Journal of dental anesthesia and pain medicine最新文献

{"title":"Nationwide trends in intravenous sedative and analgesic drug use in Korean dental institutions: a big data analysis using the Narcotics Information Management System from 2020 to 2024.","authors":"Kyeong Jun Cheon, Seung-Hwa Ryoo, Myong-Hwan Karm, Hyun Jeong Kim, Hyo Jo Han, Kwang-Suk Seo","doi":"10.17245/jdapm.2026.26.085","DOIUrl":"10.17245/jdapm.2026.26.085","url":null,"abstract":"<p><strong>Background: </strong>Intravenous (IV) sedation is an effective method of alleviating patient anxiety and pain, thereby improving cooperation during dental procedures. In South Korea, most drugs used for IV sedation are classified as psychotropic substances, which require strict management throughout the processes of administration, storage, and disposal. In 2018, all medical institutions in Korea were mandated to report on the manufacture, import, use, administration, and disposal of narcotic and psychotropic drugs to the Narcotics Information Management System (NIMS). Thus, in this study, we aimed to analyze the current status and trends of narcotic and psychotropic drug use in IV sedation performed at domestic dental clinics and hospitals by year, region, sex, and age using the aforementioned big data.</p><p><strong>Methods: </strong>Data on narcotic and psychotropic drug use reported nationwide by dental clinics and hospitals between January 2020 and December 2024 were collected. The drugs analyzed included midazolam, propofol, ketamine, and remimazolam (used for intravenous sedation), as well as fentanyl, remifentanil, and pethidine (used as analgesic adjuncts). Annual trends, regional distributions, and usage ratios by age and sex were analyzed for these medications.</p><p><strong>Results: </strong>During the analysis period, the use of intravenous sedatives in domestic dental practice showed a continuous annual increase. As of 2024, midazolam account for the largest share, at approximately 76.5% of the total sedative use, followed by propofol (10.6%), ketamine (9.9%), and remimazolam (2.8%). Notably, ketamine showed the most rapid growth, with its annual usage increasing by approximately 152% in 2023 compared to the previous year. According to the type of medical institution, the volume of sedatives used in dental clinics account for 90.8% of the sedatives in 2024, indicating a higher growth rate in dental clinics than in dental hospitals. The average annual growth rate of sedative use is high among adults. Regionally, usage tends to become increasingly concentrated in the Seoul Metropolitan Area (Seoul and Gyeonggi).</p><p><strong>Conclusion: </strong>The use of IV sedation in Korean dentistry is consistently increasing. Safe IV sedation methods, primarily involving midazolam, are being widely implemented for adults in dental clinic settings.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"247-264"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213896","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":"Changes in preoperative serum immunoglobulin concentrations in dental patients receiving long-term anticonvulsant therapy.","authors":"Shinichiro Kira, Chiharu Arai","doi":"10.17245/jdapm.2026.26.040","DOIUrl":"10.17245/jdapm.2026.26.040","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"277-280"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213881","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":"Effect of rotary and reciprocating instrumentation kinematics on postoperative pain following endodontic retreatment: a systematic review.","authors":"Pratibha Singh, Akash Bhatnagar, Sharique Alam, Kanupriya Rathore","doi":"10.17245/jdapm.2026.26.051","DOIUrl":"10.17245/jdapm.2026.26.051","url":null,"abstract":"<p><p>This review aimed to systematically evaluate whether rotary or reciprocating nickel-titanium instrumentation systems influence postoperative pain after nonsurgical endodontic retreatment. This systematic review was conducted according to PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261325110). A comprehensive electronic search was conducted in the PubMed, Scopus, Web of Science, and Embase databases. Randomized clinical trials comparing rotary and reciprocating systems for nonsurgical endodontic retreatment and reporting postoperative pain outcomes were included. Risk of bias was assessed using the Modified Cochrane RoB-2 tool. Due to clinical and methodological heterogeneity, a qualitative synthesis was performed. A total of 194 records were identified through a database search, and five randomized clinical trials fulfilled the inclusion criteria. Most studies reported no statistically significant differences in the incidence or intensity of postoperative pain between the rotary and reciprocating retreatment systems at 24, 48, and 72 h. However, one randomized clinical trial reported significantly higher early postoperative pain associated with the reciprocating system than with the rotary system during the initial postoperative period, whereas no significant difference was observed at longer follow-up intervals. Furthermore, no statistically significant differences were observed between the rotary and reciprocating kinematics regarding analgesic intake following the retreatment procedures. Based on available randomized evidence, rotary and reciprocating instrumentation systems appear to produce comparable postoperative pain following nonsurgical endodontic retreatment. Postoperative discomfort is generally mild, decreases over time, and does not demonstrate a consistent dependence on instrumentation kinematics.