Int J Evidence-Based Practice Dent Hygienist 2 (2016), No. 4 5. Dec. 2016
Background: The most common first course of treatment to control periodontal disease is subgingival scaling and root planing (SRP), which can be painful for some patients and require the use of anesthesia.
Clinical question: Does intrapocket anesthesia compared to a placebo influence pain during probing and/or SRP in adult periodontitis patients?
Summary of methods and results: A comprehensive literature search was conducted to identify randomized clinical trials (RCTs) with parallel, crossover, or split-mouth designs that compared pain with intrapocket anesthesia during probing and/or SRP to pain with placebo in adult patients of any age group. The primary outcomes were risk and intensity of pain during probing and/or SRP, and the secondary outcomes were pain and the need for rescue anesthesia. A total of 11 studies with 1,004 total subjects met the inclusion criteria. When compared to placebo, anesthetic gel reduced pain intensity. Those receiving anesthetic gel were 97.5% less likely to experience pain and 64.2% less likely to need rescue anesthesia.
Critical appraisal: This systematic review had a robust search strategy to assess a clearly focused PICO question. Clinical heterogeneity, such as the use of different types of topical anesthetic gels with different times of onset, may have affected the results. However, since topical anesthetics have been used in a clinical setting for years to reduce pain, the results of this systematic review were expected.
Practical implications: The results of this systematic review were clinically relevant and indicate that intrapocket anesthetics may be considered for pain management in patients undergoing probing and/or SRP.