Chronic periodontitis affects about half of the adult population over 30 in the United States. Despite the efforts of dentists and organizations advocating for good oral hygiene habits, periodontal disease is still extremely common. Scaling and root planing is the standard procedure used for reducing the severity of chronic periodontitis. However getting patients to return for the multiple sessions needed to see results can be difficult.

The deep cleaning of SRP can be painful and involves instrumentation in sensitive areas. Often patients have painful inflammation, especially where the pockets are particularly deep, that can be difficult to work around without anesthetic. An injected local anesthetic is always an option, and works well for many patients. Others might not return for the next session because of how much they dislike needles. Since multiple scaling and root planing sessions are usually needed to get results, it is important to find ways to get patients to return for consecutive treatments.

Compounded Topical Anesthetic for Scaling and Root Planing

Many dentists use compounded topical anesthetics because they are both powerful and affordable. There are numerous situations where a topical anesthetic is beneficial for making the visit easier for both the patient and practitioner. Topical anesthetics have been proven in studies to be as effective as injectable anesthetics for managing pain associated with scaling and root planing. Patients usually report that they prefer topical anesthetic gels to injectable local anesthetic, and are willing to pay more for an anesthetic gel option.

One study compared topical lidocaine 2.5% and prilocaine 2.5% (Oraqix) with injected articaine. The topical gel was preferred by 69% of patients even though procedural pain scores were slightly higher than with the injected anesthetic. The strengths of topical anesthetics used in most of the studies are based on commercially available products. These strengths are usually much lower than those that can be made by a compounding pharmacy. If the ingredient strengths are higher, it may be possible to get the same powerful anesthetic effects of injected anesthetic combined with the greater patient satisfaction that comes from using a topical gel.

It has also been confirmed in research that the use of a topical anesthetic gel does not compromise the treatment outcome of scaling and root planing compared to the use of injected anesthetic. No effect can be seen by either method of anesthesia on the change in pocket-depth after treatment. Topical anesthetic gels are generally safe when used appropriately. Learn more about how to use dental anesthetic gels on our blog: Dental Anesthetic Gels – Instructions and Safety.

Topical Anesthetic Effects Post-Procedure

Post-procedure problems may also be reduced with the use of topical anesthetic. While compounded topical anesthetics have a longer duration of action than most commercially available products, they do not last as long as injected anesthetics. In one study, 15% of patients reported post-procedure numbness when a topical gel was used vs. 66% with an injected anesthetic. Problems connected with daily activities were noted by 19% of patients given topical gel vs. 69% with injected anesthetic. This study used only lidocaine 2%, meaning the topical anesthesia was less profound than the injectable but still preferred by patients.

Compounded Topical Anesthetic Formulations

There are a few standard formulations of topical anesthetic that are most popular. These combinations are not commercially available. They can not be purchased from the usual dental suppliers, but instead need to be custom-made by a compounding pharmacy.

TAC 20: Lidocaine 20%, Tetracaine 4%, Phenylephrine 2%

Profound: Lidocaine 10%, Tetracaine 4%, Prilocaine 10%

Profound-PE: Lidocaine 10%, Tetracaine 4%, Prilocaine 10%, Phenylephrine 2%

BTT 12.5: Lidocaine 12.5%, Tetracaine 12.5%, Prilocaine 3%, Phenylephrine 3%

All of these compounded topical anesthetics can be made with a strawberry, grape, blueberry, mint, bubblegum, or pina colada flavor to make them more palatable. They are easy to apply and use. Check out our blog: How Do Topical Anesthetics for Dental Treatments Work?

Patients are more likely to cancel appointments or not seek treatment at all because of anxiety about injections. That is why an alternative pain control method can be an essential part of any dentist’s daily practice. Compounded topical anesthetics are more powerful than commercially available anesthetics. Their increased ability to anesthetize can help offset the difference in profound anesthesia between a topical and an injected anesthetic. Increased return visits and better treatment outcomes can result when the anxiety associated with scaling and root planing is reduced.

Research

• Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients. – International Journal of Dental Hygiene (PubMed)
• Influence of intra-pocket anesthesia gel on treatment outcome in periodontal patients: a randomized controlled trial. – Journal of Clinical Periodontology (PubMed)
• Non-interventional study to collect data for the application of lidocaine gel 2% during scaling and root planing and professional mechanical plaque removal. – Clinical Oral Investigations (PubMed)
• Quantification of patient fears regarding dental injections and patient perceptions of a local noninjectable anesthetic gel.  – Compendium of Continuing Education in Dentistry (PubMed)
• Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing. – Journal of Periodontology (PubMed)