Study of OraVerse® for Safety and Efficacy in Pediatric Dental Patients

• Incidence and severity of adverse events [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]
• Clinically significant changes in vital signs [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]
  Blood pressure and pulse
• Clinically significant changes in oral cavity assessments [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]
• Nerve injury [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]
• Analgesics required for intraoral pain [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]

• incidence, severity and duration of intraoral pain as measured by W-B PRS [ Time Frame: Up to 3 days ] [ Designated as safety issue: Yes ]
  Wong-Baker Pain Rating Scale used to assess subject pain
• Time to normal function [ Time Frame: Up to 3 days ] [ Designated as safety issue: No ]
  Measured by pediatric Functional Assessment Battery (pFAB) to determine when speaking, eating, drinking, drooling return to baseline
• Time to normal lip sensation [ Time Frame: Up to 3 days ] [ Designated as safety issue: No ]
  Measures time to normal lip and tongue sensation using standardized lip/tongue palpation procedure
• Time to normal tongue sensation [ Time Frame: Up to 3 days ] [ Designated as safety issue: No ]
  Measures time to normal tongue sensation using standardized lip/tongue palpation procedure

The purpose of this study is to determine whether OraVerse is safe and effective for the reversal of dental anesthesia in children 2 to 5 years of age weighing at least 10 kg.

This Phase 4 clinical study is designed as a multicenter, randomized, double-blinded, controlled study to evaluate the safety and efficacy of OraVerse in approximately 150 children 2 to 5 years of age. OraVerse or sham injection is administered at the completion of a dental procedure requiring local anesthesia with lidocaine 2% with 1:100,000 epinephrine. The dental procedure(s) comprising restoration/fillings shall be performed in a single quadrant of the mouth.

The primary endpoint is safety and tolerability of OraVerse as measured by adverse events, vital signs, oral cavity assessments, nerve injury, and analgesics for intraoral pain. Secondary objectives in subjects 4 and 5 years of age include the safety and tolerability of OraVerse as measured by pain assessments using W-B PRS and evaluation of efficacy assessed by a pediatric Functional Assessment Battery (pFAB) and standardized lip and tongue palpation procedure.

• Dental Anesthesia
• Anesthesia, Local
• Anesthesia, Reversal

• Drug: OraVerse
  1.8mL dental cartridge delivered in doses of either 1/4, 1/2 or 1 cartridge depending on subject weight
• Other: Sham injection
  No drug administered, simulation of injection used in same manner as drug

• Experimental: OraVerse
  OraVerse in doses of either 1/4, 1/2 or 1 cartridge (1.8mL)
  Intervention: Drug: OraVerse
• Sham Comparator: Sham injection
  Dentist simulates injection with dental syringe
  Intervention: Other: Sham injection

• Hersh EV, Moore PA, Papas AS, Goodson JM, Navalta LA, Rogy S, Rutherford B, Yagiela JA; Soft Tissue Anesthesia Recovery Group. Reversal of soft-tissue local anesthesia with phentolamine mesylate in adolescents and adults. J Am Dent Assoc. 2008 Aug;139(8):1080-93.
• Moore PA, Hersh EV, Papas AS, Goodson JM, Yagiela JA, Rutherford B, Rogy S, Navalta L. Pharmacokinetics of lidocaine with epinephrine following local anesthesia reversal with phentolamine mesylate. Anesth Prog. 2008 Summer;55(2):40-8.
• Tavares M, Goodson JM, Studen-Pavlovich D, Yagiela JA, Navalta LA, Rogy S, Rutherford B, Gordon S, Papas AS; Soft Tissue Anesthesia Reversal Group. Reversal of soft-tissue local anesthesia with phentolamine mesylate in pediatric patients. J Am Dent Assoc. 2008 Aug;139(8):1095-104. Erratum in: J Am Dent Assoc. 2008 Oct;139(10):1312.
• Laviola M, McGavin SK, Freer GA, Plancich G, Woodbury SC, Marinkovich S, Morrison R, Reader A, Rutherford RB, Yagiela JA. Randomized study of phentolamine mesylate for reversal of local anesthesia. J Dent Res. 2008 Jul;87(7):635-9.

Inclusion Criteria:

• Male or female, 2 to 5 years of age
• Sufficiently healthy as determined by the Investigator to receive routine dental care
• Requires a restorative procedure (restoration/filling) in a single quadrant of the mouth
• Requires local anesthesia with lidocaine 2% with 1:100,000 epinephrine administered by submucosal injection
• For subjects undergoing mandibular procedures, require an inferior alveolar nerve block for the restorative procedure
• Dental procedure(s) completed within 60 minutes of injection of local anesthetic
• For subjects 4 and 5 years of age, can be trained in standardized lip/tongue palpation procedure and pFAB

• Subjects who are trainable in pFAB and standardized lip/tongue palpation procedure have either:

  • normal pFAB at baseline prior to administration of local anesthetic and
  • at least one abnormal function (smiling, speaking, drinking or drooling) at the completion of the dental procedure OR
  • normal lip sensation at baseline prior to administration of local anesthetic and
  • numbness of the relevant lip quadrant at completion of the dental procedure
• Subjects give written or verbal assent, as capable and appropriate, and parent(s) or legal guardian(s) give written informed consent

Exclusion Criteria:

• Weight less than 10 kg
• Weight less than 15 kg if 4 or 5 years of age
• History or presence of any condition that contraindicates routine dental care or use of local anesthetic
• Requires more than ¼ cartridge of local anesthetic if weight is ≥ 10 kg and < 15 kg, more than ½ cartridge of local anesthetic if weight is ≥ 15 kg and < 30 kg, and more than 1 cartridge of local anesthetic if weight is ≥ 30 kg, excluding supplemental injections
• Allergy or intolerance to lidocaine, epinephrine, sulfites, phentolamine, nitrous oxide or topical benzocaine
• Has used any investigational drug and/or participated in any clinical study within 30 days of study drug administration
• Has participated in this study or any previous study of phentolamine mesylate for reversal of local soft tissue anesthesia (STA)
• Any use of commercial OraVerse™ within 30 days of study drug administration
• Use of opioid or opioid-like analgesics within 24 hours prior to administration of local anesthetic
• Requires the use of local anesthetic other than lidocaine 2% with 1:100,000 epinephrine to perform the scheduled dental procedure
• Requires the use of general anesthesia or sedatives except for nitrous oxide to perform the scheduled dental procedure
• Any condition which in the opinion of the Investigator increases the risk to the subject of participating in this study or decreases the likelihood of compliance with the protocol