The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety

Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to evaluate the effectiveness of computer-controlled local anesthetic delivery (CCLAD) systems in reducing injection pain in pediatric patients aged 3-14 years, including subgroup analysis across different injection techniques.

DATA

Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.

SOURCES

Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.

STUDY SELECTION

From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.

CONCLUSION

CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.

CLINICAL SIGNIFICANCE

This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.

Influence of Premedication and Dental Anxiety on Anesthetic Efficacy in Patients Undergoing Root Canal for Symptomatic Irreversible Pulpitis in Upper and Lower Molars: A Comparative Study of Articaine and Bupivacaine

The use of local anesthetics in dentistry is crucial for pain control. Their efficacy may be related to multiple factors, including gender, the clinical status of the patient, anatomical factors, the type of anesthetic, premedication treatment, and the experience of the professional. Aim: The objective of this study was to analyze whether premedication or the degree of patient anxiety influences the anesthetic efficacy of 4% articaine with epinephrine 1:100,000 and 0.5% bupivacaine with epinephrine 1:100,000 in patients undergoing root canal treatment for symptomatic irreversible pulpitis in the upper and lower molars. The null hypothesis (H0) of this study was that articaine and bupivacaine would have a similar anesthetic efficacy when used during the treatment of symptomatic irreversible pulpitis of the posterior mandibular and maxillary teeth, independent of non-steroidal anti-inflammatory drugs (NSAIDs) premedication or the patient's anxiety levels. Methods: A total of 140 patients presenting with pulpitis in the upper and lower molars were randomly assigned to one of two anesthetics: articaine or bupivacaine. Before root canal treatment, patients completed the Modified Corah Dental Anxiety Scale (MDAS) and a Visual Analog Scale (VAS) for pain intensity. Inferior alveolar nerve block was performed for the lower molars and buccal infiltration for the upper molars, and the anesthetic efficacy was verified by the Endo Coldspray® test. During the procedure, the patients' heart rate and oxygen saturation were monitored using a pulse oximeter. The patients reported their pain levels using a VAS twenty-four hours postoperatively. Results: High levels of dental anxiety were significantly associated with higher pain scores (p = 0.000) for both groups. The hemodynamic changes during treatment remained within normal limits. The need for anesthetic reinforcement was higher in the bupivacaine group (p = 0.004). The patients in both groups reported low-intensity postoperative pain, although the pain level was slightly lower in the bupivacaine group. Conclusions: The anesthetic efficacy of articaine and bupivacaine in patients with irreversible pulpitis did not appear to be influenced by the degree of anxiety or the intake of AINEs as premedication. The intrinsic anesthetic efficacy was higher for articaine, which required less reinforcement than bupivacaine. Comparing the results obtained when performing buccal infiltration and inferior alveolar nerve block further highlighted the differences between the two anesthetics; these differences were more pronounced in the bupivacaine group, leading to rejection of the null hypothesis proposed at the beginning of the study.

Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review

OBJECTIVES

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents.

METHODS

A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application.

RESULTS

Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others.

CONCLUSIONS

Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

Pain-Related Behavior and Pain Perception Associated with Intraosseous Local Anesthesia (QuickSleeper 5®) in Pediatric Patients: A Randomized Controlled Clinical Trial

BACKGROUND

Managing pain during dental procedures is crucial, particularly for children, as pain can induce anxiety. Local anesthesia is the most anxiety-inducing procedure in pediatric patients. Consequently, this study aimed to assess and compare the pain-related behaviors and perceptions associated with two anesthesia techniques for children: traditional local anesthesia and intraosseous local anesthesia administered via the QuickSleeper 5® system.

METHODS

A split-mouth randomized clinical trial was conducted involving 33 children aged 4-9 years. Each participant received both traditional local anesthesia and intraosseous local anesthesia with QuickSleeper 5 across two visits. Pain-related behaviors were evaluated by calibrated pediatric dentists through video recordings, and pain perceptions were assessed using the Wong-Baker Faces Pain Rating Scale. Heart rate measurements offered objective insights into patients' anxiety; finally, the time needed to administer anesthesia was recorded.

RESULTS

This study found no statistically significant differences between traditional local anesthesia and intraosseous local anesthesia with QuickSleeper 5 regarding pain perception, heart rate, or pain-related behaviors, indicating that both techniques are effective at minimizing discomfort. However, QuickSleeper 5 demonstrated a significantly shorter administration time, enhancing the procedural efficiency of pediatric dentistry.

