Computerized local dental anesthetic systems: patient and dentist satisfaction

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.

A Novel Scale to Assess Parental Satisfaction of Dental Local Anesthetic Techniques in Children: A Cross-Sectional Study

Background

Pain control is one of the most important aspects that can affect parental satisfaction of the dental care provided for children. Dental local anesthesia has the highest impact on pain sensation of the children. However, there is no scale in the literature to assess parental satisfaction of dental local anesthetic techniques.

Objectives

This study was aimed to assess the parental satisfaction with dental local anesthetic techniques for their children through designing a scale that reflects satisfaction and to study the validity and reliability of this scale.

Methods

A cross-sectional observational study was conducted on 150 parents (102 mothers and 48 fathers). Two techniques of local anesthesia were used for each child participated in this study (inferior alveolar nerve block and computerized intraosseous anesthesia). The developed scale consisted of 20 items in a 5-point Likert scale. Half of the items were written in a negative format. Internal consistency, validity, and factor analysis were performed in this study. Independent t-test was used to compare between the two techniques of anesthesia, between boys and girls and among fathers and mothers.

Results

Parental satisfaction mean values were higher in the computerized intraosseous anesthesia group in comparison to inferior alveolar nerve block (P value <0.05). The T-test showed that there was no difference between boys and girls regarding parental satisfaction (P value >0.05). Furthermore, fathers show lower satisfaction in the computerized interosseous anesthesia group (P value <0.05). Excellent internal consistency of this scale was resulted as Cronbach's alpha reliability coefficient was 0.985. After factor analysis, seven factor components were retained by using varimax rotation.

Conclusions

Findings of this study reported that the designed parental satisfaction of dental local anesthetic techniques scale (PSLAS) is a valid and reliable scale to be used. Moreover, this study showed that parental satisfaction was higher when computerized intraosseous anesthesia was used in comparison to inferior alveolar nerve block.

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.

Computer-controlled Intraligamentary local anaesthesia in extraction of mandibular primary molars: randomised controlled clinical trial

BACKGROUND

Local anesthesia (LA) poses a threat in children more than the treatment process itself, so pediatric dentists are always demanding less painful techniques. Computer-controlled Intraligamentary anaesthesia (CC-ILA) is designed to reduce injection pain and side effects of conventional techniques. The present study aims to assess the pain experience using Computer-controlled Intraligamentary anaesthesia (CC-ILA) during injection and its effectiveness in controlling pain during extraction of mandibular primary molars in pediatric patients.

METHODS

This randomized controlled clinical trial includes 50 healthy cooperative children, aged 5-7 years with mandibular primary molars indicated for extraction. They were randomly allocated to two groups according to LA technique: test group received CC-ILA and control group received Inferior alveolar nerve block (IANB). Pain was measured during injection and extraction: physiologically using Heart rate (HR), subjectively using Face-Pain-Scale (FPS), and objectively using Sound-Eye-Motor scale (SEM). Patients were recalled after 24-h to record lip-biting events. Data was collected and statistically analysed.

RESULTS

A total of 50 children (29 females and 21 males) with mean age 6.10 ± 0.76 participated in the study. There were significantly lower scores in the heart rate in the CC-ILA group during injection (p = 0.04), but no significant difference was recorded between the two groups during extraction (p = 0.17). The SEM and FPS showed significant lower scores in the CC-ILA group during injection (p < 0.0001, p < 0.0001) and extraction (p < 0.0001, p = 0.01) respectively. No children in CC-ILA group reported lip-biting after 24-h compared to 32% in IANB (p < 0.0001).

CONCLUSION

CC-ILA provides significantly less painful injections than conventional techniques and has proved to be as effective as IANB during extraction of mandibular primary molars. An important advantage of this technique was the complete absence of any lip/cheek biting events. Trial registration The study was prospectively registered in ClinicalTrials.gov with the identifier: NCT04739735 on 26th of January 2021, https://clinicaltrials.gov/ct2/show/NCT04739735 .

