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vol 31 no 4 2006 effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth 1 wan sik chu seung ho park dong kuk ahn sung kyo kim ...

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                                                                                                                       대한치과보존학회지: Vol. 31, No. 4, 2006
                                           Effect of local anesthesia on pulpal blood flow 
                                                        in mechanically stimulated teeth
                                                                                                    1
                                              Wan-Sik Chu, Seung-Ho Park, Dong-Kuk Ahn , Sung Kyo Kim*
                                                                               1
                                   Department of Conservative Dentistry and  Department of Oral Physiology, School of Dentistry, 
                                                           Kyungpook National University, Daegu, Korea
                      ABSTRACT
                      The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on
                    pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF
                    was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats
                    under general anesthesia before and after injection of local anesthetics and after cavity preparation.
                    2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given
                    apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was
                    injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with
                    isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into
                    the dentin on both teeth. The obtained data was analyzed with paired t-test. 
                      Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). 
                      Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05),
                    whereas there was no significant change of PBF with the physiologic saline as a control. 
                      Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less
                    increase of PBF than in control tooth (p < 0.05). 
                      Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with
                    1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.  [J Kor Acad
                    Cons Dent 31(4):257-262, 2006]
                      Key words : Pulpal blood flow, Epinephrine, Lidocaine, Cavity preparation, Local anesthetics,
                                       Neurogenic inflammation
                                                                                 - Received 2005.8.23., revised 2006.1.24., accepted 2006.2.9. 
                                Ⅰ. INTRODUCTION                                        and abrasion, pulpal response to these injuries
                                                                                                                                       1)
                                                                                       can stimulate inflammatory activity . Although
                  Whenever the tooth dentin-pulp complex is                            the pulp injury caused by these irritants can be
                affected by caries, attrition, erosion, chemicals                      important, in many cases the most severe tissue
                                                                                       trauma is not a direct result of these environmen-
                 * Corresponding Author: Sung Kyo Kim                                  tal or accidental events, instead, it results from
                 Department of Conservative Dentistry,                                 the surgical techniques such as tooth preparation
                 School of Dentistry, Kyungpook National University                    used to restore tooth structure following these
                 188-1, Samdeok-Dong, 2-Ga, Jung-Gu,                                           2-4)
                                                                                       events     .
                 Daegu, Korea, 700-412                                                   As a result of noxious stimulation, inflammatory
                 Tel: 82-53-420-5935      Fax: 82-53-426-8958                          mediators and neuropeptides are released. These
                 E-mail: skykim@knu.ac.kr 
                                                                                                                                                  257
               대한치과보존학회지: Vol. 31, No. 4, 2006
               mediators alter normal neural and vascular func-                 mg/kg) through the femoral vein. To monitor sys-
               tions, which results in an increase in blood flow.               temic blood pressure continuously, a femoral
               Increased blood flow facilitates the removal of the              artery was cannulated. Air way was maintained
               inflammatory mediators and thereby helps to heal                 through the tracheostomy. Body temperature was
               the tissue. However, these inflammatory reactions                monitored with a rectal thermometer and main-
               can cause many pulpal complications in low com-                  tained between 36℃ and 39℃ with a heating pad.
               pliance environment of the pulp.                                 The mandible was immobilized by intermaxillary
                 Once the pulp becomes inflamed, it becomes                     splinting with dental plaster and a steel rod that
               hypersensitive so that thermal, mechanical or                    was anchored to a base by a fixing device.
               osmotic stimuli encountered in normal function
               can cause intense pain. Consequently, it is impor-                 2. PBF measurement
               tant to ensure that potential sources of injury
               that stimulate inflammatory activity be mini-                     Enamel of both mandibular canine was removed
               mized. Management of pulpal inflammation may                     by a high-speed dental round bur on the labial
               reduce the incidence of post-operative pulpal com-               surface of the crown over the cervical third. The
               plications. Therefore, a more complete under-                    laser Doppler flowmeter probe (PF416, Perimed
               standing of the relationship between pulpal                      Co., Stockholm, Sweden) was positioned on the
               inflammation and cavity preparation events may                   exposed dentin for recording PBF. To avoid drying
               also lead to further improvements in the clinical                of the dentin, isotonic saline was flooded between
                                      5)
               management of pain .                                             the dentin surface and the probe tip. The PBF
                 In tooth grinding procedures, local anesthesia is              was monitored with a laser Doppler flowmetry
               usually used to control patient’s pain and dis-                  (Periflux 4001, Perimed Co., Stockholm, Sweden,
               comfort. Many previous studies investigated the                  Figure 1). Systemic blood pressure (in ㎜Hg) and
               effect of epinephrine-containing local anesthetics               PBF (in perfusion unit) were monitored continu-
                                                6-8)
               on pulpal blood flow (PBF)           and the effect of           ously and simultaneously throughout the experi-
                                             9,10)
               cavity preparation on PBF        . However, few stud-            ments and recorded with a computer software,
               ies investigated on the effect of local anesthetics              Digidata 1200 and Axoscope (Axon Instruments
               on cavity preparation-induced PBF change.                        Inc., Foster City, CA, USA).
