Abstract to compare the efficacy of local anesthetic

ABSTRACT                                                                                   Introduction:The experience of pain duringdental procedures is a concern to many individuals. In periodontal practice,the first meet between the patient and the periodontist is usually aperiodontal examination.

Probing of periodontal pockets to determine the extentof the disease is an essential part of this examination and may cause pain insome individuals. Periodontal probing has been reported to be a significantlypainful experience for as many as 15-77% of patients with untreated periodontaldisease. So far, anesthetic gel, injection, and topical anesthetic agents usingdifferent modes such as before and after scaling and root planning have beenused to reduce this type of pain. The present study aims to compare theefficacy of  local anesthetic gel &spray in the reduction of pain on periodontal probing in a group of individualswith untreated chronic periodontitis.Materials and Methods: Thirty participants meeting theinclusion criteria were included in the study and had full-mouth periodontalprobing done at six sites per tooth. The participants were divided into 2groups: Group I; 15patients with LOX 2% gel  and Group II; 15patients were assessed with LIGNOCAINE spray . Intragroup comparison was doneusing paired t-test and Analysis of Variance was done for inter groupcomparison.

Results: The pre and post VAS score of twogroups over the periods.  In Group I, themean VAS decrease comparatively after the treatment and remain lower ascompared to baseline. In contrast, in Group II, it decrease comparatively atafter 2 min but increase at after 5 min and reach almost baseline .Conclusion : For early pain relief, study foundLOX 2% gel more effective than LIGNOCAINE SPRAY in the management of untreatedchronic periodontitis .Keywords : Lignocaine , LOX 2% gelINTRODUCTIONExamination and evaluation of any response to periodontaltherapy are measured most of all through the surrogate variable of periodontalprobing depth (PD) and its derivatives (attachment loss/clinical attachmentlevel).1 The experience of pain during dental procedures is aconcern to many individuals. In periodontal practice, the first encounterbetween the patient and the periodontist is usually a periodontal examination. Probingof periodontal pockets to determine the extent of the disease is an essentialpart of this examination and may cause pain in some individuals.

Periodontalprobing has been reported to be a significantly painful experience for as manyas 15-77% of patients with untreated periodontal disease, mainly attributableto the fact that periodontal tissues are in their most inflamed state.2-4It is important that the periodontist at this encounter issensitive to the discomfort level that the probing may entail.Quantification of pain as a measurement is inherentlydifficult because it has both physical and psychological aspects. A commonmethod used in pain studies is the visual analog scale (VAS). It has beenrevealed previously to be simple to use, consistent, and valid.5-6Injection anesthesia is an established method,7but the unwanted side effects of prolonged anesthesia, anesthesia of adjacentstructures (lips and/or tongue) and the psychological trauma of receivingmultiple invasive ”injections” makes it impractical.8 Topical anesthetics (jellies, ointments, or sprays) preferredbecause they produce less post procedure numbness, but problems relating tolack of efficacy attributable to inadequate depth of penetration, uncontrolledspreading, insufficient duration of action, and difficulties of administrationhave limited their use.

7,9-13   MATERIAL AND METHODOLOGYThe clinicaltrial was conducted in the Department of Periodontics, Sardar Patel PostGraduate Institute of Dental & Medical Sciences, Lucknow, Uttar Pradesh,India. The EthicaL Committee and Review Board of the Institute approved thestudy protocol. Total 30 subjects were selected from patients who reported tothe Department of Periodontics. The protocol was clearly explained to all thepatients and informed consent was obtained from all recruits.Study PopulationA total of30 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-mouthperiodontal probing done at six sites per tooth.Inclusioncriteria were : (1).  22-71 years of age(2). Patients with atleast 20 natural teeth (3). Patients should not have undergone SRP in previous12 months (4). Patientswith chronic periodontitis .

Exclusion criteria were : (1). Allergic tolocal anesthetics (2).  Patients withcoagulation disorders/or an anticoagulation therapy (3). Patients sufferingfrom any psychiatric disorder with chronic pain (4). Patientstaking non-steroidal anti-inflammatory drugs in 3 days before participation inthe study (5). Patients having acute periodontal pain, pulpitis, abscesses, orother acute infections (6). Ulcerative lesions in the oral cavity . The 30 selected patients were divided into twogroups of 15 subjects each.

They are as follows:Group I: 15 patients with LOX 2% gelGroup II: 15 patients were assessed withLIGNOCAINE spray for reduction               of pain during periodontal probing.  STATISTICAL ANALYSISDatawere summarised as Mean ± SE (standard error of the mean). Groups were comparedby repeated measures two way analysis of variance (ANOVA) and the significanceof mean difference within (intra) and between (inter) groups was done byTukey’s HSD (honestly significant difference) post hoc test. A two-tailed (?=2)p<0.05 was considered statistically significant. Analysis was performed onSPSS software (windows version 17.0).RESULTSThe present study compares the effect of tropical localanaesthetic spray and gel in reduction of pain on periodontal probing inindividual with untreated chronic periodontitis.

Total 30 age and sex matchedpatients were randomized equally into two groups and treated with LOX 2% gel(Group I) or LIGNOCAINE SPRAY (Group II). The primary outcome measure of thestudy was pain (VAS score) assessed at pre -treatment (baseline) and posttreatment (after 2 min and after 5 min). The objective of the study was tocompare the VAS score between the groups. The pre and post VAS score of two groups over the periods aresummarised in Table 1 and also depicted in Fig. 5. In Group I, the mean VASdecrease comparatively after the treatment and remain lower as compared tobaseline. In contrast, in Group II, it decrease comparatively at after 2 minbut increase at after 5 min and reach almost baseline.

For each group, comparing the mean VAS score between theperiods (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 5min) as compared to baseline but not differ significantly (p>0.05) betweenafter 2 min and after 5 min i.

e. found to be statistically the same.  In contrast, in Group II, it decreasesignificantly (p<0.

001) at after 2 min but not differ (p>0.05) at after 5min as compared to baseline.  Conversely,in Group II, it increase significantly (p<0.001) at after 5 min as comparedto at after 2 min.  Similarly, for each period, comparing the mean VAS scorebetween 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, atafter 5 min, it was significantly (p<0.001) different and higher in Group IIas 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 groupsover the periods. Vertical bar denotes 95% CI (confidence interval) of themean.

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  DISCUSSIONStudies13,14 have shown that full-mouth periodontal probingcan potentially be a more painful experience compared to SRP procedures whenreported using a VAS pain scoring system. The amount of pain during probingprocedures is associated with the extent of periodontal inflammation.

15The LOX 2 % gel used in this study contains 2% lidocaine  (by weight) with the addition of athermosetting 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 afterapplication.9 The results of this study demonstrated a highlysignificant reduction in pain compared to baseline values as measured on VASscale in Group I after application of LOX 2 % gel.

On the other hand, lignocaine spray also demonstrated more VAS scorecompared to gels. This could be attributed to its unfavorable bioadhesion andpoor possibility of the solution to confine at the preferred site. It also hasdeferred onset of action of 112 sec due to its relatively weak surfaceanesthetic activity. Therefore 1-2 min of contact with the mucosa is essential.CONCLUSIONBoth the LOX 2% gel & Lignocaine spray are effective in reducingpain on periodontal probing in untreated chronic periodontitis patients. However, LOX 2% is superior to Lignocaine spray in reducing pain forlonger duration.

Local anesthetic agents thus can be practiced as an adjunctivemeasure to reduce patient anxiety and attain patient cooperation. However, further studies should be conducted to assess whether achievingany level of anesthesia and patient comfort during full-mouth probing willresult in more accurate periodontal probing and to what magnitude.