Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Clinical Oral Investigations
Published in: Clinical Oral Investigations 6/2021

01-06-2021 | Local Anesthesia in Dentistry | Original Article

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

Authors: Priscila de Camargo Smolarek, Leonardo Siqueira da Silva, Paula Regina Dias Martins, Karen da Cruz Hartman, Marcelo Carlos Bortoluzzi, Ana Cláudia Rodrigues Chibinski

Published in: Clinical Oral Investigations | Issue 6/2021

Login to get access

Abstract

Objectives

To evaluate pain, disruptive behavior, and anxiety in children undergoing different local dental anesthetic techniques.

Methods

This randomized/parallel clinical trial analyzed three groups of patients (9–12 years old) (n = 35) who received infiltrative anesthesia using conventional (CA), vibrational (VBA), and computer-controlled techniques (CCLAD). The outcomes were pain self-perception (Wong-Baker Faces Pain Rating Scale (WBF); Numerical Ranting Scale (NRS)), disruptive behavior (Face, Legg, Activity, Crying, Consolability Scale (FLACC)), anxiety (Corah’s Dental Anxiety Scale; modified Venham Picture test (VPTm)), and physiological parameters (systolic (SBP)/diastolic pressure (DBP); heart rate (HR); oxygen saturation (SpO2); respiratory rate (RR)). Statistical analysis was accomplished using Kruskall-Wallis test and ANOVA for repeated measures (α = 0.05).

Results

Dental anxiety levels at the baseline were similar for all patients. CA promoted less pain than VBA in WBF (p = 0.018) and NRS (p = 0.006) and CCLAD in WBF (p = 0.029). There were no differences in disruptive behavior (FLACC p = 0.573), anxiety (VPTm p = 0.474), blood pressure (SBP p = 0.954; DBP p = 0.899), heart rate (p = 0.726), oxygen saturation (p = 0.477), and respiratory rate (p = 0.930) between anesthetic techniques.

Conclusion

Conventional technique resulted in less pain perception for dental local anesthesia.