Pain Experienced during Various Dental Procedures: Clinical Trial Comparing the Use of Traditional Syringes with the Controlled-Flow Delivery Dentapen® Technique

Background and Objectives: Currently, one of the most discouraging aspects for many patients undergoing dental procedures is the administration of anaesthesia. Consequently, there is a constant search for new techniques to avoid the invasive and painful nature of the injection. A new motorised syringe system (Dentapen^®) has recently been developed, standing out for its convenience and ease of use. Material and Methods: Randomised, controlled, single-blind, and single-centre study including 178 voluntary adult participants aged between 18 and 90 years. Individuals were randomly assigned using a randomised table. Patients were asked to rate the level of pain experienced during the injections, using a 10-point visual analogue scale (VAS). The following data were recorded: pain index, heart rate, blood pressure, and saturation, both before and after anaesthesia. Results: Of the total 178 participants, 87 participants (48.9%) were men and 91 (51.1%) were women. The first variable to be assessed was the pain experienced by patients when anaesthetised with a syringe, obtaining a mean value of 2.63 ± 1.86 on the VAS with the conventional syringe and 1.06 ± 1.28 with the Dentapen^® syringe, showing statistically significant differences (p-value < 0.01). When stratifying, based on the procedure that was undertaken, differences were also significant for all treatments (p-value < 0.01) except for endodontics, where differences were likely to be significant (p-value = 0.02). Conclusions: In conclusion, from a clinical standpoint, the Dentapen^® syringe is a valid alternative to traditional infiltration syringes, causing minimum pain with the injection.

"Comparative study of conventional anesthesia technique versus computerized system anesthesia: a randomized clinical trial"

OBJECTIVE

The aim of the present study was to compare in terms of pain perception the use of conventional anesthesia and a computerized system.

MATERIALS AND METHODS

Forty patients in need for extractions, dental restorative, or periodontal treatment bilaterally, were selected. Each patient served as his/her own control being subjected to two anesthesia techniques: conventional and electronically controlled anesthesia with Calaject® (Rønvig Dental MFG, Daugaard, Denmark). Each patient received both treatments in a blind way 1 week apart. The order was previously randomized. After performing the anesthesia (upper dental nerve, palatal posterior nerve, or inferior alveolar nerve), the patients evaluated their pain sensation with a visual analogue scale (VAS) (0-10). After treatment, the patients were asked about the presence of pain during the procedure. Finally, the patients selected their preference between the conventional and electronic anesthesia technique. Differences in assessment of pain's injection were analyzed using the Wilcoxon test and the Kruskal-Wallis test (α = 0.05).

RESULTS

The mean general pain experienced was 3.73 (1.55 SD) for the conventional anesthesia, and 1.95 (0.53 SD) for computerized anesthesia. Statistical differences (p < 0.05) were found. There was no difference between the treatments (p value = 0.061). Most patients did not feel any pain during the treatment. Finally, 92.5% of the patients preferred the electronic system.

CONCLUSIONS

Computerized anesthesia system produces significantly less pain compared with a conventional anesthesia syringe. Although both obtained sufficient anesthetic depth to perform treatments, the majority of patients chose electronic anesthesia as the most satisfactory.

CLINICAL RELEVANCE

Computerized anesthesia devices are valid and more comfortable alternative to conventional anesthesia.

Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: A randomized clinical trial

BACKGROUND

Contemporary innovations in the area of local anesthesia have attempted to provide an absolutely pain free experience for patients. Since the introduction of Computer-Controlled Local Anesthetic Delivery Systems to dentistry, many studies have compared its efficacy and safety to conventional anesthesia. However, very few studies have compared single tooth anesthesia (STA) and traditional local anesthesia.

AIM

To compare pain rating, changes in blood pressure, and heart rate during the local anesthetic injection. The secondary objectives were to measure the patients’ level of satisfaction and the differences in anesthetic efficiency between the STA system and traditional local infiltration.

METHODS

A randomized controlled trial was conducted and a total of 80 patients with dental restorative needs were enrolled for the study. The patients were evaluated for their general physical status and oral clinical findings before enrollment. Information regarding perceived pain, changes in heart rate and blood pressure, and patients’ satisfaction was collected using an electronic data form and was analyzed using paired and unpaired t-tests.

