Introduction: The high success achieved in maxillary local anesthesia is unfortunately impossible in needle-phobic patients who avoid their dental appointments, which is approximately 10% of the U.S. population. Needle-free alternatives to local anesthesia would therefore be beneficial. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze ®) nasal spray in maxillary lateral incisors and first premolars. Methods: Fifty adult subjects randomly received a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze ®) nasal spray and mock injection or a mock nasal spray and 2% lidocaine with 1:100,000 epinephrine injection at the maxillary lateral incisor or first premolar in two appointments spaced at least 1 week apart in a single-blind cross-over design. Pulpal anesthesia was evaluated with an electric pulp tester. Side effects and subject preferences were also recorded. Results: Anesthetic success was significantly lower for the Kovanaze ® nasal spray and mock injection (22-37%) than for the mock nasal spray and lidocaine injection (89-91%). Subjects reported more side effects and pain after the Kovanaze ® nasal spray and mock injection appointment than the control. All subjects (100%) preferred the injection after experiencing both routes of administration.
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