title: Extraction of Maxillary Teeth Using Articaine Without a Palatal Injection: A Comparison Between the Anterior and Posterior Regions of the Maxilla.
abstract: OBJECTIVE
  The injection of a local anesthetic before tooth extraction is always associated with pain, and palatal anesthesia is the most painful type of injection for the patient. The specific aims of the study were to evaluate "pain control" using 4% articaine without palatal injection and to compare adequate anesthesia and pain control in the anterior and posterior regions of the maxilla.
  
  
  METHODS
  This prospective controlled study followed a split-mouth protocol, in which patients served as their own control. Forty-eight patients who needed routine extraction of permanent maxillary anterior and posterior teeth were referred. After an injection of 4% articaine and a 5-minute wait, 1 posterior tooth and 1 anterior tooth were extracted using standard techniques. The patient's perception of pain was assessed using a visual analog scale and a verbal rating scale after each injection and extraction. Statistical analysis consisted of descriptive statistics, paired-sample t test, and independent-samples t test to determine whether differences were statistically significant (P < .05).
  
  
  RESULTS
  In total, 48 anterior and 48 posterior teeth were extracted from 48 patients. Extraction of maxillary teeth was possible without an additional palatal injection for 87 teeth (90.6%), whereas only 9 teeth (9.4%) needed an additional palatal injection to complete the extraction. Of the total number of patients, 90% reported that the pain caused by tooth extraction in the anterior and posterior regions of the maxilla was mild. None of the patients rated the pain of extraction in the maxilla as severe.
  
  
  CONCLUSIONS
  There was no difference in pain perception when extracting anterior and posterior teeth. Of the total number of teeth, 90.6% were extracted without the need for palatal injection. In this study, extraction of erupted maxillary teeth using 4% articaine without manipulation of the palatal mucosa obviated palatal infiltration during extraction. Articaine anesthesia provides adequate palatal anesthesia for maxillary teeth extraction in the anterior and posterior regions without the need for a palatal block.
authors.affiliation: Professor, Department of Oral Medicine and Surgery, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan. Electronic address: anwar@just.edu.jo.
authors.forename: Anwar B
authors.initials: AB
authors.lastname: Bataineh
authors.affiliation: Master's Degree Student, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
authors.forename: Ghamdan A
authors.initials: GA
authors.lastname: Al-Sabri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D002355:Carticaine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla; D008875:Middle Aged; D010147:Pain Measurement; D014081:Tooth Extraction / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D002355:Carticaine