Clinical relevance

Conventional technique reduces the self-reported pain in children 9–12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.
Appendix
Available only for authorised users
Literature
1.
Veneva E, Cholakova R, Raycheva R (2019) Efficacy of vibrotactile device DentalVibe in reducing injection pain and anxiety during local anaesthesia in paediatric dental patients: a study protocol for a randomised controlled clinical trial. BMJ Open 9(7):1–7CrossRef
2.
Kuscu OO, Akyuz S (2008) Is it the injection device or the anxiety experienced that causes pain during dental local anaesthesia? Int J Paediatr Dent 18(2):139–145PubMedCrossRef
3.
Tellez M, Potter CM, Kinner DG, Jensen D, Waldron E, Heimberg RG, Myers Virtue S, Zhao H, Ismail AI (2015) Computerized tool to manage dental anxiety: a randomized clinical trial. J Dent Res 94(9 Suppl):174–180CrossRef
4.
Raslan N, Masri R (2018) A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvibe((R)) on injection pain in children. Int J Paediatr Dent 28(1):102–110PubMedCrossRef
5.
Elbay M, Sermet Elbay Ü, Yildirim S, Ugurluel C, Kaya C, Baydemir C (2015) Comparison of injection pain caused by the DentalVibe Injection System versus a traditional syringe for inferior alveolar nerve block anaesthesia in paediatric patients. Eur J Paediatr Dent 16(2):123–131PubMed
6.
APA (2013) American Psychiatric Association. Diagnostic and statistical mannual of mental disorders. American Psychatric Association Publising, Arlington
7.
Khan S, Hamedy R, Lei Y, Ogawa RS, White SN (2016) Anxiety related to nonsurgical root canal treatment: a systematic review. J Endod 42(12):1726–1736PubMedCrossRef
8.
AAPD (2015) American Academy Pediatric Dentistry. Behavior guidance for te pediatric dental patient. Pediatr Dent 37(special issue):266–280
9.
Sriram G (2014) Advances in local anaesthesia: a paediatric overview. Indian J Dent Adv 6(3):1605–1607
10.
Melzack R, Wall PD (1965) Pain mechanisms: a new theory. Science 150(3699):971–979
11.
Ching D, Finkelman M, Loo CY (2014) Effect of the DentalVibe injection system on pain during local anesthesia injections in adolescent patients. Pediatr Dent 36(1):51–56PubMed
12.
Dak-Albab R, Al-Monaqel MB, Koshha R, Shakhashero H, Soudan R (2016) A comparison between the effectiveness of vibration with Dentalvibe and benzocaine gel in relieving pain associated with mandibular injection: a randomized clinical trial. Anaesth Pain Intensive Care 20(1):43–49
13.
Erdogan O, Sinsawat A, Pawa S, Rintanalert D, Vuddhakanok S (2018) Utility of vibratory stimulation for reducing intraoral injection pain. Anesth Prog 65(2):95–99PubMedPubMedCentralCrossRef
14.
Sermet Elbay Ü, Elbay M, Yildirim S, Kaya E, Kaya C, Ugurluel C, BaydemIr C (2016) Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial. Int J Paediatr Dent 26(5):336–345PubMedCrossRef
15.
Grace EG, Barnes DM, Macek MD, Tatum N (2000) Patient and dentist satisfaction with a computerized local anesthetic injection system. Compend Contin Educ Dent 21(9):746–754PubMed
16.
Baghlaf K, Alamoudi N, Elashiry E, Farsi N, El Derwi DA, Abdullah AM (2015) The pain-related behavior and pain perception associated with computerized anesthesia in pulpotomies of mandibular primary molars: a randomized controlled trial. Quintessence Int 46(9):799–806PubMed
17.
Deepak V, Challa RR, Kamatham R, Nuvvula S (2017) Comparison of a new auto-controlled injection system with traditional syringe for mandibular infiltrations in children: a randomized clinical trial. Anesth Essays Res 11(2):431–438PubMedPubMedCentralCrossRef
18.
Mittal M, Kumar A, Srivastava D, Sharma P, Sharma S (2015) Pain perception: computerized versus traditional local anesthesia in pediatric patients. J Clin Pediatr Dent 39(5):470–474PubMedCrossRef
19.
Palm AM, Kirkegaard U, Poulsen S (2004) The wand versus traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset. Pediatr Dent 26(6):481–484PubMed
20.
Versloot J, Veerkamp JS, Hoogstraten J (2008) Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe. Br Dent J 205(1):30–31CrossRef
21.
Smolarek PC, da Silva LS, Martins PRD, Hartman KC, Bortoluzzi MC, Chibinski ACR (2020) Evaluation of pain, disruptive behaviour and anxiety in children aging 5-8 years old undergoing different modalities of local anaesthetic injection for dental treatment: old undergoing different modalities of local anaesthetic injection for dental treatment: a randomised clinical trial. Acta Odontol Scand 78(6):445–453
22.
23.
Frankl SN, Shiere FR, Fogels HR (1962) Should the parent remain with the child in the dental operatory? J Den Child 29(1):150–163
24.
Asarch T, Allen K, Petersen B, Beiraghi S (1999) Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent 21(7):421–425PubMed
25.
Walker BJPDM, Berde B (2019) Acute pain. In: Practice of anesthesia for infants and children. Elservier, Philadelphia, p 1280
26.
