title: Is it possible to anesthetize palatal tissues with buccal 4% articaine injection?
abstract: OBJECTIVE
  The aim of this study was to evaluate the presence of probable diffused local anesthetic solution at and anesthesia of palatal tissues after buccal injection of 4% articaine hydrochloride (HCl) with 1:100,000 epinephrine or 1:200,000 epinephrine at the premolar and molar region.
  
  
  METHODS
  Thirty volunteers received maxillary buccal injections of 4% articaine HCl with 1:100,000 epinephrine or 1:200,000 epinephrine bilaterally to the first premolar or first molar. Magnetic resonance images were obtained before and 5 minutes after local anesthetic injections, and a visual evaluation was done to determine the presence of local anesthetic solution at palatal tissues. Anesthesia of palatal tissues after buccal injection was assessed by needle-prick stimulation pain with a visual analog scale (VAS). The Kruskal-Wallis test was used for comparison of the VAS values.
  
  
  RESULTS
  The visual evaluation of the magnetic resonance images did not show any signal change as an indicator of the presence of local anesthetic solution at the palatal region. Most of the volunteers described moderate or severe pain with needle-prick stimulation. The mean VAS score for needle-prick stimulation was 86.33 +/- 39.45 mm (1:100,000 epinephrine) and 87.0 +/- 36.28 mm (1:200,000 epinephrine) in the first premolar region and 57.20 +/- 46.69 mm (1:100,000 epinephrine) and 75.53 +/- 49.78 mm (1:200,000 epinephrine) in the molar region (P > .05).
  
  
  CONCLUSIONS
  We could not establish the presence of anesthesia or 4% articaine HCl at the palatal tissues after buccal injection. Maxillary tooth removal without palatal injection requires further objective investigations.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Cumhuriyet University, Sivas, Turkey. iozec@cumhuriyet.edu.tr
authors.forename: Ilker
authors.initials: I
authors.lastname: Ozeç
authors.forename: Ufuk
authors.initials: U
authors.lastname: Taşdemir
authors.forename: Cesur
authors.initials: C
authors.lastname: Gümüş
authors.forename: Orhan
authors.initials: O
authors.lastname: Solak
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001641:Bicuspid; D002355:Carticaine / Q000008:administration & dosage*; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D008279:Magnetic Resonance Imaging; D008297:Male; D008963:Molar; D009061:Mouth Mucosa; D010147:Pain Measurement; D010159:Palate / Q000033:anatomy & histology / Q000187:drug effects*; D010812:Physical Stimulation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002355:Carticaine; D004837:Epinephrine