               Therefore, the purposes of this study were to
               evaluate the effect of epinephrine-containing local
               anesthetics on PBF and to investigate its effect
               on cavity preparation-induced PBF change.
                     Ⅱ. MATERIALS AND METHODS                                                              Laser Doppler Flowmeter
                                                                                                           Probe
                 1. Animal preparation                                                                   Saline
                 Nine cats of average weight of 2.8 kg were used.
               All procedures involving the use of animals were
               approved by the Institutional Animal Care and                                                 Laser Doppler Flowmetry
               Use Committee of the School of Dentistry,
               Kyungpook National University. Animals were                        Figure 1. Schematic drawing of devices used to
               initially anesthetized with intra-muscular injec-                  record pulpal blood flow.
               tion of ketamine (75 mg/kg) and acepromazine
               (2.5 mg/kg) followed by intra-venous injection of
               alpha-chloralose (40 mg/kg) and urethane (500
               258
                                                                          Effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth
               3. Administration of local anesthetics and             paired variables of control and experimental data
                  preparation of cavities                             were compared by paired t-test and differences
                                                                      with p < 0.05 were considered statistically signifi-
               To determine the PBF and systemic blood pres-          cant.
             sure during resting state, they were recorded for
             30 minutes. 0.1 ㎖ of local anesthetic solution was                        Ⅲ. RESULTS
             administered by local infiltration given apical to
             the mandibular canine at the buccal vestibular             1. Effect of cavity preparation on PBF
             area. The local anesthetic was 2% lidoocaine
             hydrochloride with 1 : 100,000 epinephrine                 A typical strip-chart recording of systemic blood
             (Kwang Myung Lidocaine, Kwang Myung,                     pressure and PBF in response to cavity prepara-
             Kyunggi-Do, Korea). The same volume of isotonic          tion on both teeth is presented in Figure 2.
             saline was injected on the controlateral tooth as a      Cavity preparation caused significant increases of
             control. PBF was recorded for 10 minutes after           PBF by 96.7 ± 4.9% from the baseline value
             injection.                                               (n = 9, p < 0.05). 
               A round carbide bur was operated at slow speed
             to grind spherical cavities with increasing depth          2. Effect of 2% lidocaine with 1 : 100,000 ep-
             through the enamel and into the dentin on both                inephrine on PBF
             teeth. The grinding procedure was intermittent
             and accompanied by flushing with isotonic saline           Percentage changes of PBF in response to local
             to minimize the heat production. After cavity            infiltration of 2% lidocaine with 1 : 100,000 epi-
             preparation, PBF was also recorded on both teeth         nephrine and saline as a control are given in
             for 30 minutes.                                          Figure 3. Local infiltration of 2% lidocaine with
                                                                      1 : 100,000 epinephrine resulted in decreases of
               4. Statistics                                          PBF by 31.2 ± 2.5% from the baseline value (n
                                                                      = 9, p < 0.05), whereas there was no significant
               All numerical data in the text and tables are          change of PBF with the physiologic saline as a
             expressed as percent change from control and             control (n = 9, p > 0.05).
             mean ± standard error of the mean (SEM). The
                                                                             0
                                                                            -5                           Control
                                                                                                         (Saline injection)
                                                                            -10
                                                                            -15
                                                                            -20
                                                                                                         Experimental
                                                                            -25                          (2% lidocaine 
                                                                                                         hydrochloride 
                                                                            -30                          with 1:100,000 
                                                                                                         epinephrine 
                                                                            -35                          injection)
                                                                            -40
               Figure 2. Changes in pulpal blood flow in response to    Figure 3. Changes in pulpal blood flow PBF in
               the cavity preparation.                                  response to local infiltration of 2% lidocaine with
                                                                        1 : 100,000 epinephrine (mean ± SEM).
                                                                        *Statistically significant in paired t-test (p < 0.05).
