunteers received 60 mg topical anesthetics: Liposome-encapsulated 1% ropivacaine, 1% plain ropivacaine, 2.5% lidocaine and 2.5% prilocaine mixture (EMLA), and 20% benzocaine gel, in the buccal fold of the upper-right canine for 2 min in different sessions. After insertion of 30-G needles, pain was rated on a visual analog scale (VAS). A pinprick test was used to measure the duration of topical anesthesia. The pulpar response was assessed by an electric pulp tester.VAS median and interquartile range (in cm) were 0.8 (0.4-1.5), 1.6 (0.8-2.6), 1.1 (0.3-2.7), 2.2 (0.9-2.9) for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. The liposome-encapsulated ropivacaine group showed lower VAS mean values when compared with the benzocaine group (P = 0.0205). The median values and interquartile range for the duration of soft tissue anesthesia were 11 (7-14), 6.5 (4-11), 14 (11-16), and 7 (6-9) min for liposome-encapsulated ropivacaine, ropivacaine, EMLA, and benzocaine groups, respectively. EMLA and liposome-encapsulated ropivacaine were just as efficient for reducing pain, and showed longer soft tissue anesthesia when compared to the other local anesthetics (P = 0.0001).Liposomal-encapsulated 1% ropivacaine gel was equivalent to EMLA for reducing pain during needle insertion and for the duration of soft tissue anesthesia. None of the topical anesthetics was effective for inducing pulpal anesthesia.

This double-blind cross-over study compared the anesthetic success and onset and duration of lip and pulpal anesthesia of 0.5% bupivacaine and levobupivacaine solutions, both with 1:200,000 epinephrine, when administered for inferior alveolar nerve anesthesia. Thirty healthy volunteers were randomly anesthetized using one of the solutions. The inferior canine, second premolar, and molar were tested with electric stimulation. The pulpal anesthetic success rates for bupivacaine and levobupivacaine were 80% and 76.66%, respectively, for molars, 76.66% (both solutions) for premolars, and 70% (both solutions) for canines. At least 250 minutes of pulpal anesthesia was achieved. There were no significant differences between the solutions considering the measured parameters (P > .05). Because of the similar anesthetic behavior of the 2 solutions in this study and the low toxicity related in the literature for levobupivacaine, there is justification for replacing bupivacaine with levobupivacaine for inferior alveolar nerve local anesthesia.

Aim The purpose of this study was to evaluate the onset of action of pulpal and soft tissue anaesthesia, and pain experience after buccal and palatal infiltrative injections with 4% articaine with 1:100,000 adrenaline, and 2% lignocaine with 1:100,000 adrenaline. Method A double blind cross-over study was conducted with 20 healthy adult subjects who, in two appointments at least two weeks apart, randomly received an infiltration anaesthesia with the solutions in the buccal and palatal regions of the upper right canine. The tooth was tested with a pulp tester before (to establish its baseline response), and after the injection, until return to the base threshold level. The pain experience caused by palatal injection was verified by the visual analogue scale (VAS). Data were analysed using Wilcoxons test (α = 0.05). Results There were no significant statistical differences between the solutions with respect to VAS (p = 0.45), onset of action (p = 0.80) and pulpal (p = 0.08) and soft tissue (p = 0.18) anaesthesia duration, although pulpal anaesthesia may have reached statistical significance if a higher number of volunteers had been used. Conclusion Under the conditions of this study it can be concluded that both anaesthetic solutions showed similar pain experience.

Foram avaliadas neste trabalho agulhas anestésicas odontológicas descartáveis, comercializadas no Brasil no segundo semestre de 1997, quanto às medidas: comprimento da cânula, da porção que perfura o tubete e da porção que permanece no interior do adaptador plástico e diâmetros externo e interno. A resistência à corrosão da cânula e as informações da embalagem (caixa e protetor) também foram avaliadas. Os resultados foram comparados com as normas Internacional (ISO)8, Americana (ANSI/ADA)¹ e Francesa (NF). Foram observadas variações, não havendo uma só marca que estivesse de acordo com qualquer das normas, para todas as medidas. Todas as agulhas atingiram as especificações do teste de corrosão. Algumas embalagens mostraram conteúdo de informação incompleto e uma marca estava sendo vendida sem prazo de validade. Alguns protetores não permitiam identificar a violação do lacre, quando isto ocorria. Estes resultados demonstram a necessidade de se estabelecerem normas brasileiras, para regulamentar a produção e venda de agulhas odontológicas no país. The standardization of sterile, single-use dental injection needles marketed in Brazil in 1997 was evaluated. The effective needle length (L1), butt end length (L2), socket depth (L3), external (ED) and internal (ID) diameters, corrosion resistance of the cannula, and the information printed on the package (unitary protector and box) were evaluated. The data were compared with the International Standard (ISO), American specification no. 54 (ANSI/ADA) and French Standard (FS). There were great variations for L1, L2, L3 and ID, and no trade mark fitted in any of the standards for all the dimensions. The external diameter showed very little variation in all the trade marks according to the ANSI/ADA and FS. All of the needles withstood the corrosion test. Some trade marks had incomplete information in their package and one of them had no expiration date. Some of the unitary protectors, once opened, did not show clear evidence of having been violated. These results show the need for a Brazilian specification to regulate the manufacturing of single-use dental injection needles.

