Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6-11 years: A crossover split-mouth study

Photobiomodulation therapy on puncture-associated pain: A controlled randomized double-blind clinical trial

Dental fear and phobia are prevalent worldwide, with local anesthesia being the most feared procedure. This study aimed to determine whether photobiomodulation therapy (PBMT), used as a pre-anesthetic, could modulate puncture pain and enhance the effectiveness of local anesthesia. In this controlled, randomized, double-blind study, 49 participants were divided into an experimental group (n = 24), which received infrared laser therapy (100 mW, at 808 nm, 8 J, 80 s at a single point) immediately before standard anesthesia; and control group (n = 25), which received the standard anesthetic technique and sham laser. Pain levels were measured using the visual analog scale, and anesthetic efficacy was assessed through electrical tests (latency), percentage of failures, and cartridge usage. Anxiety levels were evaluated using the Beck Anxiety Inventory. Cardiovascular parameters were evaluated through blood pressure, oxygen levels, and heart rate. This randomized, double-blind study found no difference between groups in these experimental conditions. The bias toward a positive PBMT result was sufficiently removed. Autonomic responses of the PBMT group were maintained stable during the procedure.

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.

Auxillary aids for pain and anxiety reduction during dental local anesthesia in pediatric patients: a systematic review

AIMS/OBJECTIVES

This systematic review aimed to evaluate the effectiveness of auxiliary aids-Transcutaneous Electrical Nerve Stimulation (TENS), vibrotactile devices, and Low-Level Laser Therapy (LLLT) in reducing pain and anxiety during dental local anesthesia in pediatric patients.

METHODS

The review followed PRISMA guidelines, employing a comprehensive search strategy across multiple databases (PubMed, Cochrane, EBSCO, LILACS, Google Scholar, and Embase) from 2014 to July 2024. Eligibility criteria were based on the PICOS framework, focusing on randomized clinical trials and clinical studies involving pediatric patients undergoing dental procedures with local anesthesia. The interventions included TENS, vibrotactile devices, or LLLT. Pain and anxiety were assessed using validated scales such as the Wong-Baker Faces Pain Rating Scale and physiological measures like heart rate.

RESULTS

Nineteen studies with a total of 1094 pediatric patients aged 4-12 were included. TENS and vibrotactile devices consistently showed significant reductions in pain and anxiety compared to standard methods. LLLT results were more variable, with some studies reporting significant pain reduction while others showed no significant difference. Meta-analysis was not possible due to heterogeneity among the studies. Overall, TENS and vibrotactile devices were more effective in alleviating injection-related pain, especially when combined with cold applications or topical anesthetics.

DISCUSSION

The findings highlight the potential of these auxillary aids as non-invasive and effective adjuncts for reducing pain and anxiety in pediatric dental procedures. LLLT showed mixed outcomes, likely due to variability in application protocols, suggesting a need for standardized methods. While all interventions demonstrated promise, inconsistencies in study designs and subjective measures limit the generalizability of the results.

CONCLUSIONS

TENS and vibrotactile devices are effective auxiliary aids for reducing pain and anxiety during dental local anesthesia in children. Further research is required to optimize LLLT protocols and standardize intervention applications to achieve consistent results across studies.

Effectiveness of an External Cooling and Vibrating Device vs Counterstimulation in Reducing Discomfort of Inferior Alveolar Nerve Block in Pediatric Dental Patients: A Single-blinded Randomized Controlled Trial

Background

Pain management in pediatric patients during dental procedures is very important. Here, the traditional method of behavior management is compared with novel methods.

Aim

To compare and determine the effectiveness of an external cooling and vibrating device vs counterstimulation with the conventional technique in reducing the fear and discomfort of pediatric dental patients aged 5-7 years during inferior alveolar nerve block (IANB).

Materials and methods

The study population consisted of children aged 5-7 years, rated as positive (+) or negative (-) on the Frankl behavior rating scale, who reported to the Department of Pediatric and Preventive Dentistry and required dental procedures in posterior teeth that warranted the use of IANB.Anxiety measurement was conducted by both objective and subjective means. The subjective measures included Wong-Baker Faces Pain Rating Scale (WBFPRS), as chosen by the patient, and Face, Legs, Activity, Cry, Consolability Scale (FLACC), as recorded by the observer, while the objective measure was pulse rate, recorded by a pulse oximeter.Group A: External cooling and vibrating device (Buzzy).Group B: Counterstimulation group.Group C: Control group.