                                                                                                                     259
                대한치과보존학회지: Vol. 31, No. 4, 2006
                         100                                                        on many other factors. These include thermal
                          90                                                        injury, especially frictional heat; transsection of
                                                        Control
                          80                            (Saline injection)          the odontoblastic processes; and vibration. As
                          70                                                                                          14)
                                                                                    studied by vital microscopy , a clearance tech-
                          60                                                              15,16)                                 17)
                                                                                    nique     , or laser Doppler flowmetry , PBF has
                          50                                                        been shown to be increased by heating and
                          40                            Experimental
                                                        (2% lidocaine               decreased by cooling of the tooth in anesthetized
                          30                            hydrochloride 
                                                        with 1:100,000                                      18)
                          20                            epinephrine                 animals. Kim et al. , measured the changes in
                          10                            injection)                  PBF (in ㎖/min/100g pulpal tissue) in dogs in
                           0                                                        response to an incremental increase in tooth sur-
                  Figure 4. Changes in pulpal blood flow PBF in                     face temperature using the Xenon133 washout
                  response to cavity preparation (mean ± SEM).                      method. PBF increased slightly and gradually as
                  *Statistically significant in paired t-test (p < 0.05).           the tooth surface temperature was raised from 35
                                                                                    to 40℃. However, PBF increased sharply (40%
                                                                                    above control) when the surface temperature was
                                                                                    elevated from 35 to 55℃. In the present study,
                  3. Effect of local anesthesia on cavity prepa-                    saline cooling was applied during the cavity
                      ration-induced PBF change                                     preparation to avoid heating. 
                                                                                      Local infiltration of 2% lidocaine with 1 :
                  Cavity preparation on tooth anesthetized with                     100,000 epinephrine resulted in significant
                2% lidocaine with 1 : 100,000 epinephrine caused                    decreases of PBF, whereas there was no signifi-
                increases of PBF by 33.8 ± 43.6% (n = 9). Local                     cant change of PBF with the physiologic saline as
                infiltration of 2% lidocaine with 1 : 100,000 epi-                  a control in the present study. This result is in
                nephrine caused significantly less increase of PBF                                                             7,8,19)
                                                                                    agreement with the previous studies             . In a pre-
                induced by cavity preparation than in control (p <                  liminary study for the present investigation, plain
                0.05, Figure 4).                                                    2% lidocaine injection induced no change in PBF
                                                                                    as in the control with saline. 1 : 100,000 epi-
                                 Ⅳ. DISCUSSION                                      nephrine injection caused decrease of PBF while
                                                                                    there was no change in PBF with saline as a con-
                  In the present study, tooth cavity preparation                    trol. Therefore, the PBF reduction in the present
                caused increase of PBF significantly. This obser-                   study can be interpreted by the action of epineph-
                vation of strong vasodilatation effect in the feline                rine. This phenomenon may also be explained by
                dental pulp is similar to the findings by Olgart et                 the study of Kim et al.19) who investigated effects
                   9)          10)
                al.  and Kim . This vascular reaction in the pulp                   of vasoconstrictor contained local anesthetics on
                might be explained by the complex interactions                      pulpal blood flow in the dog teeth. In their study,
                occurring within the pulp between the dental                        an infiltration injection of 2% lidocaine with 1 :
                nerves and pulp vessels, mediated by neurovascu-                    100,000 epinephrine caused a temporary reduc-
                                9,11,12)
                lar regulators       . A simple tooth preparation can               tion of PBF in the maxillary canine teeth in dogs
                cause the release of a significant amount of sub-                   and a similar injection with epinephrine only
                                                                    13)
                stance P-like or bradykinin-like substances , and                   caused the same flow reduction, suggesting that
                noxious stimuli of mechanical, thermal, and                         the flow reduction to local anesthesia was due to
                chemical characters, which excite C-fibers, can                     the epinephrine.
                trigger the release of neuropeptides. These, in                       Epinephrine acts on the adrenergic receptors in
                turn, have an effect on PBF and pulpal tissue                       the smooth muscle wall of the arterioles causing
                          10)
                pressure .                                                          vasoconstriction. It is known that stimulation of
                  Pulpal responses to cavity preparation depend                     α-adrenergic receptors causes vasoconstriction
                260
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...Vol no effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth wan sik chu seung ho park dong kuk ahn sung kyo kim department conservative dentistry and oral physiology school kyungpook national university daegu korea abstract the aims study were to evaluate epinephrine containing anesthetics pbf investigate its cavity preparation induced change was recorded using a laser doppler flowmeter perimed co sweden from canines nine cats under general before after injection lidocaine hydrochloride with administered by infiltration given apical mandibular canine at vestibular area same volume isotonic saline injected contralateral tooth as control round carbide bur operated slow speed flushing grind spherical cavities increasing depth through enamel into dentin both obtained data analyzed paired t test caused significant increase n p resulted decreases whereas there physiologic anesthetized significantly less than therefore result present demonstrates that effectively r...

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