Avaliação do risco e intensidade da dor utilizando anestesia tópica em diferentes procedimentos odontológicos

Abstract

The objective of these researche was to conduct systematic reviews and randomized clinical trials to evaluate the effectiveness of topical anesthetics to reduce the risk and intensity of pain during dental procedures in children and adults. In the experiments, 1 and 2, systematic reviews were conducted to answer the PICO questions: "Does topical anesthesia influence pain during scaling and root planing (SRP) in adult patients?" and "Does infiltrative anesthesia influence pain during scaling and root planing (SRP) in adult patients?" The patent was obtained with the light-curred anesthetic gel. In the studies 3 and 4, one of the anesthetic gels (thermosensitive liposomal or light-curred gel versus placebo) was applied around the lower permanent first molars gingiva to adapted the clamp # 26, placement of the rubber dam and application of resin sealant. In the study 5, adults with non-carious cervical lesions, whose treatment was performed with the light-curred anesthetic gel versus placebo for the clamp # 212 adaptation,were enrolled.The data from study 1 showed that topical anesthesia reduced risk (p = 0.002), pain intensity (VAS and Heft Parker, p = 0.002; VRS, p = 0.023) and need for rescue anesthesia (p = 0.005) during the probing and RAP compared to the placebo. Study 2 showed that infiltrative anesthesia was better only in the assessment of pain intensity (p = 0.03) compared to topical anesthesia, with no statistical difference for pain risk (p = 0.58), need for rescue anesthesia (p<0.0001) and patients' preference (p = 0.09). In the study 3, no statistical differences were detected for the risk of pain (p = 0.52) between thermosensitive liposomal anesthetic and placebo gel in children, with differences for pain intensity with positive results for the anesthetic gel (p = 0.023 for numerical scale and = 0.013 for facial scale). Study 4 showed positive results for the light-curred anesthetic gel versus placebo, with significant differences for the risk of pain (p = 0.0002) and pain intensity at the different scales (p<0.001). Similar data were observed in study 5, with favorable results for light-curred anesthetic gel versus placebo applied in adults. Statistical differences were found for the risk of pain (p = 0.0339) and pain intensity in the different scales used (VAS, p = 0.005 and VRS, p = 0.015). Systematic reviews have demonstrated that topical anesthesia may be an alternative to replace infiltrative anesthesia in SRP, where as randomized clinical trials have demonstrated that thermosensitive liposomal and light-curred anesthetics gels are effective in reducing pain intensity in children and adults, and are an alternative for less invasive dental procedures.