Results

The WBFPRS score and FLACC score reduced following the intervention in the counterstimulation group, indicating a reduction in pain perception and anxiety compared to the application of Buzzy and the conventional technique.

Conclusion

Counterstimulation was the most effective in reducing pain perception and anxiety during the administration of IANB.

Clinical significance

The injection of local anesthetic remains one of the painful and fear-inducing procedures in pediatric dentistry. This study provides evidence that counterstimulation is effective in reducing pain perception and anxiety during the administration of IANB.

How to cite this article

Ponnan V, Santhakumar M, Thekke Veetil AK. Effectiveness of an External Cooling and Vibrating Device vs Counterstimulation in Reducing Discomfort of Inferior Alveolar Nerve Block in Pediatric Dental Patients: A Single-blinded Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(12):1335-1339.

Comparison of Conventional Syringe with Camouflaged Syringe and Vibration-assisted Syringe for Pain and Fear Perception during Local Anesthetic Administration in Children: A Split-mouth Randomized Controlled Trial

Aim and background

Although local anesthesia (LA) eliminates pain and instills a positive dental attitude, the physical appearance of its syringe is highly fear provoking and often intolerable. Therefore, the purpose of this study was to evaluate the pain and fear perception in camouflaged syringe (CS) and vibration-assisted syringe (VA) when compared with conventional syringe and with each other (VACS) during local anesthetic administration in pediatric patients aged between 6 and 12 years.

Materials and methods

Eighty-five subjects were randomly assigned into three groups: CS group (n = 7), VA group (n = 26), and VACS group (n = 27). Physiological and psychometric scale readings were noted before and after injection. The primary outcome was to assess the change in patients' fear and pain levels using CS and VA vs conventional injection techniques, using the above scales. The secondary outcome was to learn the preference for a particular injection technique by the subjects.

Results

Based on the changes seen in the physiological and psychometric scales, pain and fear control was better in CS in the CS group (p < 0.00 for heart rate, VAS, and SEM score), vibration-assisted syringe in the VA group (p < 0.00 for VAS and SEM score), and vibration-assisted syringe in the VACS group (p < 0.00 for VAS score). The majority preference was CS in the CS group (64%), vibration-assisted syringe in the VA group (60%), and CS in the VACS group (52%).

Conclusion

VA followed by CS is better than the conventional syringe in terms of reducing pain and fear perceived during LA administration. Children preferred CS over VA or the conventional syringe.

Clinical significance

Children's disruptive behavior due to dental fear and pain often results in difficulty in providing effective dental treatment, which is frequently caused by the syringe used in LA delivery. Thus, techniques used to minimize this fear and pain are essential to provide safe, efficient, and quality dental care to children.

Trial registration

The trial was registered with the Clinical Trial Registry of India (CTRI/2023/11/059505).

How to cite this article

Ahmad N, Jindal MK, Agrawal N, et al. Comparison of Conventional Syringe with Camouflaged Syringe and Vibration-assisted Syringe for Pain and Fear Perception during Local Anesthetic Administration in Children: A Split-mouth Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(11):1241-1247.

Recent Developments in the Non-Pharmacological Management of Children's Behavior Based on Distraction Techniques: A Concise Review

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques.

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Reducing pain using vibrating device during local anesthesia among Indian pediatric dental patients

The administration of local anesthesia constitutes one of the most anxiety-inducing and painful stimuli in pediatric dentistry. Therefore, it is of interest to evaluate the effectiveness of vibrating device in comparison to the conventional method for mitigating discomfort while administration of local anesthesia. A total of 30 children aged between 6 and 10 years, requiring local anesthesia for routine dental treatment, were allocated into two groups: a control group and an experimental group, with 15 children in each cohort. In the experimental group, a vibrating device was concurrently placed over the cheek during the administration of the local anesthesia. Pain and discomfort were assessed using both the Wong-Baker FACES Pain Rating Scale (WBFPRS) and the FLACC (Face, Legs, Activity, Cry, CONSOL ability) scale. It was observed that use of the vibrating device was found to be effective in reducing pain and discomfort during the administration of intraoral local anesthesia.