Willis MH, Merkel SI, Voepel-Lewis T, Malviya S (2003) FLACC behavioral pain assessment scale: a comparison with the child’s self-report. Pediatr Nurs 29(1):195–198PubMed
27.
28.
Corah NL, Gale EN, Illig SJ (1978) Assessment of a dental anxiety scale. J Am Dent Assoc 97(5):816–825PubMedCrossRef
29.
Ramos-Jorge ML, Pordeus IA (2004) Por que e como medir a ansiedade infantil no ambiente odontologico. Apresentacao do Teste VPT modificado. JBP – Rev Ibero-Am Odontopediatr Odontol Bebê 7(37):282–290
30.
Heaton LJ (2017) Self-reported Dental Anxiety is Associated With Both State Anxiety and Dental Procedure-Related Pain. J Evid Based Dent Pract 17(1):45–47PubMedCrossRef
31.
Maulina T, Djustiana N, Shahib MN (2017) The Effect of Music Intervention on Dental Anxiety During Dental Extraction Procedure. Open Dent J 11(1):565–572PubMedPubMedCentralCrossRef
32.
Shrivastava R, Srivastava R, Shigli K, Prashanth MB, Kumaraswamy BN, Nethravathi TD (2012) Assessment of dental anxiety and its correlation with denture satisfaction in edentulous patients. J Contemp Dent Pract 13(3):257–260PubMedCrossRef
33.
Klingberg G, Broberg AG (2007) Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. Int J Paediatr Dent 17(6):391–406PubMedCrossRef
34.
35.
Carrillo-Diaz M, Crego A, Armfield JM, Romero-Maroto M (2012) Assessing the relative efficacy of cognitive and non-cognitive factors as predictors of dental anxiety. Eur J Oral Sci 120(1):82–90PubMedCrossRef
36.
Caltabiano ML, Croker F, Page L, Sklavos A, Spiteri J, Hanrahan L, Choi R (2018) Dental anxiety in patients attending a student dental clinic. BMC Oral Health 18(1):48PubMedPubMedCentralCrossRef
37.
Costa RSM, Ribeiro SN, Cabral ED (2012) Fatores determinantes de experiência dolorosa durante atendimento odontológico. Revista Dor 13:365–370CrossRef
38.
Sanikop S, Agrawal P, Patil S (2011) Relationship between dental anxiety and pain perception during scaling. J Oral Sci 53(3):341–349PubMedCrossRef
39.
Kazancioglu HO, Dahhan AS, Acar AH (2017) How could multimedia information about dental implant surgery effects patients' anxiety level? Med Oral Patol Oral Cir Bucal 22(1):102–107
40.
Oosterink FM, de Jongh A, Aartman IH (2008) What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 116(1):44–51PubMedCrossRef
41.
Splieth CH, Bunger B, Pine C (2009) Barriers for dental treatment of primary teeth in East and West Germany. Int J Paediatr Dent 19(2):84–90PubMedCrossRef
42.
Jones JE, Dean JA (2016) Local anesthesia and pain control the child and adolescent. In: McDonald and Avery's Dentistry for the child and adolescent. Elservier Health Sciences, St. Louis, p 720
43.
Beyer JE, McGrath PJ, Berde CB (1990) Discordance between self-report and behavioral pain measures in children aged 3-7 years after surgery. J Pain Symptom Manag 5(6):350–356CrossRef
44.
Julian LJ (2011) Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res 63(11):467–472CrossRef
45.
Klein U, Hunzeker C, Hutfless S, Galloway A (2005) Quality of anesthesia for the maxillary primary anterior segment in pediatric patients: comparison of the P-ASA nerve block using CompuMed delivery system vs traditional supraperiosteal injections. J Dent Child (Chic) 72(3):119–125
46.
Eli I (1992) The expirience of pain physicological aspects. Oral psychophysiology: stress, pain and behavior in dental care. CRC press, Boca Ranton, p 214
47.
Raj S, Agarwal M, Aradhya K, Konde S, Nagakishore V (2013) Evaluation of dental fear in children during dental visit using Children's Fear Survey Schedule-Dental Subscale. Int J Clin Pediatr Dent 6(1):12–17PubMedPubMedCentralCrossRef
48.
Belcheva A, Shindova M (2014) Subjective acceptance of pediatric patients during cavity preparation with Er:YAG laser and conventional rotary instrumental. J IMAB Ann Proc (Sci Papers) 5(1):631–633
49.
Shilpapriya M, Jayanthi M, Reddy VN, Sakthivel R, Selvaraju G, Vijayakumar P (2015) Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children. J Indian Soc Pedod Prev Dent 33(3):173–179PubMedCrossRef
50.
Kandiah P, Tahmassebi JF (2012) Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the Wand in children. Br Dent J 213(9):1–5CrossRef
51.
Tahmassebi JF, Nikolaou M, Duggal MS (2009) A comparison of pain and anxiety associated with the administration of maxillary local analgesia with Wand and conventional technique. Eur Arch Paediatr Dent 10(2):77–82PubMedCrossRef
52.
Thoppe-Dhamodhara YK, Asokan S, John BJ, Pollachi-Ramakrishnan G, Ramachandran P, Vilvanathan P (2015) Cartridge syringe vs computer controlled local anesthetic delivery system: Pain related behaviour over two sequential visits—a randomized controlled trial. J Clin Exp Dent 7(4):513–518CrossRef
53.
Feda M, Al Amoudi N, Sharaf A, Hanno A, Farsi N, Masoud I, Almushyt A (2010) A comparative study of children's pain reactions and perceptions to AMSA injection using CCLAD versus traditional injections. J Clin Pediatr Dent 34(3):217–222PubMedCrossRef
54.
