Topical intra-pocket anaesthetic gel reduces the risk and intensity of pain during periodontal scaling and root planing and probing

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Abstract

Abstracted from Wambier LM, de Geus JL, Chibinski AC, Wambier DS, Rego RO, Loguercio AD, Reis A.

Intra-pocket anaesthesia and pain during probing, scaling and root planing: a systematic review and meta-analysis. J Clin Periodontol 2016; 43: 754-766.

Question: Does intra-pocket anaesthesia compared to a placebo influence the pain during probing or SRP in adult patients?

Data sources Medline, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, ProQuest Dissertations and Theses, Periódicos Capes Theses, Current Controlled Trials, International Clinical Trials Registry Platform, the ClinicalTrials.gov, Rebec (www.rebec.gov.br), EU Clinical Trials Register (www.clinicaltrialsregister.eu), abstracts of the annual conference of the International Association for Dental Research (IADR) and its regional divisions. Reference lists of primary studies and related articles from PubMed.

Question: Does intra-pocket anaesthesia compared to a placebo influence the pain during probing or SRP in adult patients?

Study selection Randomised controlled trials, parallel, crossover or split-mouth designs comparing intra-pocket anaesthesia with an anaesthetic gel with placebo in patients requiring periodontal probing or SRP were considered.

Question: Does intra-pocket anaesthesia compared to a placebo influence the pain during probing or SRP in adult patients?

Data extraction and synthesis Two authors shortlisted 11 final articles based on the inclusion criteria. Data extraction was performed by three authors using customised forms after calibration. The risk of bias in the included studies was evaluated using the Cochrane collaboration tool for assessing risk of bias in randomised controlled trials.1

Question: Does intra-pocket anaesthesia compared to a placebo influence the pain during probing or SRP in adult patients?

Results The authors used VAS and Heft-Parker scale to measure pain intensity and reported Hedge’s g standardised difference in the means. The mean reduction in VAS and Heft-Parker scale were - 0.576 (CI = - 0.94 to - 0.22; p = 0.002) and - 1.814 (CI = - 3.38 to - 0.245; p = 0.023) respectively. This indicates a positive effect of anaesthetic gel in pain intensity reduction. For risk of pain, the authors reported the odds ratio of 0.025 (CI 0.003-0.25; p = 0.002). As far as the need for rescue anaesthesia using the same anaesthetic gel and/or injected anaesthetics, the odds ratio was 0.358 (95% CI 0.174-0.736; p = 0.005). Both these findings show the efficacy of anaesthetic gel in controlling the risk of pain during SRP and probing.

Question: Does intra-pocket anaesthesia compared to a placebo influence the pain during probing or SRP in adult patients?

Conclusions The risk and intensity of pain during probing and SRP as well as the need for additional rescue anaesthesia using the same anaesthetic gel and/or injected anaesthetics is reduced with the application of topical intra-pocket anaesthetic gel.

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