Novel dental anesthetic and associated devices: a scoping review

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.

Efficacy of kaleidoscope, virtual reality, and video games to alleviate dental anxiety during local anesthesia in children: a randomized clinical trial

Background

Distraction is a technique used to divert a patient's attention from unpleasant procedures. This study aimed to evaluate the effectiveness of kaleidoscopy, virtual reality, and video games in reducing anxiety and pain during invasive dental procedures in children.

Methods

Sixty-six children aged 6 to 9 years were randomly assigned to three groups during local anesthesia administration: Group 1 (kaleidoscope), Group 2 (virtual reality), and Group 3 (mobile video games). The anxiety of the children was evaluated using physiological measures (heart rate) at three different time points: before, during, and after the procedure. The Raghavendra, Madhuri, and Sujata pictorial scale was used as a subjective measure before and after the procedure. Subjective measures of pain were assessed using the Wong-Baker Faces Pain Scale. The data were statistically analyzed using the Kruskal-Wallis and Wilcoxon signed-rank tests.

Results

In the intergroup comparison, there were no statistically significant differences in the physiological measures of anxiety scores between the three groups before, during, and after distraction. Raghavendra, Madhuri, and Sujata pictorial scale scores were assessed before and after distraction, but no statistically significant differences were observed. Among the three groups, the children in Group 2 showed a significant reduction in pain scores.

Conclusion

Compared with kaleidoscopes and video games, virtual reality is a promising distraction technique for reducing dental fear, anxiety, and pain during local anesthesia administration in children.

Intercomparison of Efficacy of Transcutaneous Electrical Nerve Stimulation and Precooling Vibration Device on Pain and Anxiety Management during Administration of Local Anesthesia Injection in 6-12-year-olds

Aim

To compare and evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) and a vibrational precooling system in reducing pain and anxiety during the administration of local anesthesia in children aged 6-12 years old.

Materials and methods

A total of 60 children aged 6-12 years old participated in this randomized controlled trial and were randomly allocated to three groups: the conventional method group, the vibrational precooling system group, and the TENS group. The Modified Dental Anxiety Scale (MDAS), pulse rate, and oxygen saturation were recorded to assess the preoperative anxiety of the participating children. Sound, motor, and eyes (SEM) and face, legs, activity, cry, and consolability (FLACC) scores were recorded during the procedure, along with pulse rate and oxygen saturation, to measure pain during the procedure. This was followed by a self-administered visual analog scale (VAS) to assess the discomfort felt by the child.

Results

A statistically significant reduction in pain was observed with the usage of the vibration system and TENS, as measured by the FLACC scale, compared to the conventional method group. Similarly, statistically significant differences in SEM scores were noted between the vibrational precooling system group and the conventional method group, as well as between the TENS group and the conventional method group, with the highest scores observed in the conventional method group. The children reported the highest comfort levels with the usage of the vibration system, as indicated by the self-administered VAS. However, no statistically significant difference was observed within any group.

Conclusion

The new vibrational precooling system as well as TENS can be effectively used to alleviate the pain experienced during the administration of local anesthesia.

How to cite this article

Singh K, Jhingan P, Mathur S, et al. Intercomparison of Efficacy of Transcutaneous Electrical Nerve Stimulation and Precooling Vibration Device on Pain and Anxiety Management during Administration of Local Anesthesia Injection in 6-12-year-olds. Int J Clin Pediatr Dent 2024;17(3):297-302.

Assessment of Different Distraction Behavioral Methods in Pediatric Dental Clinic: A Systematic Review

Dental anxiety is one of the main problems dentists may face during the treatment of pediatric dental patients; therefore, clinicians tend to perform different behavior management techniques to reduce dental anxiety in children. This review aimed to systematically compare and evaluate the published literature regarding the effects of distraction techniques on anxiety, pain perception, and patient experience during dental practice. A detailed electronic search was conducted on 3 databases including PubMed, Google Scholar, and Cochrane Library. The databases were searched for articles published in the English language between 2015 and 2022. Among 102 studies, 27 studies fulfilled the criteria of eligibility and were included in this study to be analyzed. Numerous approaches have been proposed for the reduction of dental anxiety, out of which the use of audio-visual aids and instruments, active distraction such as tablets, smartphones, and virtual reality glasses showed governance in decreasing the children's anxiety followed by cognitive and behavioral methods.

