Reaction of 5 and 6 year olds to dental injection after viewing the needle: pilot study

Comparative Evaluation of Two Different Topical Anesthetic Agents in Controlling Pain during Intraoral Local Anesthetic Administration in Children: A Split-mouth Triple-blinded Randomized Clinical Trial

Aim

To compare the efficacy of lignocaine and benzocaine when applied as a topical anesthetic before intraoral local anesthetic administration in children.

Materials and methods

Forty-four patients aged between 4 years and 10 years indicated for pulp therapy of primary teeth under inferior alveolar nerve block were selected for this study. The participants were randomly allocated into two groups of 22 each. Group I (lignocaine gel) and group II (benzocaine gel) were applied before inferior alveolar nerve block. The pain scale was assessed by a trained examiner using the visual analog scale (VAS) and sound eye motor scale.

Results

Lignocaine when used as a topical anesthetic agent showed lower mean scores under both the pain scales when compared with benzocaine but the results were statistically insignificant.

Conclusion

Lignocaine and benzocaine are equally effective when applied as a topical anesthetic agent. But lignocaine was more preferred in taste when compared with benzocaine.

How to cite this article

Kotian N, Mani G, Ramakrishnan M. Comparative Evaluation of Two Different Topical Anesthetic Agents in Controlling Pain during Intraoral Local Anesthetic Administration in Children: A Split-mouth Triple-blinded Randomized Clinical Trial. Int J Clin Pediatr Dent 2021;14(2):180–182.

Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment

BACKGROUND

Delivery of pain-free dentistry is crucial for reducing fear and anxiety, completion of treatment, and increasing acceptance of future dental treatment in children. Local anaesthetic (LA) facilitates this pain-free approach but it remains challenging. A number of interventions to help children cope with delivery of LA have been described, with no consensus on the best method to increase its acceptance.

OBJECTIVES

To evaluate the effects of methods for acceptance of LA in children and adolescents during dental treatment.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 24 May 2019); the Cochrane Central Register of Controlled Trials (CENTRAL; 2019 Issue 4) in the Cochrane Library (searched 24 May 2019); MEDLINE Ovid (1946 to 24 of May 2019); Embase Ovid (1980 to 24 May 2019); and Web of Science (1900 to 24 May 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and World Health Organization International Clinical Trials Registry Platform were also searched to 24 May 2019. There were no restrictions on language or date of publications.

SELECTION CRITERIA

Parallel randomised controlled trials (RCTs) of interventions used to increase acceptance of dental LA in children and adolescents under the age of 18 years.

DATA COLLECTION AND ANALYSIS

We used standard methodological procedures expected by Cochrane. We performed data extraction and assessment of risk of bias independently and in duplicate. We contacted authors for missing information. We assessed the certainty of the body of evidence using GRADE.

MAIN RESULTS

We included 26 trials with 2435 randomised participants aged between 2 and 16 years. Studies were carried out between 2002 and 2019 in dental clinics in the UK, USA, the Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea. Studies included equipment interventions (using several LA delivery devices for injection or audiovisual aids used immediately prior to or during LA delivery or both) and dentist interventions (psychological behaviour interventions delivered in advance of LA (video modelling), or immediately prior to or during delivery of LA or both (hypnosis, counter-stimulation). We judged one study to be at low risk and the rest at high risk of bias. Clinical heterogeneity of the included studies rendered it impossible to pool data into meta-analyses. None of the studies reported on our primary outcome of acceptance of LA. No studies reported on the following secondary outcomes: completion of dental treatment, successful LA/painless treatment, patient satisfaction, parent satisfaction, and adverse events. Audiovisual distraction compared to conventional treatment: the evidence was uncertain for the outcome pain-related behaviour during delivery of LA with a reduction in negative behaviour when 3D video glasses where used in the audiovisual distraction group (risk ratio (RR) 0.13, 95% confidence interval (CI) 0.03 to 0.50; 1 trial, 60 participants; very low-certainty evidence). The wand versus conventional treatment: the evidence was uncertain regarding the effect of the wand on pain-related behaviour during delivery of LA. Four studies reported a benefit in using the wand while the remaining studies results suggested no difference between the two methods of delivering LA (six trials, 704 participants; very low-certainty evidence). Counter-stimulation/distraction versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with children experiencing less pain when counter-stimulation was used (RR 0.12, 95% CI 0.04 to 0.34; 1 trial, 134 participants; very low-certainty evidence). Hypnosis versus conventional treatment: the evidence was uncertain for the outcome pain experience during delivery of LA with participants in the hypnosis group experiencing less pain (mean difference (MD) -1.79, 95% CI -3.01 to -0.57; 1 trial, 29 participants; very low-certainty evidence). Other comparisons considered included pre-cooling of the injection site, the wand versus Sleeper One, the use of a camouflage syringe, use of an electrical counter-stimulation device, and video modelling acclimatisation, and had a single study each. The findings from these other comparisons were insufficient to draw any affirmative conclusions about their effectiveness, and were considered to be very low-certainty evidence.

AUTHORS' CONCLUSIONS

We did not find sufficient evidence to draw firm conclusions as to the best interventions to increase acceptance of LA in children due to variation in methodology and nature/timing of outcome measures. We recommend further parallel RCTs, reported in line with the CONSORT Statement. Care should be taken when choosing outcome measures.

A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6-11-year-old children during local anesthesia administration-a novel approach

Background

The sight of dental injection can bring about severe anxiety in children. Therefore, an alternative method that is convenient, effective, and keeps the needle hidden making it child friendly is necessary. The objective of the study was to compare the efficacy of a camouflaged syringe and conventional syringe on behavior and anxiety in 6–11-year-old children during local anesthesia administration.

Methods

The study was a randomized, crossover clinical study including 30 children. Children were separated into two groups. Group 1 consisted of 15 children aged 6–8 years while group 2 consisted of 15 children aged 9–11 years. This study involved two sessions wherein all the children were injected using conventional and camouflaged syringes in separate sessions. Their behavior was assessed using the Faces, Legs, Activity, Cry, Consolability (FLACC) behavior pain scale and anxiety was assessed by measuring changes in pulse rate. Patient and operator preferences were compared.

Results

The results showed a lower mean change in pulse rate and FLACC scores in the camouflaged group, suggesting a positive behavior and lesser anxiety with camouflaged syringes than with conventional syringes.

Conclusions

The use of camouflaged syringes for anesthesia was demonstrated to be effective in improving the behavior of children and decreasing their anxiety, and is therefore recommended as an alternative to the use of conventional syringes for local anesthesia.

Empirical evidence of the relationship between parental and child dental fear: a structured review and meta-analysis

BACKGROUND

The relationship between parental and child dental fear has been studied for over a century. During this time, the concept of dental fear as well as methodological approaches to studying dental fear in children have evolved considerably.

AIM

To provide an overview of the published empirical evidence on the link between parental and child dental fear.

DESIGN

A structured literature review and meta-analysis.

RESULTS

Forty-three experimental studies from across the six continents were included in the review. The studies ranged widely with respect to research design, methods used, age of children included, and the reported link between parental and child dental fear. The majority of studies confirmed a relationship between parental and child dental fear. This relationship is most evident in children aged 8 and under. A meta-analysis of the available data also confirmed an association between parental and child dental fear.

CONCLUSION

The narrative synthesis as well as the meta-analysis demonstrate a significant relationship between parental and child dental fear, particularly in children 8 years and younger.