Safety and efficacy of a novel nasal spray for maxillary dental anesthesia.

This study examines the efficacy, safety, and tolerability of a nasal spray to induce anesthesia of maxillary teeth. Forty-five healthy adults requiring restoration of one maxillary tooth were randomized in a 1:2 ratio to receive (1) an intra-oral lidocaine-epinephrine injection with buffered saline nasal spray bilaterally, or (2) a tetracaine hydrochloride-oxymetazoline hydrochloride nasal spray bilaterally with sham injection. Primary endpoints were use of rescue anesthesia and patient global pain assessment. Secondary outcomes included vital sign changes, soft-tissue anesthesia, and treatment-emergent adverse events. In intent-to-treat analysis, 25 of 30 patients given nasal spray (83.3%) did not require rescue anesthesia. Proportion of anesthesia successes for nasal spray was significantly different from the hypothesized placebo anesthesia success of 30% (one-sided p value < .0001 by exact binomial test). Mean duration of soft-tissue anesthesia did not differ significantly by treatment for 3 of 4 sites assessed. No serious adverse events or systemic effects were observed. Tetracaine hydrochloride-oxymetazoline nasal spray appears to provide adequate and safe anesthesia for the majority of maxillary dental procedures. Based on the results from this Phase 2 study, pivotal trials are warranted to validate these findings in an expanded patient population.

Trends in endodontic instruments and materials.

It is the skill and knowledge of the clinician using the technique or material that determines success. This article provides an overview of some current trends in endodontic instruments and materials.

Reliability of electric pulp testing after pulpal testing with dichlorodifluoromethane.

The purpose of this study was to determine if the sequence and interval between electric pulp testing and cold vitality testing with dichlorodifluoromethane affects the reliability of pulpal diagnostic testing. Sixty vital teeth in 15 volunteers were tested. Ten endodontically treated teeth were used as negative controls. After isolation and asepsis techniques, baseline threshold responses from a digital electric pulp tester were recorded from the maxillary incisors. A dichlorodifluoromethane-saturated cotton pellet was applied to teeth 8, 9, and 10. Electric pulp testing was repeated at 30-s, 1-min, and 2-min intervals on all test teeth after the cold test. The level of responses were recorded and statistically analyzed. The results of this study indicate that electric pulp testing is not adversely affected by the use of dichlorodifluoromethane.

Use of dental instruments for bridging during electric pulp testing.

It has been suggested that dental instruments can be used as bridging instruments to facilitate electric pulp testing of teeth with extensive restorations. This study reports a clinical investigation to evaluate the effectiveness of this procedure. One hundred seventeen vital teeth in 20 volunteers were tested. Ten endodontically treated teeth functioned as controls. Following appropriate isolation and asepsis technique, baseline recordings of the threshold response with the electric pulp tester were taken. With the use of dental explorers and endodontic files to bridge between the probe tip and the tooth surface, recordings were made of the threshold responses. Findings indicate that electrically conductive dental instruments can be reliably used as bridging instruments with the electric pulp tester.