ABSTRACT to compare the efficacy of local anesthetic

ABSTRACT                                                                                   

Introduction:
The experience of pain during
dental procedures is a concern to many individuals. In periodontal practice,
the first meet between the patient and the periodontist is usually a
periodontal examination. Probing of periodontal pockets to determine the extent
of the disease is an essential part of this examination and may cause pain in
some individuals. Periodontal probing has been reported to be a significantly
painful experience for as many as 15-77% of patients with untreated periodontal
disease. So far, anesthetic gel, injection, and topical anesthetic agents using
different modes such as before and after scaling and root planning have been
used to reduce this type of pain. The present study aims to compare the
efficacy of  local anesthetic gel &
spray in the reduction of pain on periodontal probing in a group of individuals
with untreated chronic periodontitis.

Materials and Methods: Thirty participants meeting the
inclusion criteria were included in the study and had full-mouth periodontal
probing done at six sites per tooth. The participants were divided into 2
groups: Group I; 15
patients with LOX 2% gel  and Group II; 15
patients were assessed with LIGNOCAINE spray . Intragroup comparison was done
using paired t-test and Analysis of Variance was done for inter group
comparison.

Results: The pre and post VAS score of two
groups over the periods.  In Group I, the
mean VAS decrease comparatively after the treatment and remain lower as
compared to baseline. In contrast, in Group II, it decrease comparatively at
after 2 min but increase at after 5 min and reach almost baseline .

Conclusion : For early pain relief, study found
LOX 2% gel more effective than LIGNOCAINE SPRAY in the management of untreated
chronic periodontitis .

Keywords : Lignocaine , LOX 2% gel

INTRODUCTION

Examination and evaluation of any response to periodontal
therapy are measured most of all through the surrogate variable of periodontal
probing depth (PD) and its derivatives (attachment loss/clinical attachment
level).1 The experience of pain during dental procedures is a
concern to many individuals. In periodontal practice, the first encounter
between the patient and the periodontist is usually a periodontal examination. Probing
of periodontal pockets to determine the extent of the disease is an essential
part of this examination and may cause pain in some individuals. Periodontal
probing has been reported to be a significantly painful experience for as many
as 15-77% of patients with untreated periodontal disease, mainly attributable
to the fact that periodontal tissues are in their most inflamed state.2-4

It is important that the periodontist at this encounter is
sensitive to the discomfort level that the probing may entail.

Quantification of pain as a measurement is inherently
difficult because it has both physical and psychological aspects. A common
method used in pain studies is the visual analog scale (VAS). It has been
revealed previously to be simple to use, consistent, and valid.5-6

Injection anesthesia is an established method,7
but the unwanted side effects of prolonged anesthesia, anesthesia of adjacent
structures (lips and/or tongue) and the psychological trauma of receiving
multiple invasive ”injections” makes it impractical.8

Topical anesthetics (jellies, ointments, or sprays) preferred
because they produce less post procedure numbness, but problems relating to
lack of efficacy attributable to inadequate depth of penetration, uncontrolled
spreading, insufficient duration of action, and difficulties of administration
have limited their use.7,9-13

 

 

 

MATERIAL AND METHODOLOGY

The clinical
trial was conducted in the Department of Periodontics, Sardar Patel Post
Graduate Institute of Dental & Medical Sciences, Lucknow, Uttar Pradesh,
India. The EthicaL Committee and Review Board of the Institute approved the
study protocol. Total 30 subjects were selected from patients who reported to
the Department of Periodontics. The protocol was clearly explained to all the
patients and informed consent was obtained from all recruits.

Study Population

A total of
30 participants (17 males and 13 females, aged 27-71 years; mean age: 43.90 ±
11.04) meeting the inclusion criteria were included in this study and had full-mouth
periodontal probing done at six sites per tooth.

Inclusion
criteria were : (1).  22-71 years of age
(2). Patients with at
least 20 natural teeth (3). Patients should not have undergone SRP in previous
12 months (4). Patients
with chronic periodontitis .

 Exclusion criteria were : (1). Allergic to
local anesthetics (2).  Patients with
coagulation disorders/or an anticoagulation therapy (3). Patients suffering
from any psychiatric disorder with chronic pain 
(4). Patients
taking non-steroidal anti-inflammatory drugs in 3 days before participation in
the study (5). Patients having acute periodontal pain, pulpitis, abscesses, or
other acute infections (6). Ulcerative lesions in the oral cavity .

