After re-reading the cover story in June JADA ("Pain After Periodontal Scaling and Root Planing" by Drs. Bruce L. Pihlstrom and colleagues), questions arise as to the study design and selection of the local anesthetic used.
The article stated that the study was undertaken with a view toward helping practitioners and their patients manage postprocedural discomfort.
That being the case, a question needs to be asked: Why should the study not evaluate prevention of the patient experiencing the pain?
Numerous studies exist that describe the benefits of using one of the long-acting local anesthetics currently available for a multitude of dental and surgical procedures.
The results of such studies have repeatedly shown a significant decrease in both postoperative pain and pain medications used. These studies have also shown that the long-acting anesthetics offer extended soft-tissue anesthesia of between five and 12 hours, depending on the site and manner of injection.
It is my opinion that the study would truly be useful to the profession if it were repeated in a double-blind manner, comparing the medium-acting anesthetic mepevicaine 2 percent with levonordefrin 1:20,000 to either bupivacaine 0.5 percent or etidocaine 1.5 percent, both with epinephrine 1:200,000.
Such a blind comparison might yield information affecting the choice of anesthetics used in periodontal scaling and root planing procedures that might decrease the incidence of pain altogether.