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"185-198"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213893","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":"Advanced bibliometric analysis of computer-controlled local anesthesia research in pediatric dentistry incorporating productivity laws and network analysis.","authors":"Erdal Cem Kargu, Hülya Çerçi Akçay","doi":"10.17245/jdapm.2026.26.026","DOIUrl":"10.17245/jdapm.2026.26.026","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to provide a comprehensive bibliometric overview of the research on computer-controlled local anesthesia in pediatric dentistry by analyzing publication trends, citation patterns, collaborative structures, and thematic evolution within the field.</p><p><strong>Methods: </strong>A bibliometric analysis was conducted on publications indexed in Scopus, Web of Science, and PubMed from 2000 to 2024. After excluding duplicates, 80 eligible documents were included. Descriptive indicators, such as annual scientific production, citation performance, authorship patterns, and core sources, were analyzed using the Bibliometrix package (Biblioshiny). Keyword co-occurrence and co-authorship network visualizations were generated using VOSviewer to explore thematic structures and collaboration patterns.</p><p><strong>Results: </strong>The findings revealed a gradual increase in scientific output over time, with a marked rise after 2014 and a peak in publication activity from 2018 to 2024. A limited number of core journals accounted for a substantial proportion of the publications, consistent with Bradford's law. Author productivity followed Lotka's law, with most authors contributing to a single publication. Keyword co-occurrence analysis identified major thematic clusters centered on local anesthesia, pain management, anxiety, pediatric dental procedures, and behavioral considerations. Co-authorship analysis demonstrated that research collaboration was concentrated within a small number of author groups.</p><p><strong>Conclusions: </strong>This bibliometric analysis demonstrates the increasing scientific interest in computer-controlled local anesthesia in pediatric dentistry and identifies the field's core journals, key research themes, and collaborative structures. These findings provide a concise reference framework for future clinical and research-oriented studies on pediatric dental anesthesia.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"225-236"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213870","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":"MaxSafe: a mobile-friendly calculator for fractional local anesthetic toxicity and epinephrine dose tracking in dental practice.","authors":"Soren A Christensen, Evan M Shipp","doi":"10.17245/jdapm.2026.26.031","DOIUrl":"10.17245/jdapm.2026.26.031","url":null,"abstract":"<p><strong>Background: </strong>Local anesthetic systemic toxicity (LAST) is a preventable complication associated with regional anesthesia. When multiple local anesthetic (LA) agents are administered during dental procedures, calculating the cumulative fractional toxicity is cognitively demanding and error-prone. Studies have demonstrated that up to 87% of dental practitioners cannot correctly calculate the LA doses. The risk is amplified in pediatric patients, where fatal overdoses have been reported from dosing calculation errors. Despite the clinical importance of accurate dosing, no freely available peer-reviewed tool combines cartridge-based input, cumulative fractional toxicity calculations, and epinephrine dose tracking in dental practice.</p><p><strong>Methods: </strong>MaxSafe is a free open-source web application. The tool accepts patient weight, age (less than 1 year through 17 years or adult), and status (with independent cardiac and pregnant toggles). It provides five common dental LA formulations with multiple epinephrine concentration options, and uses dental cartridge counts as the input. It calculates the cumulative fractional toxicity in real-time and independently tracks the epinephrine dose against patient-specific limits. In the pediatric mode, the tool applies the American Academy of Pediatric Dentistry (AAPD) Conservative maximum recommended doses and visually restricts age-inappropriate drugs. Additional features include multi-concentration tracking per drug, advisory warnings for hepatic and renal impairments, and a verification summary panel to mitigate automation bias. The accuracy was validated against 23 manually calculated clinical test scenarios, including adult dosing, pediatric dosing, and alternative epinephrine concentration calculations.