Biomedical subjects

John G Meechan

Publications and source records attributed to John G Meechan.

3 recordsLinked to original sources

PubMed2005

Dental management of patients taking methadone.

Methadone is a synthetic opiate used in the treatment of opiate addiction. Various side-effects have been associated with the use of methadone. These include xerostomia, which can contribute to a high caries rate. The UK Regional Drug Misuse Database reported that around 118,500 drug users were receiving treatment from drug misuse agencies and GPs. The vast majority (87%) were receiving treatment from community specialist services. As many drug abusers have poor oral health, general dental practitioners are likely to encounter such individuals. It is essential therefore that dentists are aware of the potential difficulties that may be encountered when treating subjects receiving methadone. These problems may relate to previous drug abuse and to the effects of methadone therapy.

Dental Care↗

PubMed2003

Injection pain: comparison of three mandibular block techniques and modulation by nitrous oxide:oxygen.

BACKGROUND: The authors conducted this study to compare the pain on injection of the three mandibular block techniques and to determine the effect that the delivery of nitrous oxide:oxygen, or N2O:O2, had on this pain. METHODS: Based on sample size calculation, the authors randomly assigned 60 subjects to receive either local anesthetic alone or local anesthetic with N2O:O2 titrated to effect. Each subject received two mandibular block injections bilaterally from three possible pairings: Gow-Gates/standard block, standard block/Vazirani-Akinosi or Gow-Gates/ Vazirani-Akinosi. Subjects scored their pain using a 100-millimeter visual analog scale immediately after each injection. The authors analyzed data using analysis of variance, Student t tests and multiple regression analyses. RESULTS: There were no significant differences in pain on injection among the three injection techniques. The subjects in the group that received N2O:O2 and the local anesthetic demonstrated a statistically significant reduction in pain on injection compared with subjects in the group that received the local anesthetic only (P < .05). When N2O:O2 was used, there was a statistically significant decrease in pain with the first injection (P < .0005), an effect not seen with the second injection. CONCLUSIONS: There was no significant difference in pain among the three mandibular block techniques. N2O:O2 can reduce pain on the first injection given, but this effect is not seen subsequently. CLINICAL IMPLICATIONS: The decision to select one of the three mandibular block techniques should be based on factors other than pain on injection. N2O:O2 reduces pain on the first injection only.

Adolescent↗

PubMed2002

Effective topical anesthetic agents and techniques.

What conclusions can be drawn concerning intraoral topical anesthesia? First, a variety of agents have been shown to have a pharmacologic effect. When used as a single agent, lidocaine is effective at concentrations between 5% and 20%. There is evidence of a dose response with lidocaine [17]. The combination of 2.5% lidocaine and 2.5% prilocaine has been shown to be a reliable agent; however, at the time of writing, this mixture is not licensed for intraoral use. Benzocaine is effective when used alone at a concentration of 20% and when combined at a dose of 15% with 1.7% amethocaine. Second, a crucial factor governing effectiveness is the time of application. One study cited in this paper [23] has shown an effect occurring in the maxillary buccal sulcus after a 1-minute application. Others [17,25] have shown that a 2- to 3-minute application at the same site is no better than placebo. The differences in these studies may be caused by the use of different test stimuli, such as the gauge of the needle used and the depth of insertion. When applied for 5 minutes, it seems that success is guaranteed when used in the buccal fold of either jaw. Finally, the site of application is important. Palatal mucosa is more resistant to the effects of topical anesthetics than other intraoral sites investigated. There is no evidence that topical anesthetics have any value in reducing the discomfort of deep regional block administrations such as inferior alveolar nerve block injections.

Anesthesia, Dental↗