Pain Relief in Dental Local Anaesthesia with Vibrational Devices: Much Ado about Nothing? A Scoping Review

In recent years, vibrational devices have been introduced in order to reduce patient discomfort in some situations such as orofacial pain, orthodontic therapy, and injection of local anaesthetics. This article aims to review the clinical experience given by the use of these devices in local anaesthesia. The literature search was carried out on the main scientific databases for articles up to November 2022. Eligibility criteria were established, and pertinent articles selected. The results were classified by author, year, type of study, sample size and characteristics, purpose of use, type of vibrational device used, protocol used, and outcomes. Nine relevant articles were found. These are split mouth randomized clinical trials which evaluate the reduction in pain perception with different devices and different protocols of use in children, during procedures which require local analgesia by injection, compared with traditional local anaesthesia with premedication based on anaesthetic gels. Different objective and subjective scales of pain and discomfort perception were used. Although results are promising, some data, such as those relating to vibrational intensity and frequency, are not clear. Evaluations on samples varying by age and context of use are necessary to fully define the indications for this type of aid during oral rehabilitation procedures.

Efficacy of two behavioural management techniques during inferior alveolar nerve block administration in pre-school children: a randomised clinical trial

PURPOSE

To evaluate and compare the efficacy of the hands-eyes-mouth distraction technique (HEM-DT) in reducing anxiety and pain levels and improving the behaviour of pre-school children during inferior alveolar nerve block (IANB) administration to that of the covering patient's vision technique (CPV-T).

METHODS

This study included 52 children aged 3-5 years old with primary dentition, no history of receiving local anaesthesia, and whose treatments required an IANB. These children were randomly assigned into two groups: HEM-DT (G1; n = 26) and CPV-T (G2; n = 26). Anxiety and pain levels were assessed using the Facial Image Scale and the Wong-Baker Scale, respectively, while the patient's behaviour was evaluated using the Frankl Behaviour Scale. This study was divided into two sessions including the treatment session (administration of IANB) and the control session (7 days after anaesthesia). Chi-square test, the Mann-Whitney U test and Wilcoxon test were used for statistical analyses.

RESULTS

The patients' anxiety levels did not increase 7 days after IANB in G1 (p value = 0.798); however, higher anxiety levels were observed in the G2 group (p value = 0.039). No significant differences in pain levels and behaviour were observed between the groups during administration of anaesthesia (p value > 0.005).

CONCLUSION

HEM-DT and CPV-T showed efficacy in terms of pain and behaviour during IANB administration. Pre-school children in the HEM-DT group exhibited lower anxiety levels in the control session.

TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION

ClinicalTrials.gov (NCT02591797). October 28, 2015.

Management of fear and anxiety in dental treatments: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVES

This systematic review was to compare the effects of interventions for the management of fear and anxiety for dental treatments.

METHODS

This research project was applied to PubMed, CENTRAL, Web of Science, Cochrane library databases. The last search was run on March 31st, 2021. A list of references of relevant articles and previous reviews were checked. Qualitative and quantitative analyses were performed.

RESULTS

A total of 20 eligible randomized controlled trials were included, and 969 participations in experimental group and 892 participations in the control group were involved. Anxiety levels decreased more in intervention groups than in control groups (Z = 3.47, P = 0.0005, SMD = - 0.62, 95% CI - 0.98 to - 0.27). For adults, there was statistical difference between experimental and control groups [Z = 2.14, P = 0.03, 95% CI - 0.54 (- 1.03, - 0.04)], while there was not no such statistical difference in children and adolescents [Z = 1.62, P = 0.11, 95% CI - 0.60 (- 1.32, 0.13)]. Patients experienced a significant decrease in anxiety level using sedation drugs [Z = 2.44, P = 0.01, 95% CI - 0.61 (- 1.10, - 0.12)] and audio-visual distractions [Z = 3.1, P = 0.002, 95% CI - 0.86 (- 1.40, - 0.32)]. For the informative intervention groups, patients did not show significant difference than control groups [Z = 1.22, P = 0.22, 95% CI - 0.55 (- 1.43, 0. 33)]. There was no statistical difference in vital signs [Z = 1.39, P = 0.16, 95% CI - 0.25 (- 0.61, 0.10)] and pain levels [Z = 0.69, P = 0.49; SMD = - 0.06, 95% CI (0.27, 0.11)] between intervention and control groups.