</p><p><strong>Results: </strong>The app-calculated values matched the manual calculations exactly across all 23 test scenarios. In pediatric scenarios, the AAPD Conservative maximum recommended doses were substantially more restrictive than the Food and Drug Administration-labeled values; a single cartridge of lidocaine in an 8-kg infant produced 96.6% cumulative LA toxicity, and two cartridges of mepivacaine in an 18-kg child exceeded the safe threshold at 128.8%.</p><p><strong>Conclusion: </strong>MaxSafe is a validated, free, open-source clinical decision-support tool that automates fractional toxicity calculations and epinephrine dose tracking for multi-agent LA administration in both adult and pediatric dental practices. This tool is available as a progressive web application at https://thesorenc.github.io/maxsafe-local-anesthesia/.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"265-275"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213950","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":"Diet-induced obesity exacerbates and prolongs postoperative pain via peripheral DRG transcriptional changes in rats.","authors":"Norika Katagiri, Kanta Kido, Shigekazu Sugino, Daisuke Konno, Jun Suzuki, Masanori Yamauchi, Yukie Nitta, Takuro Sanuki","doi":"10.17245/jdapm.2026.26.171","DOIUrl":"10.17245/jdapm.2026.26.171","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a known risk factor for the increased severity and persistence of postoperative pain; however, the underlying mechanisms remain incompletely understood. The primary objective of this study was to elucidate the peripheral mechanisms underlying obesity-related exacerbation and prolongation of postoperative pain. A comparative transcriptomic analysis of the spinal cord was performed as a secondary exploratory assessment.</p><p><strong>Methods: </strong>Male Wistar rats were fed a high-fat diet (HFD) or standard diet (SD) to induce obesity. Postoperative pain was modeled using the plantar incision (Brennan) model. Pain-related behaviors including spontaneous pain, mechanical withdrawal thresholds, and thermal withdrawal latencies were evaluated longitudinally. Electrophysiological recordings were performed to assess the mechanical sensitivity of primary afferent fibers in the tibial nerve-plantar skin preparation. Transcriptome analyses were conducted on the dorsal root ganglia (DRG) and spinal cord on postoperative day 4 to identify the differentially expressed genes (DEGs) associated with obesity-related pain modulation.</p><p><strong>Results: </strong>Rats fed an HFD exhibited increased body weight and body fat percentage compared with SD-fed rats. Following surgery, the HFD-fed rats showed significantly higher spontaneous pain scores and prolonged mechanical hypersensitivity than the SD-fed rats, whereas preoperative pain sensitivity did not differ between the groups. Electrophysiological analysis revealed no significant differences in the mechanical thresholds or stimulus-response relationship of mechanosensitive C-fibers between the groups. Transcriptome analysis identified 19 DEGs in the DRG of HFD-fed rats; however, no genes in the spinal cord dorsal horn met the statistical threshold for differential expression under the present analytical conditions. Pathway analysis indicated that the DRG DEGs were primarily associated with endocrine disorders and lipid metabolism.</p><p><strong>Conclusion: </strong>Diet-induced obesity exacerbated and prolonged postoperative pain in rats. This effect may be associated with peripheral molecular adaptations in primary sensory neurons, including changes in DRG gene expression related to metabolic and endocrine pathways. In contrast, no genes met the statistical threshold for differential expression in the spinal cord dorsal horn on postoperative day 4 under the present analytical conditions.