Os bloqueadores dos canais de cálcio são largamente utilizados em distúrbios cardiovasculares, usualmente em tratamentos prolongados, ocasionalmente em mulheres grávidas. Foram estudados os efeitos do verapamil sobre a implantação uterina, a reabsorção fetal e os níveis de cálcio, fosfato e proteínas totais plasmáticos de mães e filhotes. Foram utilizadas 75 ratas fêmeas Wistar, com qualidade controlada. Os animais tratados foram divididos em dois grupos: o primeiro recebeu verapamil na dose 2,4 mg/rato/dia de e o segundo, 24 mg/rato/dia. A droga foi administrado na água de beber durante 10 semanas: 7 semanas antes do acasalamento e 3 semanas durante a gestação, sendo a operação cesariana realizada ao 21º dia. Por ocasião da cesariana, foram tomadas amostras de sangue das mães e filhotes. O verapamil, na dose mais elevada, causou diminuição dos níveis plasmáticos de cálcio e fosfato nas mães a par de diminuir o peso corpóreo dos filhotes. Os níveis séricos de cálcio, fosfato e proteínas foram comparáveis nos filhotes dos grupos controle e tratado. Contudo, foram significativamente mais baixos em todos os filhotes, em comparação com as respectivas mães. Os resultados mostraram que o verapamil estimulou a ovulação, aumentando o número de implantações uterinas, enquanto induziu morte fetal precoce e reabsorção fetal. Abstract Calcium channel blockers are widely used in cardiovascular diseases, usually in long-term treatments, occasionally in pregnant women. The effects of verapamil were studied on uterine implantation, fetal reabsorption and mother’s and offspring’s plasmatic levels of calcium, phosphate and total protein. Seventy-five quality-controlled female Wistar rats were used. The drug-treated animals were divided in two groups: the first received verapamil in doses of 2.4 mg/rat/day and the second, doses of 24 mg/rat/day. The drug was administered by means of the drinking water for 10 weeks: 7 weeks before mating and 3 weeks during pregnancy; cesarean surgery was performed on the 21st. day. On the occasion of the cesarean, mother’s and newborn’s blood samples were taken. Verapamil, in the higher dose, caused a lowering of plasmatic calcium and phosphate in mothers and reduced body weight in offspring. In the young, plasmatic calcium, phosphate and total proteins were comparable in verapamil treated and control. However, these values were significantly lower in newborn of treated and control groups, as compared to their respective mothers. Results show that verapamil stimulated ovulation, increasing the uterine implantation but induced early fetal death and reabsorption.

This study reports four cases of mucosa ulceration after a 30-minute application of EMLA (0.3 g) as a topical anaesthetic in dentistry. The subjects returned the next day with a white ulceration and desquamation on the application site. EMLA cream should not be applied to the oral mucosa for 30 minutes.

In the last few years allergic reactions to natural rubber latex (NRL) have increased in dental practice affecting both the dental team and patients. Some case reports discuss the potential risks of hypersensitivity to NRL products. An adverse patient reaction after dental rubber dam placement is reported. About 1 min after the isolation of the tooth with a rubber dam the patient presented signs and symptoms of hypersensitivity. Oxygen and intravenous hydrocortisone were administered and the patient kept under observation. After 2 h she had stable vital signs and no more allergics symptoms. It is unclear whether components of the NRL dam or the cornstarch powder incorporated with the rubber dam was responsible for the allergic reaction. Dentists must be aware of the health problem and be prepared for an adequate management in dental practice.