Anesthetic effect of lidocaine injection for maxillary teeth with or without tetracaine gel as topical agent during dental extraction in sensitive patients

Aims: Anxiety and fear from dental injections are common and particularly tense features in dental treatment. The direct sense of pain during the injection technique contributes significantly to this dread. The aim of the study was to assess the anesthetic effectiveness and pain of injectable buffered lidocaine with epinephrine with topical tetracaine gel (1%, 1.5%, and 2%) and placebo gel before injection. Methods: A randomized clinical trial was conducted patients attending the integrated clinics of the dentistry at Mosul University who needed dental surgical treatment. A total of 96 adult patients participated in the study, including 51 males and 45 females. Participants were randomly allocated into four groups, 24 for each one. The injection site was dried with gauze and approximately 0.2 mL of topical anesthetic agent with different concentrations utilized, then after 2 minutes’ local anesthesia, lidocaine with adrenaline with needle gauge 27 was applied for maxillary premolars and molars for infiltration technique and using pain scores as a parameter to assess pain and anxiety sensation. Therefore, the study involves 4 groups. Group A 1%, group B 1.5%, group C 2% tetracaine gel, and group D placebo (ultrasonic gel) as the control group, the data collected and analyzed. Results: From 96 participants (53.13% male and 46.87% female), there was a highly statistically significant difference between groups regarding pain sensation at time of injection, especially group C with 2% concentration of tetracaine in comparison with other groups. Conclusion: Topical anesthetics considerably lessened injection and needle insertion pain as compared to the placebo group, also topical anesthesia has a significant psychological impact on patients’ attitudes toward dental treatment, with most patients demanding topical anesthesia before dental injections in order to reduce their level of anxiety and fear toward dental injections.