CONCLUSIONS

Interventions should be used in managing anxiety and fear for dental treatment. It might be effective for anxiety alleviating for adults, but there was a low certainty of evidence that interventions could reduce anxiety level in children and adolescents. Sedation drugs and audio-visual distractions might be useful for managing dental fear and anxiety. Pain levels and vital signs could not be improved form our study. High-quality randomized clinical trials are required for further study.

The Effect of External Cold and Vibration on Infiltration-Induced Pain in Children: A Randomized Clinical Trial

Introduction. Children’s fear of and anxiety about dental treatments are important problems in maintaining health. The anesthetic injection is the main cause of dental fear. One of the methods to reduce the infiltration-induced pain is to use external cold or vibration using the gate control system. Various devices have been used to apply cold and vibration, including the BUZZY device (BUZZY Company, Arizona). Studies have shown contradictory results for the effectiveness of cold and vibration. This study aimed to investigate the effect of cold and vibration versus cold alone on maxillary infiltration-induced pain and stress. Methods. Thirty children aged 6–12 years who required profound restoration of deciduous or permanent first molars were recruited in this randomized double-blind clinical trial. The anesthetic gel and BUZZY device were used in half of the children’s jaws, and the anesthetic gel and the cold alone were used in the other half of the jaws. To measure stress from the heart rate, the Wong–Baker scale was used as the subjective scale, and the face, legs, activity, cry, consolability (FLACC) scale was used as the objective scale. Results. The FLACC score was significantly lower in the BUZZY group than in the cold-alone group, but the Wong–Baker scale and heart rate did not show a significant difference between the two groups. Conclusions. The BUZZY device can be effective in reducing infiltration-induced dental pain.

Topical Anesthesia in Pediatric Dentistry: An Update

Topical anesthetics are very important tools for improving comfort in any dental procedure in children. different methods, techniques of achieving topical anesthesia are reported in the literature. The present narrative review focuses on explaining different types of topical anesthesia with a special focus on pediatric dentistry. How to cite this article: Tirupathi S, Rajasekhar S. Topical Anesthesia in Pediatric Dentistry: An Update. Int J Clin Pediatr Dent 2022;15(2):240-245.

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.

Effect of vibration devices on pain associated with dental injections in children: A systematic review and meta-analysis

BACKGROUND

Several methods including vibration have been proposed for pain control during a local anaesthetic injection. This study was aimed to evaluate the scientific evidence on vibration devices used to reduce injection pain perception in children.

METHODS

The search terms were chosen according to the Medical Subject Headings MeSH and non-MeSH. Potentially eligible studies involved the subjective or objective pain evaluation in children receiving any type of dental injection. An electronic search of published studies in English language was carried out in March 2020 on Scopus, Cochrane, and PubMed databases.Of 1659 articles retrieved initially, 14 were eligible to be included in the systematic review, of which eight articles were excluded. The vibration devices used in the studies included Buzzy or DentalVibe. Four studies using Dentalvibe contributed to the meta-analysis.

RESULTS

The results of meta-analysis indicated a mean difference of 0.057 for FLACC pain scores between intervention and control conditions (P-value = 0.740). Wong-Baker Faces scores showed a mean difference of 0.009 (P-value = 0.964), which also showed no statistically significant difference between the intervention and control groups.

CONCLUSIONS

The findings revealed that use of DentalVibe for Paediatric dental injections was not effective in reducing pain perception. However, use of Buzzy showed promising results.

DentalVibe reduces pain during the administration of local anesthetic injection in comparison to 2% lignocaine gel: results from a clinical study

BACKGROUND

This study was designed to compare the efficacy of DentalVibe against 2% lidocaine gel in reducing pain during the administration of local anesthetic injection in the adult population.

