Iontophoresis

When it comes to getting dental treatment, people often avoid it because of anxiety or

fear of pain. As dental hygienists or dentists, we relieve that pain by administering a local

anesthetic by a needle injection. Because of the needles, fear can arise from most patients,

especially in children. With the use of iontophoresis, local anesthetics can be administered by an

electric current instead of needles. The idea of iontophoresis was first introduced in 1993 and is

considered a suitable alternative for administering anesthetics (Kee, 2013). The purpose of this

research project is to educate individuals on the studies and information provided by peers on the

topic of Iontophoresis in Dentistry. We believe the information provided in this presentation will

not only benefit dental hygienists but also dentists. This method has the potential to increase

patient compliance and eliminate needles in the office, while also decreasing the risk of

intoxication and contamination.

The delivery of both charged and uncharged drugs can be enhanced by iontophoresis

through the application of an electric current across the membrane (Wanasathop, 2018). There

are three different mechanisms that are included in this process and they are: electrophoresis,

electroosmosis, and electropermeabilization. According to Wanasathop (2018):

Electrophoresis is based on the principle that positively charged ions are repelled from

anode and attracted to cathode and negatively charged ions are repelled from cathode and

attracted to anode. Electroosmosis can enhance transport of neutral and ionic drugs.

Electropermeabilization alters the barrier of membrane under the influence of an electric

field​.
Since electrophoresis plays a major role in the enhanced transport of ionic drugs, it adds an

additional force that can help the penetration of ions through the skin (Shahi, 2017). With

electroosmosis, it allows large movements of a solvent to carry neutral and ionic drugs across a

charged membrane that was created by an electric field (Wanasathop, 2018). As for

Electropermeabilization, the barrier of a membrane can be altered under the influence of an

electric field to where the membrane pore charges or size can be altered (Wanasathop, 2018).

The areas that were tested were the buccal area of the oral mucosa, the palate, and enamel and

dentin. The buccal area showed that it was the area of choice for drugs that could not be

absorbed through the GI tract. The palate was less permeable, as compared to the buccal mucosa,

due to the cornified epithelium in the palate. However, with both areas, it showed that

electroosmosis was the main mechanism for iontophoretic transport (Wanasathop, 2018).

Iontophoresis can also enhance the delivery of drugs into enamel and dentin which can aid in the

control of dental caries and dentin hypersensitivity. Overall, iontophoretic drug delivery is

considered to be generally safe and noninvasive. Treatments were only given at a slow,

increasing rate until the patient felt a slight tingle (Wanasathop, 2018).

With the use of iontophoresis, there comes advantages and disadvantages. According to

Angelo (2018), iontophoresis can be used for the treatment of hypersensitive dentin, treatment of

oral ulcers and herpes labialis lesions, and be used as a topical anesthetic. The penetration of

drug is increased and there is better control of the delivered dose (Roustit, 2013). By having

better control of the dose being administered, it can decrease the risk of intoxication. Other

advantages include alleviation of discomfort, fear, and anxiety of needles. In the article

Iontophoresis: Painless Electric Currents May Soon Replace Needles At The Dentist​, Professor
Renata Fonseca Vianna Lopez (2016) stated that, “Needle-free administration could save costs,

improve patient compliance, facilitate application and decrease the risks of intoxication and

contamination.” The disadvantages of iontophoresis is that there is a lack of recent studies in

regards to dentistry. Wanasathop (2018) has stated that there are fewer studies that involve the

oral cavity more studies involved with the skin, eyes, and nails. Another disadvantage is that it

can irritate the skin and oral mucosa at higher voltages. Iontophoresis is preferred to be

administered in short durations to avoid irritation, but also because the oral cavity is used for

eating and drinking, it can disrupt the delivery of the drug when a long-duration drug application

is needed (Wanasathop, 2018).

Of course, with any drug administration, whether what technique or procedure used, there

are adverse effects. The most common, but harmless effects were skin irritation or erythema as

stated by Roustit (2013). Kee’s (2013), study found adverse effects that included the following:

Minimal to moderate redness was reported and central nervous system manifestations

(excitatory and/or depressant). It is characterized by lightheadedness, nervousness,

apprehension, euphoria, confusion, dizziness, drowsiness, tinnitus, blurred or double

vision, vomiting, sensations of heat, cold, or numbness, twitching, tremors, convulsions,

unconsciousness, respiratory depression and arrest; cardiovascular system effects are

usually depressant and characterized by bradycardia, hypotension, and cardiovascular

collapse

Allergic reactions were also noted and characterized by cutaneous lesions, urticaria, edema, and

anaphylactoid reactions. Allergic reactions to the use of lidocaine were extremely rare and this
technique is not recommended for pediatric patients because of the time it would take for the

onset of anesthesia (Kee, 2013).

As dentists and dental hygienists, it is important that we create a comfortable

environment for patients to come to receive dental treatment. Dental treatment is often deferred

due to the fear of pain or just fear and anxiety itself. One way to alleviate that fear or anxiety is

by administering local anesthetics via needle injection, which can trigger that fear or anxiety.

With the use of iontophoresis, we can alleviate that fear with just an electric current and

eliminate the use of needles. Not only can iontophoresis eliminate the use of needles, it can

decrease the risks of intoxication and contamination, and most importantly, improve patient

compliance.
 References:

Angelo, Z., & Polyvios, C. (2018). Alternative practices of achieving anaesthesia for dental

procedures: a review. ​Journal of dental anesthesia and pain medicine,​ ​18(​ 2), 79-88.

Bushak, L. (2016, January 21). Iontophoresis: Painless Electric Currents May Soon Replace

Needles At The Dentist. Retrieved November 18, 2018, from Iontophoresis: Painless

Electric Currents May Soon Replace Needles At The Dentist

Kee, Y. L., Second, & Neelakantan, P. (2013). Local Anesthetics in Dentistry - Newer Methods

of Delivery. ​International Journal of Pharmaceutical Sciences and Clinical Research,

6​(1), 4-6.

Roustit, M., Blaise, S., & Cracowski, J. (2013). Trials and tribulations of skin iontophoresis in

therapeutics. ​British Journal of Clinical Pharmacology,​ ​77​(1), 63-71.

doi:10.1111/bcp.12128

S, S., & S, D. (2013). Iontophoresis: An Approach To Drug Delivery Enhancement.

International Journal Of Pharmaceutical Sciences And Research,​ 4056-4068. Retrieved

November 18, 2018.

Wanasathop, A., & Li, S. (2018). Iontophoretic Drug Delivery in the Oral Cavity.

Pharmaceutics,10(​ 3), 121. doi:10.3390/pharmaceutics10030121