Introduction
The paper under consideration is titled “The efficacy of 6 local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia” (Abdulwahab et al 2009). It is published in the Journal of the American Dental Association (JADA) in 2009. The main purpose of this paper is to assess the efficacy of the five commonly marketed dental anesthetic formulations in achieving pulpal anesthesia after mandibular buccal infiltration and compare them with a control formulation of lidocaine with epinephrine (L100) (Abdulwahab et al 2009). Additionally, it aims to evaluate the adverse drug reactions and side effects in the participants.
Evaluation of the Paper
This paper uses the Randomized Controlled Trial (RCT) method which is commonly applied to clinical examinations. Proper randomization is effective in this case as it leaves little scope for any kind of business in the assignment of treatments to patients. Moreover, as the RCT is double-blind, the research is expected to yield objective results.
The trial is conducted on a group of 18 healthy participants between 18-65 years of age who have met certain specific criteria. Thus, a larger cross-section of the society in terms of age is taken into consideration. The local dental anesthetic formulations used in this study are the popular amide-based anesthetics commonly available in the US namely, A200, A100, P200, Mw/o, and B200 (Abdulwahab et al 2009). The participants are administered a very small amount of anesthetic (0.9ml) in the form of buccal infiltration injections of anesthetic solutions adjacent to the molar and this procedure is repeated throughout six sessions. The degree of pulpal anesthesia is then determined by analyzing the scores against the Electronic Pulp Test (EPT) criteria. The entire method is, thus, carried out on the lines of a scientific experiment.
The EPT scores for the six anesthetic formulations are 43.5% for L100, 44.8% for B200, 51.2% for P200, 66.9% for A200, 68.3% for Mw/o and 77.3% for A100 (Abdulwahab et al 2009). Minor critical reactions to the mandibular molar infiltration test are reported but these are independent of the local anesthetic formulations. The authors concluded that “mandibular infiltration with 0.9mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level … inadequate for most dental procedures” ( Abdulwahab et al 2009). As per the data available, the pulpal anesthesia achieved with A100 is found to be statistically greater than the others.
I fully agree with the conclusions of the study that the degree of pulpal anesthesia achieved after mandibular buccal infiltration of all the local anesthetic formulations is inadequate for most dental operations. Furthermore, based on the results obtained, it may be inferred that the degree of pulpal anesthesia achieved via mandibular buccal infiltration depends, to a large extent, on the type of local anesthetic formulation used. However, a larger sample would have given a more concise idea.
Criticism
Fundamentally, the study seems to overlook the fact that the efficacy of mandibular infiltration anesthesia depends, to a large extent, on the site of injection, the anesthetic formulation used as well as the technique involved. Secondly, it should be noted that anesthetic efficacy has been determined across a time frame of 20 minutes which is not sufficient for yielding effective results. Proper assessment of the technique should be done for a minimum of one hour.
Reference
Abdulwahab, M., Boynes, S., Moore, P., Seifekar, S., Al-Jazzaf, A., Alshuraldh, A., Zovko, J. & Close, J. (2009). The efficacy of 6 local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia. Journal of the American Dental Association, 140, 1018-1024.