METHODS

This was a split-mouth open-label, randomized, controlled clinical study conducted in the Department of Oral and Maxillofacial Surgery of a dental institute. Fifty patients who were scheduled for bilateral dental extractions requiring an inferior alveolar nerve block were enrolled in the study. Site A (n = 50) was coated with 2% lidocaine gel followed by a local anesthetic injection, and DentalVibe with local anesthetic injection was used for Site B (n = 50). The primary outcome was pain, which was recorded immediately after the administration of anesthetic injection using the Visual Analogue Scale [VAS 0 - 10].

RESULTS

The VAS pain scores ranged from 4 to 10 for site A and 0 to 6 for site B. Comparison between the two sites showed a statistically significant difference [Mann-Whitney U test value = 51.50, P < 0.001] favoring site B.

CONCLUSION

This study showed that DentalVibe reduces pain during injection of local anesthesia compared to topical anesthetic gel.

The effect of vibratory stimulus on pain perception during intraoral local anesthesia administration in children: a systematic review and meta-analysis

Background

To evaluate the effectiveness of vibration as a counter-stimulatory measure in reducing subjective pain due to local anesthesia administration in children.

Methods

Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched until April 2020. Studies were screened by titles and abstracts, followed by full text evaluation of the included studies.

Results

A total of seven studies involving 376 children aged 5-17 years were included in the systematic review and meta-analysis. The meta-analysis compared vibration as a counter-stimulatory measure with no vibration as a comparator. The primary outcome evaluated was pain perception or subjective pain reported by the child. The secondary outcome evaluated was objective pain evaluated in each study. The pooled mean difference favored vibration to be effective for the first outcome.

Conclusion

Within the limits of this systematic review, low quality evidence suggests that vibration as a counter-stimulatory measure is effective in reducing the subjective pain reported by children during local anesthesia administration.

The effectiveness of electronic pulsed soft tissue vibration compared with topical anaesthesia in reducing the pain of injection of local anaesthetics in adults: a randomized controlled split-mouth clinical trial

The purpose of this study was to evaluate the effectiveness of an electronic hand-held pulsed vibration device on the pain of local analgesia (LA) injection and physiologic changes. A prospective randomized controlled clinical trial using split-mouth (crossover) design was implemented. The control-side injection was performed after using topical anaesthesia. The experimental side injection was carried out without topical anaesthesia, but with the aid of a switched-on vibration device. Overall, 332 dental LA injections were given to 166 patients for routine exodontia. The pain at penetration and pain during injection were significantly lower in the experimental sides (vibrations sides) compared with those of the controls (P<0.001). Similarly, the heart rate changes at penetration and during injections were significantly lower in the experimental sides (P<0.001). The vibration device was clinically and statistically more effective than topical anaesthesia in the reduction of dental injection pain in adults, measured subjectively and objectively, regardless of the gender, injection technique (infiltration or block) or anxiety level.

Use of vibrating anesthetic device reduces the pain of mesotherapy injections: A randomized split-scalp study

Pain evaluation during local injections is a complex process. Injections cause patient's distress, especially when the target is a sensitive area such as scalp. Nonpharmacological methods as vibration before and during the procedure have been used to reduce pain. Mesotherapy has become a popular nonsurgical procedure for nonscarring alopecia, such as androgenetic alopecia (AGA) and alopecia areata (AA). Vibration has been successfully used in dermatological procedures, pediatrics, and dentistry. No study was found on vibration anesthesia during scalp mesotherapy. To analyze the effect of a vibration anesthetic device (VAD) during scalp mesotherapy on the patients' comfort.This is a randomized split-scalp study; thirty patients received mesotherapy with or without VAD on half of their scalp. Numerical rating scale (NRS) was used to measure self-reported pain. To test difference in means and medians in comparing device use and by treatment (AGA or AA), Student's t tests and Wilcoxon signed rank tests were used. Overall mean pain score on the no vibration-assisted side was 8.0 ± 1.0 while pain score for the vibration side was 2.3 ± 1.5, for AGA (P < .001) and 7.4 ± 1.2 and 2.1 ± 1.3, respectively, for AA (P < .001). Findings were similar for medians. No complications were found following procedure. To the best of our knowledge, this is the first study analyzing the effect of VAD in patients undergoing scalp mesotherapy. The VAD technique was found to be safe, effective, simple, and suitable for scalp procedures.

