Developing a method for preventing adverse reactions after local anesthesia in outpatient dental care: a digital solution

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Background: The risks and incidence of adverse reactions after local anesthesia in dentistry are constantly increasing.

Aim: To improve the safety of local anesthesia in outpatient dental care.

Methods: The study was conducted between 2022 and 2024. A survey during history taking revealed that all patients had previously received anesthesia. The patients measured their blood pressure (BP) and heart rate using automated tonometers and documented the results. The anesthetic risk was assessed using the American Society of Anesthesiologists scale.

Anesthesia was administered with 2% lidocaine solution and 4% articaine and epinephrine solution (1:200,000). The efficacy of local anesthesia was assessed using a visual analogue scale that took into account both patient and physician perspectives. The safety was assessed using a dedicated scale; the assessment involved monitoring and documenting all adverse events (including their severity and association with the study drug). The next day, a mobile survey of patients was performed.

Results: A total of 1,600 patients (900 females and 700 males) aged 18 to 70 years were examined.

Baseline BP parameters were within the normal range: systolic BP 131.45 [124.0; 136.0] mm Hg, diastolic BP 81.98 [75.0; 84.0] mm Hg, heart rate 74.65 [72.0; 80.0] bpm. The patients received 850 injections of 2% lidocaine solution (state-funded) and 750 injections of 4% articaine and epinephrine solution (1:200,000). 2% lidocaine solution (2 mL) was used in all cases of local anesthesia, with an efficacy of 75.4 to 79.3%; the efficacy of 4% articaine and epinephrine solution at a concentration of 1:200,000 (1.8 mL) ranged from 95.4 to 99.3%.

A safety assessment using a dedicated scale demonstrated high safety of local anesthesia. No adverse reactions were reported.

Conclusion: The proposed safety protocol, which is based on the risk assessment of adverse reactions (emergencies) following local anesthesia, has shown that local anesthesia is safe, with no adverse reactions.

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作者简介

Evgeniya Anisimova

Russian Biotechnological University

编辑信件的主要联系方式.
Email: evg-anis@mail.ru
ORCID iD: 0000-0001-7109-6431
SPIN 代码: 9678-7000

MD, Cand. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Natalia Anisimova

Russian Biotechnological University

Email: dent.natalia@mail.ru
ORCID iD: 0000-0002-3073-7041
SPIN 代码: 9336-3794

MD, Cand. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Nikita Ryazancev

Russian Biotechnological University

Email: nryazancev@gmail.com
ORCID iD: 0000-0002-4071-8098
SPIN 代码: 1708-8064

MD, Cand. Sci. (Medicine), Associate Professor

俄罗斯联邦, Moscow

Olga Khodnenko

Russian Biotechnological University

Email: mz_krlsp_info@mosreg.ru
ORCID iD: 0000-0001-7353-5602
SPIN 代码: 6943-0029

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Moscow

Ekaterina Chernetskaya

Russian Biotechnological University

Email: ek.chern00@mail.ru
ORCID iD: 0009-0009-3886-449X
SPIN 代码: 9446-6211
俄罗斯联邦, Moscow

参考

  1. Gulenko OV, Skatova EA, Mokronosova MA. “Criminal” local anesthesia in dentistry: a deliberate risk or a game without rules? Stomatology. 2021;100(5):77–81. doi: 10.17116/stomat202110005177 EDN: NDRGPF
  2. Anisimova EN, Anisimova NYu, Babadzhanyan RS, et al. Elaboration of safe local anesthesia protocol. The Dental Institute. 2019;(1):30–33. EDN: DLZTHU
  3. Karamlou M, Asaria I, Barron J, Boutros P, Fisher V, et al. Complications after dental sedation: a myotonic mystery case report. Anesth Prog. 2022;69(4):26–31. doi: 10.2344/anpr-69-02-09
  4. Anisimova EN, Anisimova NY, Ryazantsev NA, et al. Fundamentals of safety in the provision of dental care to drug-dependent patients in outpatient appointments. Мoscow: Russian Biotechnological University; 2024. EDN: UJVMJZ
  5. Orser BA, Byrick R. Anesthesia-related medication error: time to take action. Can J Anaesth. 2004;51(8):756–760. (In French). doi: 10.1007/BF03018447 EDN: RMOSDL
  6. Patent RUS № 2645657 C1/ 30.03.2017. Anisimova EN, Sokhov ST, Letunova NYu, et al. Method for evaluating the effectiveness of defects in the implementation of ambulator stomatological interventions. (In Russ.) Available from: https://worldwide.espacenet.com/patent/search/family/061258828/publication/RU2645657C1?q=2645657
  7. Felemban OM, Alshamrani RM, Aljeddawi DH, et al. Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial. BMC Oral Health. 2021;21(1):321. doi: 10.1186/s12903-021-01678-x
  8. Kohli N, Hugar SM, Patil VH, et al. Evaluating anxiety levels and pain perception while administering local anesthesia using conventional, insulin, and deception syringes in 6-12-year-olds. J Dent Anesth Pain Med. 2022;22(3):197–204. doi: 10.17245/jdapm.2022.22.3.197
  9. Anisimova EN, Orekhova IV. Preventive analgesia in dental interventions. In: Tsimbalistov AV, Avkhacheva NA, editors. Proceedings of the XII International Scientific and Practical Conference “Stomatology of Slavic States”. Belgorod: Belgorod State National Research University; 2019. P. 41–43. (In Russ.) EDN: FUFYVC
  10. Certificate of state registration of the computer program RUS № 2024612343/ 25.01.2024. Anisimova EN, Anisimova NY, Golikova AM, et al. Scale for assessing the risk of adverse reactions (emergencies) in a patient to the administration of local anesthetic solution in outpatient dental appointments. (In Russ.) Available from: https://fips.ru/EGD/828b82c0-8ec7-4e6e-a003-dc3e7c922bb3
  11. Certificate of state registration of the computer program RUS № 2023687901/ 11.12.2023. Anisimova EN, Shebalina AA, Labzenkova MA, et al. Online calculator of risk of bleeding during dental interventions in patients taking new oral anticoagulants. (In Russ.) Available from: Official Publications-Untitled
  12. Anisimova EN, Anisimova NYu, Orekhova IV, Sedyakina YuV. Improving the effectiveness of local anesthesia in patients with arterial hypertension in the provision of emergency dental care. Stomatology. 2024;103(2):32–35. doi: 10.17116/stomat202410302132 EDN: WVOTLL
  13. Certificate of state registration of the computer program RUS № 2023689019 /11.12.2023. Anisimova EN, Anisimova NY, Ryzhkov DD, et al. Online calculator of integrative assessment of psychological state of a dentist. (In Russ.) Available from: https://fips.ru/EGD/7d19b878-c066-4d67-bc68-444929b3597b

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2. Fig. 1. Measurement of blood pressure and heart rate in a polyclinic using an automated certified blood pressure monitor.

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3. Fig. 2. Analog-visual scale for evaluating the effectiveness of anesthesia during outpatient dental procedures.

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