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Anesthetic Efficacy of the Inferior Alveolar Nerve Block in Red-haired Women

Published:October 05, 2012DOI:https://doi.org/10.1016/j.joen.2012.08.014

      Abstract

      Introduction

      The exact reasons for failure of the inferior alveolar nerve (IAN) block are not completely known, but red hair could play a role. The genetic basis for red hair involves specific mutations, red hair color (RHC) alleles, in the melanocortin-1 receptor (MC1R) gene. The purpose of this prospective randomized study was to investigate a possible link between certain variant alleles of the MC1R gene or its phenotypic expression of red hair and the anesthetic efficacy of the IAN block in women.

      Materials

      One-hundred twenty-four adult female subjects (62 red haired and 62 dark haired) participated in this study. Dental anxiety was determined in each subject using the Corah Dental Anxiety Questionnaire. The subjects were given 2 cartridges of 2% lidocaine with 1:100,000 epinephrine via the IAN block. Pulpal anesthesia was measured in the posterior and anterior teeth in 4-minute cycles for 60 minutes using an electric pulp tester. The MC1R alleles were genotyped for each subject from cheek cells containing DNA collected using buccal swabs.

      Results

      Women with red hair and women with 2 RHC alleles reported significantly higher levels of dental anxiety compared with women with dark hair or women with 0 RHC alleles. No significant differences in anesthetic success were found between any of the groups for any of the teeth.

      Conclusions

      Red hair and the MC1R gene were significantly linked to higher levels of dental anxiety but were unrelated to success rates of the IAN block in women with healthy pulps.

