Topical intrapocket anesthesia during scaling and root planing: a randomized clinical trial

Area of Science:

• Periodontology
• Anesthesiology
• Pharmacology

Background:

• Subgingival scaling and root planing (SRP) often requires anesthesia to manage patient pain and discomfort.
• Injectable anesthesia, while effective, can cause fear and prolonged numbness.
• Alternative anesthetic methods are sought to improve patient experience during SRP.

Purpose of the Study:

• To compare the efficacy of EMLA (eutectic mixture of 25 mg/g lidocaine and 25 mg/g prilocaine) against injectable 2% lidocaine, topical 2% benzocaine, and placebo for pain reduction during SRP.
• To assess patient satisfaction with different anesthetic options during SRP.

Main Methods:

• A randomized, split-mouth, masked clinical trial involving 32 patients with moderate to severe periodontal disease.
• Four treatment groups: EMLA, injectable 2% lidocaine, topical 2% benzocaine, and placebo.
• Pain and discomfort were measured using Visual Analogue Scale (VAS) and Verbal Scale (VS).
• Statistical analysis included repeated-measures ANOVA and Poisson regression.

Main Results:

• EMLA and injectable 2% lidocaine demonstrated comparable pain control (p > 0.05).
• Both EMLA and injectable lidocaine were significantly more effective in pain reduction than 2% benzocaine and placebo (p < 0.05).
• Patient satisfaction was high for both injectable lidocaine (93.7%) and EMLA (81.2%), with significantly greater dissatisfaction observed with benzocaine and placebo.

Conclusions:

• EMLA provides equivalent pain control to injectable anesthesia during SRP and superior pain control compared to benzocaine.
• EMLA is a viable anesthetic option for SRP, though repeat applications may be necessary.
• The findings support EMLA as an effective alternative for managing pain during periodontal procedures.