CONCLUSIONS

The QuickSleeper 5 system is a valuable tool for pediatric dental care, delivering comparable comfort levels to traditional anesthesia while significantly reducing the time that is required for administration. The QuickSleeper 5 system's efficiency advantage could make it the preferred choice for treating children, especially given the stress that is often associated with local anesthesia and the need for quick, smooth procedures in pediatric care.

Efficacy of computer-controlled local anesthesia delivery system on pain in dental anesthesia: a systematic review of randomized clinical trials

Computer-controlled local anesthesia delivery (CCLAD) is an innovative electronic injection device that represents a cutting-edge approach to dental anesthesia. This system is promising for painless anesthesia using controlled anesthetic injections. This review aimed to compare the discomfort experienced by patients during local anesthesia using a traditional syringe and the CCLAD system and evaluate the potential of the CCLAD system as a painless dental anesthesia solution. The inclusion criteria for this study were based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The study population, including children and adults, underwent dental anesthesia using the CCLAD system, ensuring a comprehensive and representative sample that instills confidence in the validity of the results. Fourteen clinical trials were included in the analysis after they fulfilled the eligibility criteria. We found that using computer-assisted anesthetic equipment not only led to a significantly lower pain perception score, but also had a profound positive impact on patient behavior. Patients using the CCLAD device exhibited more cooperative and helpful conduct, indicating the system's effectiveness in improving patient comfort and experience and reassuring the audience about its positive impact. In conclusion, using a computer-assisted anesthetic device such as the CCLAD system significantly reduced pain perception scores and improved patient behavior, making them more cooperative and helpful. These findings offer hope for pediatric dentistry and apprehensive adult patients, suggesting a more comfortable and less daunting dental experience with the CCLAD system.

Pain perception following computer-controlled versus conventional dental anesthesia: randomized controlled trial

BACKGROUND

The administration of local anesthesia (LA) in dental practice requires an injection which is the leading cause of patients' fear and anxiety. Computer-controlled local anesthetic injector, designed to reduce the pain of performing local anesthesia by controlling the speed of injection. This single-blind randomised control trial aimed to compare the pain perception after computer-controlled local anesthesia (CCLA) and conventional LA.

METHODS

Dental students were both test and operator group versus an experienced dentist as additional operator of the LA. Data were collected regarding gender, age, medical condition, smoking habits. Additionally, operator feedback about the handling, pain at insertion and during infiltration, excitement (Dental Anxiety Scale), and complications were assessed.

RESULTS

Out of the 60 included participants, the majority were females (n = 41; 68.3%), medically healthy (n = 54; 90%), and did not receive medications (n = 54; 90%). While the participating students administered 62 (51.7%) injections, the experienced dentist administered 58 (48.3%) injections. The difference in pain perception on puncture between CCLA and conventional injections was not statistically significant (Sig. = 0.285); however, pain perception during injection was significantly different (Sig. = 0.029) between CCLA (1.65 ± 1.93) and conventional injections (2.49 ± 2.31).

CONCLUSION

The professional experience influenced the pain perception while applying the LA. CCLA did not reduce pain on puncture significantly; however, pain perception during the injection was significantly reduced in the case of using CCLA devices compared to the conventional syringe.

The combined effect of extraoral vibratory stimulus and external cooling on pain perception during intra-oral local anesthesia administration in children: a systematic review and meta-analysis

This study aimed to assess the combined use of extraoral vibratory stimulation and extraoral cooling in reducing the pain (subjective and objective) of dental local anesthesia administration in children.

PubMed, Cochrane Central Register of Controlled Trials, and Ovid SP databases were searched up to July 2021. Article titles were screened and full-text evaluations of the selected articles were performed. Finally, seven studies (391 children, aged 4 – 12 years) were included in this qualitative and quantitative analysis. The pooled data determined the combined effect of extraoral vibration and extraoral cooling as a single measure. Extraoral vibration or cooling alone were not compared. The measured primary and secondary outcomes were pain perception and subjective and objective pain, respectively. When compared with the control, extraoral vibration and cooling resulted in significant differences in the mean combined data for the variables, pain perception, and pain reaction. Children’s subjective pain as measured by pain scores were reduced when extraoral vibration and cooling was used during local anesthesia administration (mean difference -3.52; 95% confidence interval [-5.06 - 1.98]) and objective pain (mean difference -1.46; 95% confidence interval [-2.95 - 0.02] ; mean difference -1.93; 95% confidence interval [-3.72 - 0.14]).

Within the confines of this systematic review, there is low-quality evidence to support the use of combined extraoral vibration and cooling for reducing pain (subjective and objective) during intraoral local anesthesia administration in children.