Journal of dental anesthesia and pain medicine最新文献

{"title":"Ultrasound-guided lateral pterygoid muscle block as an adjunct to multimodal analgesia for impacted third molar extraction: a two-center retrospective exploratory study.","authors":"Keisuke Nakazawa, Shun Hoshino, Ryota Tsukui, Motohiro Muranaka, Yuto Oshizaka, Yoshio Ohyama, Junko Tamari, Noriya Hirose, Hisataka Kitano, Takahiro Suzuki","doi":"10.17245/jdapm.2026.26.076","DOIUrl":"10.17245/jdapm.2026.26.076","url":null,"abstract":"<p><strong>Background: </strong>Ultrasound-guided lateral pterygoid muscle (LPM) block, a single-intramuscular-injection technique originally described for sagittal split ramus osteotomy, may offer a simplified regional analgesic option for dental surgery. However, its application as an adjunct to wound infiltration in impacted third molar extraction has not been reported.</p><p><strong>Methods: </strong>This retrospective two-center exploratory study included 48 consecutive patients who underwent impacted third molar extraction under general anesthesia between September and November 2025. All patients received standardized intraoperative multimodal analgesia (intravenous acetaminophen and dexamethasone) and wound local infiltration; the LPM group (n = 27) additionally received an ultrasound-guided LPM block with 10 ml of 0.25% levobupivacaine, whereas the NE group (n = 21) received wound infiltration alone. The primary outcome was the Numeric Rating Scale (NRS) score at rest 6 h postoperatively. Institutional and extraction-pattern imbalances were addressed using adjusted ordinal logistic regression sensitivity analyses.</p><p><strong>Results: </strong>The median NRS score at rest 6 h postoperatively was lower in the LPM group than in the NE group (0 [0, 2] vs. 3 [1.5, 4.0], P < 0.001). The institution- and extraction-pattern-adjusted ordinal logistic regression preserved the direction of the association (adjusted odds ratio 0.14, 95% confidence interval 0.04-0.48, P = 0.002). The recorded total volume of wound local anesthetic was similar between the groups (LPM 9.0 ml vs. NE 8.4 ml, P = 0.729). Lower NRS scores were also observed at 2 h and 21:00; differences resolved by the following morning. The median time to first rescue analgesia was 10 h in the LPM group versus 7 h in the NE group (log-rank P = 0.294). No complications directly attributable to the LPM block were documented during the recorded early postoperative observation window.</p><p><strong>Conclusion: </strong>An adjunctive ultrasound-guided LPM block was associated with lower recorded early postoperative pain scores after impacted third molar extraction. These hypothesis-generating findings require confirmation in the ongoing ALPINE randomized controlled trial (jRCT1031250592).</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"317-327"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of the anesthetic efficacy of 4% buffered articaine versus 2% un-buffered lidocaine for dental injections in children: a double-blind randomized parallel group control trial.","authors":"Ashish Suresh, Sunny Priyatham Tirupathi","doi":"10.17245/jdapm.2026.26.075","DOIUrl":"10.17245/jdapm.2026.26.075","url":null,"abstract":"<p><strong>Background: </strong>Effective pain control is central to the pediatric dental practice. Buffering local anesthetics with sodium bicarbonate raises the solution pH to physiological levels, theoretically accelerating the onset and reducing injection discomfort. Although buffered lidocaine has been studied in children, direct evidence comparing buffered 4% articaine with the most widely used clinical alternative (non-buffered 2% lidocaine) in a pediatric outpatient setting with a comprehensive outcome assessment remains scarce. This study aimed to compare buffered 4% articaine with 1:100,000 epinephrine and non-buffered 2% lidocaine with 1:100,000 epinephrine in children aged 6-12 years requiring single-tooth dental procedures and evaluate multiple clinically relevant outcomes, including pain, anesthetic onset, operator experience, and postoperative safety.</p><p><strong>Methods: </strong>This parallel-group, double-blind, randomized controlled trial enrolled 100 healthy children (American Society of Anesthesiologists (ASA) Physical Status I, aged 6-12 years). The participants were randomly allocated in a 1:1 ratio to receive either buffered 4% articaine (n = 50) or non-buffered 2% lidocaine (n = 50). The primary outcomes were injection pain (visual analog scale [VAS] score), anesthetic onset time (s), and operator-rated difficulty (VAS). Secondary outcomes included intraoperative pain, duration of soft tissue anesthesia, cardiovascular response (heart rate), behavioral cooperation (Frankl scale), pulpal success, need for reinjection, lip or cheek biting, and delayed adverse events at one week.</p><p><strong>Results: </strong>Buffered articaine produced significantly lower injection pain (2.25 ± 0.94 vs. 3.93 ± 0.90; P < 0.001), faster anesthetic onset (71.98 ± 15.24 vs. 115.28 ± 20.04 s; P < 0.001), lower operator difficulty scores (2.27 ± 0.99 vs. 4.22 ± 0.98; P < 0.001), and reduced procedure pain (2.15 ± 0.99 vs. 3.56 ± 1.05; P < 0.001). Soft tissue anesthesia lasted significantly longer with buffered articaine (159.02 ± 19.10 vs. 137.84 ± 17.54 min; P < 0.001). Heart rate elevation during the injection was significantly attenuated in the articaine group (P = 0.0003). Pulpal success rates were comparable (84% vs. 82%; P = 1.000), and no significant between-group differences were observed in the reinjection rate, lip or cheek biting, or delayed adverse events.