Garret-Bernardin A, Cantile T, D’Antò V, Galanakis A, Fauxpoint G, Ferrazzano GF, De Rosa S, Vallogini G, Romeo U, Galeotti A (2017) Pain experience and behavior management in pediatric dentistry: a comparison between traditional local anesthesia and the wand computerized delivery system. Pain Res Manag 2017(1):1–6CrossRef
55.
Oztas N, Ulusu T, Bodur H, Dogan C (2005) The wand in pulp therapy: an alternative to inferior alveolar nerve block. Quintessence Int 36(7-8):559–564PubMed
56.
Smolarek PC, Wambier LM, Siqueira Silva L, Chibinski ACR (2020) Does computerized anaesthesia reduce pain during local anaesthesia in paediatric patients for dental treatment? A systematic review and meta-analysis. Int J Paediatr Dent 30(2):118–135PubMedCrossRef
57.
Al Amoudi N, Feda M, Sharaf A, Hanno A, Farsi N (2008) Assessment of the anesthetic effectiveness of anterior and middle superior alveolar injection using a computerized device versus traditional technique in children. J Clin Pediatr Dent 33(2):97–102PubMedCrossRef
58.
Allen KD, Kotil D, Larzelere RE, Hutfless S, Beiraghi S (2002) Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatr Dent 24(4):315–320PubMed
59.
Franck LS, Greenberg CS, Stevens B (2000) Pain assessment in infants and children. Pediatr Clin N Am 47(3):487–512CrossRef
60.
Mischkowski D, Palacios-Barrios EE, Banker L, Dildine TC, Atlas LY (2018) Pain or nociception? Subjective experience mediates the effects of acute noxious heat on autonomic responses. Pain 159(4):699–711PubMedPubMedCentralCrossRef
61.
Miranda AFA, Silva LF, Caetano JÁ, Sousa AC, Almeida PC (2011) Avaliação da intensidade de dor e sinais vitais no pós-operatório de cirurgia cardíaca. Rev Escola Enfermagem USP 45(1):327–333CrossRef
62.
Sikter A, Frecska E, Braun IM, Gonda X, Rihmer Z (2007) O papel da hiperventilação: a hipocapnia no patomecanismo do distúrbio de pânico. Braz J Psychiatry 29(4):375–379PubMedCrossRef
63.
Chaudhry K, Shishodia M, Singh C, Tuli A (2015) Comparative evaluation of pain perception by vibrating needle (Vibraject™) and conventional syringe anesthesia during various dental procedures in pediatric patients: a short study. Int Dent Med J Adv Res 1(1):1–5
64.
Patini R, Staderini E, Cantiani M, Camodeca A, Guglielmi F, Gallenzi P (2018) Dental anaesthesia for children—effects of a computer-controlled delivery system on pain and heart rate: a randomised clinical trial. Br J Oral Maxillofac Surg 56(8):744–749PubMedCrossRef
65.
Tung J, Carillo C, Udin R, Wilson M, Tanbonliong T (2018) Clinical performance of the DentalVibe(R) injection system on pain perception during local anesthesia in children. J Dent Child (Chic) 85(2):51–57
66.
Masaoka Y, Homma I (1999) Expiratory time determined by individual anxiety levels in humans. J Appl Physiol 86(4):1329–1336PubMedCrossRef
67.
Lopes AC, Amato Neto V, Halpern A, Fonseca AM, Chiattone CS, Quagliato EM, Baracat F, Messas GP, Junior M, Jayme A (2006) Tratado de clínica médica, 1st edn. Roca, São Paulo
68.
Versloot J, Veerkamp JS, Hoogstraten J (2005) Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children. Eur J Oral Sci 113(6):488–493PubMedCrossRef
69.
Gibson RS, Allen K, Hutfless S, Beiraghi S (2000) The Wand vs. traditional injection: a comparison of pain related behaviors. Pediatr Dent 22(6):458–462PubMed
70.
Oliveira MF, Moraes MVM, Cardoso DD (2012) Avaliação da ansiedade infantil prévia ao tratamento odontológico. Publ UEPG Ci Biol Saúde 18(1):31–38CrossRef
71.
72.
Versloot J, Veerkamp JS, Hoogstraten JJP (2008) Children’s self-reported pain at the dentist. Pain 137(2):389–394
Metadata
Title
The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety
Authors
Priscila de Camargo Smolarek
Leonardo Siqueira da Silva
Paula Regina Dias Martins
Karen da Cruz Hartman
Marcelo Carlos Bortoluzzi
Ana Cláudia Rodrigues Chibinski
Publication date
01-06-2021
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 6/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-020-03713-7

Other articles of this Issue 6/2021

Clinical Oral Investigations 6/2021 Go to the issue

Original Article

Free amino acid composition of saliva in patients with healthy periodontium and periodontitis

Original Article

Influence of different endodontic sealers on bond strength of fiber posts to weakened roots after resin restoration

Original Article

Is MRI a viable alternative to CT/CBCT to identify the course of the inferior alveolar nerve in relation to the roots of the third molars?

Original Article

Clinical, radiographic, and histological evaluation of three different pulp-capping materials in indirect pulp treatment of primary teeth: a randomized clinical trial

Original Article

Localization of interleukin-6 signaling complex in epithelialized apical lesions of endodontic origin

Original Article

The consumption of milk supplemented with probiotics decreases the occurrence of caries and the salivary concentration of hβD-3 in children