 The 30 selected patients were divided into two
groups of 15 subjects each. They are as follows:

Group I: 15 patients with LOX 2% gel

Group II: 15 patients were assessed with
LIGNOCAINE spray for reduction               of pain during periodontal probing.

 

 STATISTICAL ANALYSIS

Data
were summarised as Mean ± SE (standard error of the mean). Groups were compared
by repeated measures two way analysis of variance (ANOVA) and the significance
of mean difference within (intra) and between (inter) groups was done by
Tukey’s HSD (honestly significant difference) post hoc test. A two-tailed (?=2)
p<0.05 was considered statistically significant. Analysis was performed on SPSS software (windows version 17.0). RESULTS The present study compares the effect of tropical local anaesthetic spray and gel in reduction of pain on periodontal probing in individual with untreated chronic periodontitis. Total 30 age and sex matched patients were randomized equally into two groups and treated with LOX 2% gel (Group I) or LIGNOCAINE SPRAY (Group II). The primary outcome measure of the study was pain (VAS score) assessed at pre -treatment (baseline) and post treatment (after 2 min and after 5 min). The objective of the study was to compare the VAS score between the groups. The pre and post VAS score of two groups over the periods are summarised in Table 1 and also depicted in Fig. 5. In Group I, the mean VAS decrease comparatively after the treatment and remain lower as compared to baseline. In contrast, in Group II, it decrease comparatively at after 2 min but increase at after 5 min and reach almost baseline. For each group, comparing the mean VAS score between the periods (table 2 and Fig. 6), Tukey test showed significant (p<0.001) decrease in VAS score in Group I at both post periods (after 2 min and after 5 min) as compared to baseline but not differ significantly (p>0.05) between
after 2 min and after 5 min i.e. found to be statistically the same.  In contrast, in Group II, it decrease
significantly (p<0.001) at after 2 min but not differ (p>0.05) at after 5
min as compared to baseline.  Conversely,
in Group II, it increase significantly (p<0.001) at after 5 min as compared to at after 2 min.  Similarly, for each period, comparing the mean VAS score between the periods (Table 1 and Fig. 7), Tukey test showed similar (p>0.05)
VAS score between the groups at both baseline and after 5 min. However, at
after 5 min, it was significantly (p<0.001) different and higher in Group II as compared to Group I.     Time period Group I Group II p value Baseline 5.87 ± 0.22 5.60 ± 0.19 0.933 After 2 min 1.47 ± 0.24 1.93 ± 0.15 0.564 After 5 min 1.80 ± 0.17 5.40 ± 0.21 <0.001   Table 1: Pre and post VAS score (Mean ± SE, n=15) of two groups over the periods     Fig. 5 . Mean VAS score of two groups over the periods. Vertical bar denotes 95% CI (confidence interval) of the mean.     Comparison Group I Group II Baseline vs. After 2 min <0.001 <0.001 Baseline vs. After 5 min <0.001 0.963 After 2 min vs. After 5 min 0.748 <0.001   Table 2: For each group, comparison (p value) of mean VAS score between the periods by Tukey test     DISCUSSION Studies13,14 have shown that full-mouth periodontal probing can potentially be a more painful experience compared to SRP procedures when reported using a VAS pain scoring system. The amount of pain during probing procedures is associated with the extent of periodontal inflammation.15 The LOX 2 % gel used in this study contains 2% lidocaine  (by weight) with the addition of a thermosetting agent. This enables the gel to flow into the periodontal pocket, in which it becomes an elastic gel at body temperature. The onset of anesthesia has been shown to be 30 s to 5 min after application.9 The results of this study demonstrated a highly significant reduction in pain compared to baseline values as measured on VAS scale in Group I after application of LOX 2 % gel. On the other hand, lignocaine spray also demonstrated more VAS score compared to gels. This could be attributed to its unfavorable bioadhesion and poor possibility of the solution to confine at the preferred site. It also has deferred onset of action of 112 sec due to its relatively weak surface anesthetic activity. Therefore 1-2 min of contact with the mucosa is essential. CONCLUSION Both the LOX 2% gel & Lignocaine spray are effective in reducing pain on periodontal probing in untreated chronic periodontitis patients. However, LOX 2% is superior to Lignocaine spray in reducing pain for longer duration. Local anesthetic agents thus can be practiced as an adjunctive measure to reduce patient anxiety and attain patient cooperation. However, further studies should be conducted to assess whether achieving any level of anesthesia and patient comfort during full-mouth probing will result in more accurate periodontal probing and to what magnitude.