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"199-208"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213867","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":"Evaluation of phytochemical components, cytotoxicity, and molecular docking of <i>Anacyclus pyrethrum</i> and <i>Commiphora myrrha</i> for formulating a herbal topical anaesthetic gel development.","authors":"Parthipann J, Geetha Priya Pr, Sharath Asokan, Yogesh Kumar Thoppe Dhamodharan, Sudhandra Viswanath","doi":"10.17245/jdapm.2026.26.007","DOIUrl":"10.17245/jdapm.2026.26.007","url":null,"abstract":"<p><strong>Background: </strong>Synthetic intraoral topical anesthetics, such as lignocaine and benzocaine can cause adverse effects in pediatric dentistry, creating a need for safer plant-based alternatives. <i>Anacyclus pyrethrum</i> (<i>A. pyrethrum</i>) and <i>Commiphora myrrha</i> (<i>C. myrrha</i>) have traditionally demonstrated anesthetic and analgesic properties. Therefore, we aimed to evaluate the phytochemical composition, cytotoxicity, and molecular docking interactions of <i>A. pyrethrum</i> and <i>C. myrrha</i> extracts for potential use as novel herbal topical anesthetic gels.</p><p><strong>Methods: </strong>Ethanolic extracts of <i>A. pyrethrum</i> roots and <i>C. myrrha</i> resin were prepared by Soxhlet extraction and maceration, respectively. Phytochemical profiling was performed using High-Performance Liquid Chromatography (HPLC), gas chromatography-mass spectrometry (GC-MS), and Fourier-Transform Infrared Spectroscopy (FTIR). Cytotoxicity was assessed in L929 fibroblasts and neural cells using the MTT assay. Molecular docking and codocking of pyrethrin and furanoeudesma-1,3-diene with neuronal sodium, potassium, and GABA-A receptors were performed.</p><p><strong>Results: </strong>HPLC and GC-MS confirmed the presence of bioactive compounds, including pyrethrin and furanoeudesma-1,3-diene, and the functional groups were validated by FTIR. Cytotoxicity assays revealed high biocompatibility, with half-maximal Inhibitory Concentration (IC₅₀) values of 53 ± 0.21 µg/mL for <i>A. pyrethrum</i> and 54 µg/mL for <i>C. myrrha</i>. Molecular Docking studies showed strong binding affinities (-6.1 to -8.2 kcal/mol) across target receptors, and co-docking demonstrated synergistic ligand-receptor interactions.</p><p><strong>Conclusion: </strong>Phytochemical, cytotoxic, and molecular docking analyses confirmed the anesthetic potentials of <i>A. pyrethrum</i> and <i>C. myrrha</i>. These findings support their further development as safe plant-based topical anesthetic gels.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"209-224"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213908","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":"Agreement between noninvasive hemoglobin monitoring (SpHb) and laboratory hemoglobin in patients undergoing free-flap reconstruction for oral squamous cell carcinoma.","authors":"Giyoung Yun, Ji-Young Yoon, Cheul-Hong Kim, Hee Young Kim, Eun-Jung Kim","doi":"10.17245/jdapm.2026.26.053","DOIUrl":"10.17245/jdapm.2026.26.053","url":null,"abstract":"<p><strong>Background: </strong>Surgery for head and neck squamous cell carcinoma (HNSCC) often involves extensive resection with free-flap reconstruction, leading to significant blood loss. Accurate intraoperative hemoglobin (Hb) monitoring is crucial to guide transfusion. Non-invasive Hb monitoring (SpHb) offers continuous Hb measurement; however, its reliability in major oncological surgeries remains uncertain. Thus, this study evaluated the agreement between SpHb and point-of-care testing-measured Hb (POCT-Hb).</p><p><strong>Methods: </strong>In this retrospective study, patients undergoing oral squamous cell carcinoma (SCC) resection with free-flap reconstruction (Sep 2023-Oct 2025) were analyzed. Hb levels were measured at the time of anesthesia induction (T1) and surgical closure (T2) using POCT and simultaneous SpHb. The postoperative central-laboratory Hb level validated the POCT accuracy. Correlation (Pearson), intraclass correlation coefficient (ICC), and agreement (Bland-Altman) analyses were performed. Effects of intraoperative blood loss and dopamine infusion on SpHb accuracy were assessed using subgroup analyses, t-tests, and a univariate general linear model.</p><p><strong>Results: </strong>Fifty-five patients were included. SpHb showed a moderate correlation with POCT-Hb at T1 (r = 0.619, ICC = 0.563) and T2 (r = 0.639, ICC = 0.563), with wider Bland-Altman limits at T2. Furthermore, changes in SpHb underestimated ΔHb compared with POCT (r = 0.439). Intraoperative blood loss did not significantly affect SpHb accuracy, whereas dopamine use was associated with larger absolute differences and wider limits of agreement. The dopamine level remained an independent predictor of SpHb-POCT discrepancy.</p><p><strong>Conclusion: </strong>SpHb showed moderate agreement with POCT-Hb and was affected by dopamine use. Although its absolute accuracy is limited, SpHb may serve as a useful adjunct for trend monitoring and for guiding the timing of laboratory testing.