Can lavender oil inhalation help to overcome dental anxiety and pain in children? A randomized clinical trial

Aromatherapy with essential oils can be used to relieve children. The aim of this study was to evaluate the correlations between psychological and physiologic findings after lavender oil inhalation among children assigned to undergo tooth extraction. A total of 126 children aged between 6 and 12 years were enrolled in the study. The groups were randomly divided into control and lavender groups. The lavender group inhaled 100% lavender oil for 3 min before the interventions, the control group received no prior application. Psychological assessments were made using face image scale (FIS), Face, Legs, Activity, Cry, Consolability (FLACC) and Wong-Baker pain rating scale (WBS). Physiologic changes were assessed using vital signs evaluations. All parameters were noted prior to applications, after inhalation, anesthesia injection, and tooth extraction. The lavender group showed significant lower anxiety and pain scores after tooth extraction (p < 0.05). Significantly lower levels of blood pressures and a significant pulse rate drop were found after inhalation in the lavender group. A statistically significant increase in heart rate was observed after anesthesia injection and tooth extraction in the control group (p < 0.05).Conclusion: Lavender oil can be preferred as a treatment of choice in routine pediatric dentistry.Trial registration number: NCT04115891 (Lavender Oil Inhalation Help to Overcome Dental Anxiety Among Children)What is Known:• Dental anxiety is the most common factor that causes children to have difficulty with the dentist and their parents during treatment.• Aromatherapy with essential oils can be used to relieve children.What is New:• Aromatherapy with lavender oil relieves the child by reducing the level of anxiety and facilitates dental treatment.• During surgical procedures such as local anesthesia and tooth extraction, lavender oil inhalation decreases pain levels of children.

Differential Analgesia From Vibratory Stimulation During Local Injection of Anesthetic: A Randomized Clinical Trial

BACKGROUND

Inadequate pain reduction during anesthetic injection is a significant medical and surgical problem. Vibratory distraction reduces this pain; however, there are minimal data identifying those who respond best.

OBJECTIVE

To quantify analgesia from vibration before anesthetic injection.

MATERIALS AND METHODS

In this partially blinded, single-institution trial, adult participants were randomized to intervention (vibratory anesthetic device, VAD ON) or placebo (VAD OFF). Pain was assessed using the 11-point numeric rating scale (NRS). Relative reduction in NRS between VAD OFF and ON was used to identify minimum clinically important and substantially clinically important difference in pain.

RESULTS

One hundred one tested sites from 87 subjects were assessed. Sixty-three percent were men with a median age of 66 years. From univariate analysis, males, subjects aged <60, and head and neck (HN) treated subjects had a significant reduction in NRS (p < .05). Multivariate analysis identified NRS reductions in females <60 (p = .012), males ≥70 (p = .002), females and males treated on HN (p = .048 and p = .035, respectively), and males ≥70 treated on HN (p = .012). Substantially clinically important difference (≥57% NRS reduction) included subjects <60, females <70, HN treatment aged 60 to 69, males ≥70, and females treated on HN.

CONCLUSION

Vibratory anesthetic device reduces pain during anesthetic injection, primarily for HN treatments and older male subjects.

A Comparative Evaluation of Pain Perception and Comfort of a Patient Using Conventional Syringe and Buzzy System

Aim and objective

To evaluate the pain perception and comfort of patient during local anesthesia (LA) delivery using Buzzy system and conventional syringe.

Materials and methods

Fifty children aged 5 to 10 years were randomly divided into two groups, the main inclusion criteria being administration of LA for dental treatment. Parameters include Wong Baker face pain reading scale (WBFPRS) for subjective evaluation and pulse oximeter and face leg activity crying consolability (FLACC) scale for objective evaluation. The values obtained were statistically analyzed.

Results

FLACC score was higher in conventional group as compared to the Buzzy group, which was statistically significant.

Conclusion

External cold and vibration via Buzzy can reduce pain and anxiety during LA delivery.

How to cite this article

Suohu T, Sharma S, Marwah N, et al. A Comparative Evaluation of Pain Perception and Comfort of a Patient Using Conventional Syringe and Buzzy System. Int J Clin Pediatr Dent 2020;13(1):27–30.