</p><p><strong>Conclusion: </strong>Buffered 4% articaine provides clinically superior injection comfort, faster onset, and better behavioral cooperation than non-buffered 2% lidocaine in the pediatric dental practice, with a comparable safety profile.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"329-343"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel electrospun drug delivery systems for periodontal and oral mucosal therapy: a systematic review.","authors":"Behrad Yadolahi, Mehdi Taghian, Leyli Sadri","doi":"10.17245/jdapm.2026.26.068","DOIUrl":"10.17245/jdapm.2026.26.068","url":null,"abstract":"<p><p>Advanced polymeric drug delivery systems, particularly electrospun nanofibers and mucoadhesive patches, are promising platforms for the local treatment of periodontal and oral mucosal diseases. However, evidence regarding fabrication reproducibility, mucosal interactions, therapeutic efficacy, and stability has not been systematically synthesized. This systematic review evaluated novel polymeric carriers for dental and oral applications, with emphasis on fabrication parameters, drug loading, mucoadhesion, release behavior, immunomodulatory effects, clinical outcomes, and safety. Following PRISMA guidelines and the PICO framework, two independent reviewers searched PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar for English-language studies published between 2015 and 2025. Eligible studies investigated novel polymeric carriers, primarily electrospun or composite systems, and reported fabrication parameters, including polymer type, preparation method, and drug loading, along with relevant biological or clinical outcomes. Risk of bias was assessed using SYRCLE/OHAT tools for original studies and AMSTAR-2 for review articles. Eight studies (four original research studies and four review articles) met the inclusion criteria. The included studies evaluated polymers, such as PLA/nano-HAP, chitosan/PVA/PCL, and PLLA/PEO, in combination with active agents including doxycycline, neem extract, curcumin, diclofenac sodium, and binahong extract. Electrospinning consistently generated porous, uniform carriers with fiber diameters of approximately 250-500 nm, sustained release ranging from 82% over 8 h to 60-80% over 7 days, mucoadhesive strength up to 0.34 N, immunomodulatory effects reflected by reduced IL-1, TNF-α, and MMP-8 levels, and antibacterial efficacy up to 98%. These systems also maintained mucosa-compatible pH values (6.5-7.0) and showed no evidence of irritation or toxicity. Needleless electrospinning variants further improved scalability. However, heterogeneity in fabrication parameters and moderate overall risk of bias, mainly from review-based evidence, limited direct comparisons across studies. Overall, electrospun nanofibers and mucoadhesive patches demonstrated promising potential as biocompatible platforms for targeted local drug delivery in dentistry, with the capacity to enhance immunomodulatory and antimicrobial effects in periodontitis, aphthous stomatitis, and oral ulcers. Further studies incorporating standardized fabrication validation and long-term stability testing are recommended to support clinical translation.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"305-316"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative sensory testing in oral disorders: an update on methods and clinical implications.","authors":"Myong-Hwan Karm, Seung-Hwa Ryoo, Kwang-Suk Seo, Mi Hyun Seo, Mi-Sun Kong, Hyun Jeong Kim","doi":"10.17245/jdapm.2026.26.091","DOIUrl":"10.17245/jdapm.2026.26.091","url":null,"abstract":"<p><p>Oral mucosal diseases, such as burning mouth syndrome, oral lichen planus, oral mucositis, and recurrent aphthous stomatitis, frequently present with altered sensory functions, including pain, dysesthesia, and changes in thermal and mechanical sensitivity. Accurate assessment of these sensory changes is essential for understanding disease mechanisms, evaluating treatment efficacy, and improving patient outcomes. This review summarizes current evidence on sensory measurement methods used in clinical trials involving patients with oral mucosal diseases, with a particular focus on quantitative sensory testing techniques.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"283-303"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental sedation in Japan after the 2026 reimbursement revision: patient safety, access to care, and the role of dental anesthesiologists.","authors":"Toru Yamamoto, Hiroko Kanemaru, Shigenobu Kurata, Yutaka Tanaka, Naotaka Kishimoto","doi":"10.17245/jdapm.2026.26.092","DOIUrl":"10.17245/jdapm.2026.26.092","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"365-367"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recovery phase after dental intravenous sedation: airway vigilance should continue until discharge.","authors":"Toru Yamamoto, Hiroko Kanemaru, Shigenobu Kurata, Yutaka Tanaka, Naotaka Kishimoto","doi":"10.17245/jdapm.2026.26.117","DOIUrl":"10.17245/jdapm.2026.26.117","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"369-371"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An