Anesthesia can improve patient experience, anxiety, and patient outcomes during dental procedures. Dental anesthesia can take multiple forms, ranging from topical local anesthesia to general anesthesia. Different approaches are suitable for different clinical scenarios and types of procedures
One form of anesthesia for dental procedures is the inferior alveolar nerve block (IANB). However, this block has been associated with injection pain, collateral anesthesia, and postoperative complications. Anatomical barriers to effective needle penetration like thickness in the bone cortical plate and surrounding tissue increase the likelihood that these disadvantages present. These barriers complicate pain management in the mandible region, particularly in the molar region compared to the maxilla. Clinicians report an increased chance of numbing the incorrect nerve due to these anatomical variations. Delivery of IANB through the neurovascular bundle has a high failure rate of up to 20%, which increases the likelihood of patient discomfort.1
The pediatric cohort is particularly sensitive to these downsides because discomfort during dental procedures, due to insufficient anesthesia pain management, often leads to dental anxiety and a reduced likelihood of seeking dental care in adulthood. In a study conducted by Alkhouli et al., a computerized intraosseous anesthesia technique (CIA) was compared with IANB in pediatric patients. In CIA, a computer-controlled device delivers anesthesia into dental and peri-dental tissues through bone penetration. This method was revealed to be advantageous compared with IANB: patients unanimously described a faster onset of analgesic relief and a reduction in discomfort. The primary difference in analgesic delivery between CIA and IANB is precision, which improves the anesthetic outcome. While the former delivers a lidocaine/epinephrine cocktail into the bone, the latter injects anesthesia into the surrounding soft tissue just above the bone to anesthetize the inferior alveolar nerve and lingual nerves.1
Addressing the fear of needles among both adults and children remains a pressing concern for dentists, motivating the pursuit of advanced analgesic solutions. A study from Zhou et al. compares the impact of sevoflurane general anesthesia in children compared with awake local anesthesia. The study shows that sevoflurane improves patient experience with no adverse impact on neurocognition. To assess neurocognitive changes in the children after exposing them to general anesthesia, the WPPSI-IV (Cn) scale was used to measure cognition markers like memory, reasoning, spatial ability, executive ability, and processing speed. Six months post-surgery, no adverse effects were shown. Clinicians strongly recommend general anesthesia like sevoflurane because of the anxiety caused by the needle during awake local anesthesia and the positive reports from children undergoing dental procedures. Finally, the use of sevoflurane reduces injection complications associated with IANB. 2, 3
Adverse childhood experiences have been strongly correlated with adult anxiety and fear around dental care and interventions. In many cases, adults seek dental care at the onset of heightened pain which increases the likelihood of an adverse event due to late medical intervention. Interestingly, one study reports that virtual reality has improved their experience. While virtual reality did not significantly reduce pain intensity per the Wong-Baker Faces Pain Rating Scale, 21 adult patients in the study agreed that the distraction during treatment improved their overall experience. The fact that a diversion from painful stimuli improves patient experience corroborates the growing consensus among clinicians that the sensation of pain during dental procedures is strongly associated with anxiety and fear. 4, 1
References
- Montserrat-Bosch, M., Figueiredo, R., Nogueira-Magalhaes, P., Arnabat-Dominguez, J., Valmaseda-Castellon, E., & Gay-Escoda, C. (2014b). Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial. Medicina Oral, Patología Oral Y Cirugía Bucal, e391–e397. https://doi.org/10.4317/medoral.19554
- Alkhouli, M., Al-Nerabieah, Z., & Dashash, M. (2024b). A randomized controlled trial to assess parental satisfaction with computerized intraosseous anesthesia versus inferior alveolar nerve block in children. Scientific Reports, 14(1). https://doi.org/10.1038/s41598-024-66359-5
- Zhou, P., Zhang, C., Huang, G., Hu, Y., Ma, W., & Yu, C. (2021b). The effect of sevoflurane anesthesia for dental procedure on neurocognition in children: a prospective, equivalence, controlled trial. BMC Pediatrics, 21(1). https://doi.org/10.1186/s12887-021-02649-5
- Almugait, M., & AbuMostafa, A. (2021). Comparison between the analgesic effectiveness and patients’ preference for virtual reality vs. topical anesthesia gel during the administration of local anesthesia in adult dental patients: a randomized clinical study. Scientific Reports, 11(1). https://doi.org/10.1038/s41598-021-03093-2