      Key Words

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      References

        • Nusstein J.
        • Reader A.
        • Beck F.M.
        Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks.
        Gen Dent. 2002; 50: 372-375
        • Vreeland D.L.
        • Reader A.
        • Beck M.
        • et al.
        An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block.
        J Endod. 1989; 15: 6-12
        • Nist R.
        • Reader A.
        • Beck M.
        • Meyers W.
        An evaluation of the incisive nerve block and combination inferior alveolar and incisive nerve blocks in mandibular anesthesia.
        J Endod. 1992; 18: 455-459
        • Ridenour S.
        • Reader A.
        • Beck M.
        • Weaver J.
        Anesthetic efficacy of a combination of hyaluronidase and lidocaine with epinephrine in inferior alveolar nerve blocks.
        Anesth Prog. 2001; 48: 9-15
        • Mikesell P.
        • Nusstein J.
        • Reader A.
        • et al.
        A comparison of articaine and lidocaine for inferior alveolar nerve blocks.
        J Endod. 2005; 31: 265-270
        • Willett J.
        • Reader A.
        • Drum M.
        • et al.
        The anesthetic efficacy of diphenhydramine and the combination diphenhydramine/lidocaine for the inferior alveolar nerve block.
        J Endod. 2008; 34: 1446-1450
        • Liem E.B.
        • Joiner T.V.
        • Tsueda K.
        • Sessler D.I.
        Increased sensitivity to thermal pain and reduced subcutaneous lidocaine efficacy in redheads.
        Anesthesiology. 2005; 102: 509-514
        • Liem E.B.
        • Lin C.M.
        • Suleman M.I.
        • et al.
        Anesthetic requirement is increased in redheads.
        Anesthesiology. 2004; 101: 279-283
        • Binkley C.J.
        • Beacham A.
        • Neace W.
        • et al.
        Genetic variations associated with red hair color and fear of dental pain, anxiety regarding dental care, and avoidance of dental care.
        J Am Dent Assoc. 2009; 140: 896-905
        • Corah N.L.
        • Gale E.N.
        • Illig S.J.
        Assessment of a dental anxiety scale.
        J Am Dent Assoc. 1978; 97: 816-819
        • Heft M.W.
        • Parker S.R.
        An experimental basis for revising the graphic rating scale for pain.
        Pain. 1984; 19: 153-161
        • Jorgensen N.B.
        • Hayden Jr., J.
        Premedication, Local and General Anesthesia in Dentistry.
        2nd ed. Lea & Febiger, Philadelphia, PA1967
        • Mogil J.S.
        • Wilson S.G.
        • Chesler E.J.
        • et al.
        The melanocortin-1 receptor gene mediates female-specific mechanisms of analgesia in mice and humans.
        Proc Natl Acad Sci U S A. 2003; 100: 4867-4872
        • Delaney A.
        • Keighren M.
        • Fleetwood-Walker S.M.
        • Jackson I.J.
        Involvement of the melanocortin-1 receptor in acute pain and pain of inflammatory but not neuropathic origin.
        PLoS One. 2010; 5: e12498
        • Sturm R.A.
        • Duffy D.L.
        • Box N.F.
        • et al.
        The role of melanocortin-1 receptor polymorphism in skin cancer risk phenotypes.
        Pigment Cell Res. 2003; 16: 266-272
        • Duffy D.L.
        • Box N.F.
        • Chen W.
        • et al.
        Interactive effects of MC1R and OCA2 on melanoma risk phenotypes.
        Hum Mol Genet. 2004; 13: 447-461
        • Flanagan N.
        • Healy E.
        • Ray A.
        • et al.
        Pleiotropic effects of the melanocortin 1 receptor (MC1R) gene on human pigmentation.
        Hum Mol Genet. 2000; 9: 2531-2537
        • Kanetsky P.A.
        • Rebbeck T.R.
        • Hummer A.J.
        • et al.
        Population-based study of natural variation in the melanocortin-1 receptor gene and melanoma.
        Cancer Res. 2006; 66: 9330-9337
        • Mogil J.S.
        • Ritchie J.
        • Smith S.B.
        • et al.
        Melanocortin-1 receptor gene variants affect pain and mu-opioid analgesia in mice and humans.
        J Med Genet. 2005; 42: 583-587
        • Kennedy C.
        • terHuurne J.
        • Berkhout M.
        • et al.
        Melanocortin 1 receptor (MC1R) gene variants are associated with an increased risk for cutaneous melanoma which is largely independent of skin type and hair color.
        J Invest Dermatol. 2001; 117: 294-300
        • Sánchez-Laorden B.L.
        • Sánchez-Más J.
        • Martínez-Alonso E.
        • et al.
        Dimerization of the human melanocortin 1 receptor: functional consequences and dominant-negative effects.
        J Invest Dermatol. 2006; 126: 172-181
        • Dunbar D.
        • Reader A.
        • Nist R.
        • et al.
        Anesthetic efficacy of the intraosseous injection after an inferior alveolar nerve block.
        J Endod. 1996; 22: 481-486
        • Guglielmo A.
        • Reader A.
        • Nist R.
        • et al.
        Anesthetic efficacy and heart rate effects of the supplemental intraosseous injection of 2% mepivacaine with 1:20,000 levonordefrin.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999; 87: 284-293
        • Gallatin E.
        • Stabile P.
        • Reader A.
        • et al.
        Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 83-87
        • Stabile P.
        • Reader A.
        • Gallatin E.
        • et al.
        Anesthetic efficacy and heart rate effects of the intraosseous injection of 1.5% etidocaine (1:200,000 epinephrine) after an inferior alveolar nerve block.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 89: 407-411
        • Childers M.
        • Reader A.
        • Nist R.
        • et al.
        The anesthetic efficacy of the periodontal ligament injection after an inferior alveolar nerve block.
        J Endod. 1996; 22: 317-320
        • Haase A.
        • Reader A.
        • Nusstein J.
        • Beck M.
        • et al.
        Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block.
        J Am Dent Assoc. 2008; 139: 1228-1235
        • Kanaa M.D.
        • Whitworth J.M.
        • Corbett I.P.
        • Meechan J.G.
        Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block.
        Int Endod J. 2009; 42: 238-246
        • Nuzum F.M.
        • Drum M.
        • Nusstein J.
        • et al.
        Anesthetic efficacy of articaine for combination labial plus lingual infiltrations versus labial infiltration in the mandibular lateral incisor.
        J Endod. 2010; 36: 952-956
        • Ocañez K.L.S.
        • McHugh R.K.
        • Otto M.W.
        A meta-analytic review of the association between anxiety sensitivity and pain.
        Depress Anxiety. 2010; 27: 760-767
        • Nusstein J.M.
        • Beck M.
        Effectiveness of 20% benzocaine as a topical anesthetic for intraoral injections.
        Anesth Prog. 2003; 50: 159-163
        • Nusstein J.
        • Steinkruger G.
        • Reader A.
        • et al.
        The effects of a 2-stage injection technique on inferior alveolar nerve block injection pain.
        Anesth Prog. 2006; 53: 126-130
        • Goodman A.
        • Reader A.
        • Nusstein J.
        • et al.
        Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks.
        Anesth Prog. 2006; 53: 131-139