anaphylactic reaction without skin manifestations after general anesthesia induction: a case report.","authors":"Maho Suyama, Mitsuhiro Yoshida, Serika Imamura, Aya Oda, Kana Oue, Mitsuru Doi, Yoshitaka Shimizu, Hiroshi Hanamoto","doi":"10.17245/jdapm.2026.26.064","DOIUrl":"10.17245/jdapm.2026.26.064","url":null,"abstract":"<p><p>Anaphylaxis is a severe, potentially life-threatening hypersensitivity reaction. Although anaphylaxis rarely occurs during dental anesthesia, preparation for a prompt and appropriate response is crucial. Severe anaphylaxis may occur in the absence of typical skin manifestations. We encountered anaphylaxis approximately 15 min after induction of general anesthesia, presenting with a gradual decrease in SpO₂, acute hypotension, and tachycardia without skin manifestations. After administration of epinephrine, the patient's hemodynamic status improved rapidly. Elevated serum tryptase and plasma histamine levels supported this diagnosis. This case highlights the diagnostic challenges of perioperative anaphylaxis during general anesthesia because cutaneous manifestations may be absent and alternative causes of hypoxemia or circulatory collapse must also be considered. Perioperative anaphylaxis remains an important differential diagnosis, even in the absence of skin symptoms. Prompt exclusion of alternative causes and early epinephrine administration are essential for successful management. Postoperative allergological evaluation, patient education, and institutional preparedness are important for reducing the risk of recurrence and improving patient safety.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"353-358"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First manifestation of acute exacerbation of idiopathic interstitial pneumonia during emergency maxillary drainage: a case report.","authors":"Saori Yamamoto, Masahiro Maeda, Reiko Murakami, Soichiro Iimura, Saki Nishimura, Tomoko Goto","doi":"10.17245/jdapm.2026.26.030","DOIUrl":"10.17245/jdapm.2026.26.030","url":null,"abstract":"<p><p>Acute exacerbation of idiopathic interstitial pneumonia (AE-IIP) can be triggered by invasive procedures and carries a mortality rate of approximately 50%. We report a case of a 73-year-old man who presented to a dental emergency room with maxillary swelling and a fever of 39.0℃. Initially, the patient was prescribed analgesics and antibiotics. The following day, because of an elevated C-reactive protein (CRP) level (18.0 mg/dL), emergency incision and drainage were performed. During the procedure, he developed tachypnea, dry cough, and hypoxia (SpO2, 85-90%). The patient was immediately transferred to a medical emergency hospital, where chest computed tomography confirmed the diagnosis of IIP. The patient was admitted to the respiratory care unit and was treated with corticosteroid pulse therapy and antibiotics. The patient was discharged on day 39 with ambulatory oxygen therapy. High CRP levels and acute hypoxia may be critical early indicators of AE-IIP. Dental anesthesiologists must recognize that oral infections can trigger severe and potentially fatal systemic inflammatory responses, including AE-IIP.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"359-363"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating intraoperative tooth loss during oral surgery under general anesthesia: radiographic localization and videolaryngoscopic retrieval of a supraglottic foreign body: a case report.","authors":"Sung Bin Youn, Myong-Hwan Karm, Hyun Jeong Kim, Seung-Hwa Ryoo","doi":"10.17245/jdapm.2026.26.116","DOIUrl":"10.17245/jdapm.2026.26.116","url":null,"abstract":"<p><p>Dental dislodgement during oral and maxillofacial surgery is an uncommon, but potentially serious complication. We report a case of intraoperative tooth loss with asymptomatic supraglottic retention during oral surgery under general anesthesia. A 55-year-old man underwent bilateral maxillary endoscopic sinus surgery (MESS) under general anesthesia. A severely mobile mandibular tooth was missing during surgery, although the ventilation and hemodynamic parameters remained stable. As the patient showed no evidence of airway compromise and the location of the tooth was uncertain, radiographic localization was performed after completion of the procedure. Portable radiograph revealed a tooth-shaped foreign body in the laryngeal region. Subsequent videolaryngoscopic examination revealed a tooth lodged beneath the epiglottis and above the vocal cord. The tooth was successfully removed using Magill forceps and the patient recovered without any respiratory complications. This case highlights that a dislodged tooth may remain undetected in the supraglottic airway despite stable respiratory parameters. Radiographic localization, followed by targeted video laryngoscopic retrieval, has enabled successful management.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"345-351"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedation is not sleep: changes in airway physiology during deep sedation and the duty to rescue.","authors":"Seungoh Kim","doi":"10.17245/jdapm.2026.26.087","DOIUrl":"10.17245/jdapm.2026.26.087","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 4","pages":"281-282"},"PeriodicalIF":1.8,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148681946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}