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 3","pages":"237-246"},"PeriodicalIF":1.8,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148213899","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":"General anesthesia management for oral surgery in a patient with plastic bronchitis associated with Fontan circulation: a case report.","authors":"Kaho Noda, Yukiko Nishioka, Hitoshi Higuchi, Fumika Hashimoto, Saki Miyake, Takuya Miyawaki","doi":"10.17245/jdapm.2026.26.2.175","DOIUrl":"10.17245/jdapm.2026.26.2.175","url":null,"abstract":"<p><p>Plastic bronchitis is a rare condition in which mucus plugs obstruct the bronchi, potentially leading to fatal respiratory failure. It has been reported in some patients with congenital heart disease following Fontan surgery. We report the general anesthesia management of a 22-year-old female patient with Fontan circulation and type II plastic bronchitis that was controlled using regular intravenous heparin injections. In this case, concerns existed regarding airway obstruction by bronchial plugs and hemodynamic instability specific to the Fontan circulation. During endotracheal intubation, the absence of mucus plugs was confirmed using a flexible bronchoscope. Intraoperatively, ventilation was managed at low pressure to avoid an increase in intrathoracic pressure caused by high positive-pressure ventilation. Additionally, fluid overload was avoided to prevent elevations in the central venous pressure. Consequently, perioperative management can be safely performed without any respiratory or circulatory complications. As treatment outcomes improve, the number of dental and oral surgical procedures in adult patients with congenital heart disease is expected to increase. Therefore, knowledge of congenital heart disease and its sequelae, such as plastic bronchitis, is essential to perform appropriate risk assessment and management.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 2","pages":"175-180"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641092","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":"Efficacy of the TuttleNumbNow anesthesia protocol for mandibular first molars: a retrospective study.","authors":"Gregory K Tuttle, Carter K Newell, LaDawn Boucher, Jill Taylor, Jared J Tuttle","doi":"10.17245/jdapm.2026.26.2.133","DOIUrl":"10.17245/jdapm.2026.26.2.133","url":null,"abstract":"<p><strong>Background: </strong>Inferior alveolar nerve block (IANB) is the standard anesthetic approach for mandibular first molars; however, it has well-documented limitations, including variable success rates, delayed onset, higher anesthetic dose requirements, and potential complications. The TuttleNumbNow (TNN) anesthesia protocol introduces intraosseous (IO) injections as the primary anesthetic modality, followed by infiltration and IANB as a last resort. This approach seeks to provide rapid site-specific anesthesia at reduced pharmacological doses. This study evaluated the clinical efficacy of the TNN protocol for mandibular first molar procedures in a private practice setting.</p><p><strong>Methods: </strong>This retrospective observational study reviewed patient records from Tuttle Family Dental (Orem, Utah, USA) between January and December 2023. Eligible cases included patients undergoing composite restorations, crown preparations, or crown seating on the mandibular first molars, where anesthesia was administered according to the TNN protocol. Data were extracted from Eaglesoft electronic dental records and categorized as follows: no anesthetic, single-agent TNN (articaine 4% with epinephrine 1:100,000 or mepivacaine 3% without epinephrine), dual-agent TNN, or conversion to IANB. Descriptive statistics summarized the anesthetic regimens, and Fisher's exact test assessed the association between procedure type and IANB conversion.</p><p><strong>Results: </strong>In total, 184 cases (74 composites, 57 crown preparations, and 53 crown seats) were included. One-quarter of the procedures (47; 24.9%) required no local anesthesia. Of the 137 cases requiring anesthesia, 88 (64.2%) were managed with a single agent, 41 (29.9%) with dual agents, and 8 (5.8%) required an IANB. Overall, 129 of the 137 cases (94.2%) were successfully completed without IANB. The need for IANB was significantly associated with procedure type (P = 0.0008), occurring most frequently during crown preparations (7 of 57 cases, 12.3%).</p><p><strong>Conclusion: </strong>The TNN anesthesia protocol achieved profound anesthesia in 94.2% of mandibular first molar cases without requiring IANB, demonstrating its effectiveness as a primary anesthetic strategy. Compared with traditional IANB, the TNN approach offers rapid-onset, site-specific anesthesia while reducing patient anesthetic exposure and postoperative complications. These findings support reframing IO anesthesia from a secondary \"rescue\" technique to an effective first-line modality. Prospective multicenter studies are warranted to validate its efficacy in broader patient populations.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 2","pages":"133-141"},"PeriodicalIF":1.8,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641115","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}