Influence of Local Anesthesia on the Outcomes of Non-Surgical Periodontal Treatment

Introduction

Periodontal disease, a chronic inflammatory condition driven by bacterial plaque, remains a significant global health challenge. Non-surgical periodontal therapy (NSPT), which includes scaling and root planing (SRP), is the cornerstone of periodontal treatment. While pain management during NSPT is critical for patient comfort, the influence of local anesthesia (LA) on clinical outcomes remains underexplored, particularly in Chinese populations. This retrospective cohort study aimed to evaluate the short-term effects of LA on probing depth (PD) reduction and bleeding index (BI) improvement after NSPT. Additionally, it sought to identify clinical scenarios where LA administration could optimize therapeutic outcomes.

Methodology

Study Design and Population

Data from 3,980 patients treated at Peking University School and Hospital of Stomatology (PKUSS) between June 2008 and January 2015 were analyzed. Patients aged 18–80 years who underwent NSPT and subsequent 3-month re-evaluation were included. Exclusion criteria included systemic diseases (e.g., diabetes, hypertension), pregnancy, recent periodontal surgery, or antibiotic use within six months. The study leveraged electronic periodontal charting records (EPCRS) to extract demographic, diagnostic, and clinical parameters.

Clinical Parameters and Interventions

Periodontal examinations were conducted by calibrated periodontists. Full-mouth PD measurements and Mazza BI scores (ranging 0–5) were recorded at six sites per tooth. NSPT involved SRP using ultrasonic and hand instruments, with or without LA (lidocaine or articaine). Re-evaluation occurred 1–2 months post-treatment.

Statistical Analysis

Descriptive statistics compared baseline characteristics between LA and no local anesthesia (NLA) groups. Multilevel regression models adjusted for confounders at patient (age, sex, smoking status, periodontitis stage/grade), tooth (molar/non-molar, baseline BI), and site (baseline PD) levels. Three-level linear regression (patient-tooth-site) analyzed PD reduction, while two-level logistic regression (patient-tooth) assessed BI improvement. Stratified analyses evaluated outcomes by baseline PD categories.

Results

Baseline Characteristics

The cohort comprised 53.5% LA and 46.5% NLA patients. LA recipients had higher proportions of smokers (19.1% vs. 15.3%) and advanced periodontitis (Stage IV: 64.0% vs. 46.0%; Grade C: 77.0% vs. 69.8%). Baseline PD and BI were significantly higher in the LA group (Table 1).

Probing Depth Reduction

LA administration correlated with greater PD reduction. The mean PD decrease was 0.98 mm in the LA group versus 0.54 mm in the NLA group (t = 24.12, P < 0.001). For teeth with baseline PD ≥5 mm, LA use increased the probability of PD reduction by 32.3% compared to 17.3% in NLA (t = 28.48, P < 0.001). Multilevel regression confirmed LA’s independent benefit after adjusting for confounders (Figure 2A).

Stratification by baseline PD revealed incremental advantages with deeper pockets. For sites with PD <7 mm, LA improved PD reduction by 0.12–0.22 mm. This difference escalated to 0.41–1.37 mm for PD ≥7 mm (Figure 3A).

Bleeding Index Improvement

LA enhanced BI outcomes, with higher reductions in bleeding prevalence. Teeth with BI >1 decreased by 16.7% in LA versus 13.8% in NLA (t = 3.75, P 2 reductions were 34.7% vs. 28.1% (t = 6.73, P 2 (Figure 2B). Notably, BI improvement in LA patients was more pronounced in younger (<60 years) and middle-aged (40–60 years) subgroups.

Interaction Between LA and Baseline PD

The therapeutic advantage of LA intensified with baseline PD severity. For example, teeth with baseline PD = 9 mm exhibited a 1.37 mm greater PD reduction under LA versus NLA. Similarly, the odds of BI improvement rose with increasing baseline PD in LA-treated sites (Figure 3B).

Discussion

Mechanistic Insights

The superior outcomes in LA-treated patients may stem from enhanced operator efficacy and patient cooperation. Pain reduction enables thorough debridement of deep pockets and furcation areas, critical for biofilm and calculus removal. Epinephrine in LA formulations improves hemostasis and visibility, further aiding precision. Additionally, reduced patient anxiety likely minimizes movement disruptions during SRP.

Clinical Implications

The study advocates routine LA use for sites with baseline PD ≥7 mm, where PD reductions were nearly triple those in NLA. For moderate pockets (PD 5–7 mm), LA still conferred measurable benefits, though less pronounced. Clinicians should prioritize LA in advanced periodontitis cases, smokers, and younger patients, where inflammation and pain sensitivity are heightened.

Cultural and Practical Considerations

Despite LA’s benefits, needle aversion and cost concerns contribute to its underuse in China. Topical anesthetics or intra-pocket gels may serve as alternatives for LA-averse patients, though their efficacy relative to injections warrants further study.

Limitations and Future Directions

The retrospective design introduces potential selection bias, as LA recipients had more severe disease. While multilevel modeling adjusted for confounders, randomized trials are needed to validate causality. Long-term outcomes, dentin hypersensitivity, and attachment gain metrics were unexplored and merit investigation.

Conclusion

Local anesthesia significantly enhances short-term outcomes of non-surgical periodontal therapy, particularly in deep pockets (PD ≥7 mm). By mitigating pain and improving operative conditions, LA facilitates more effective biofilm removal, translating to greater PD reduction and bleeding resolution. Clinicians should integrate LA into NSPT protocols for advanced periodontitis cases, balancing patient preferences and clinical needs.

doi.org/10.1097/CM9.0000000000000903

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