RESULTS

No significant difference was noted in perceived pain (P = 0.59) and systolic blood pressure (P = 0.09) during anesthetic injection using both traditional and STA techniques. STA patients had a significantly higher heart rate during anesthesia, although a statistically significant difference was noted among the traditional anesthesia and the STA groups even before anesthesia. During the restorative procedure, less pain was perceived by STA patients on the Wong-Baker FACES pain scale, which was statistically significant (P < 0.001). Analyses of post-procedure patient responses showed that STA patients had a significantly better treatment experience and preferred to have the same method of injection in the future (P = 0.04).

CONCLUSION

STA system can provide less painful and more comfortable restorative treatment procedures in comparison to the traditional infiltration technique.

Alternative practices of achieving anaesthesia for dental procedures: a review

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations.

Avaliação da eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de dentes decíduos: estudo-piloto

Resumo Introdução O medo de sentir dor é um dos principais motivos pelos quais muitos pacientes evitam submeter-se a tratamento dentário, principalmente as crianças. Em vários procedimentos odontopediátricos, o uso de anestésicos locais se faz necessário. O aparelho Morpheus® se propõe a uma introdução da agulha sem dor e anestesia satisfatória com uso de menor volume de anestésico local. Associando-o à técnica CaZOE, o paciente perceberia a pressão antes da dor, podendo assim evitá-la. Objetivo Avaliar a eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos. Material e método Dezenove voluntários foram selecionados de acordo com os critérios de inclusão e exclusão. O procedimento foi realizado em sessão única, utilizando 0,9 mL de Articaína 4% com epinefrina 1:100.000, através da técnica anestésica CaZOE, empregando o injetor de anestésicos Morpheus®. Esta foi realizada por um único operador, não envolvido na avaliação dos parâmetros da anestesia, e seguiu as recomendações do fabricante. Para a análise dos dados, foi realizada estatística descritiva. Resultado Dos 19 voluntários, 63% foram do sexo feminino e 37%, do masculino. Em pouco mais da metade da amostra (63%), houve sucesso na realização do procedimento. Os casos de insucesso (37%) ocorreram durante a abertura coronária e a amputação da polpa. Conclusão A eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos foi constatada em 63% da amostra. Para que possa ser comprovada a eficácia desse sistema, são necessários mais estudos.

Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

Effective anaesthesia of the acutely inflamed pulp: part 2. Clinical strategies

Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. Following discussion on the possible reasons for this occurrence in part 1, part 2 outlines the various local anaesthetic techniques that practitioners can use to overcome the acutely inflamed mandibular molar. They should then be able to apply these same principles to help anaesthetise any other tooth presenting with an acutely inflamed pulp. Techniques are discussed in detail along with key variables that have been associated with having an impact on the anaesthetic efficacy. This is to bring to light factors that can aid anaesthetic success as well as dispel common misnomers.

Advances in dental local anesthesia techniques and devices: An update

Although local anesthesia remains the backbone of pain control in dentistry, researches are going to seek new and better means of managing the pain. Most of the researches are focused on improvement in the area of anesthetic agents, delivery devices and technique involved. Newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and fewer adverse effects. This overview will enlighten the practicing dentists regarding newer devices and methods of rendering pain control comparing these with the earlier used ones on the basis of research and clinical studies available.

Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children

AIM

The present study was taken up to clinically evaluate and compare effectiveness of transcutaneous electrical nerve stimulator (TENS) and comfort control syringe (CCS) in various pediatric dental procedures as an alternative to the conventional method of local anesthesia (LA) administration.

MATERIALS AND METHODS

Ninety healthy children having at least one deciduous molar tooth indicated for extraction in either maxillary right or left quadrant in age group of 6 to 10 years were randomly divided into three equal groups having 30 subjects each. Group I: LA administration using conventional syringe, group II: LA administration using TENS along with the conventional syringe, group III: LA administration using CCS. After LA by the three techniques, pain, anxiety and heart rate were measured.

STATISTICAL ANALYSIS

The observations, thus, obtained were subjected to statistical analysis using analysis of variance (ANOVA), student t-test and paired t-test.

RESULTS

The mean pain score was maximum in group I followed by group II, while group III revealed the minimum pain, where LA was administered using CCS. Mean anxiety score was maximum in group I followed by group II, while group III revealed the minimum score. Mean heart rate was maximum in group I followed in descending order by groups II and III.

CONCLUSION

The study supports the belief that CCS could be a viable alternative in comparison to the other two methods of LA delivery in children. How to cite this article: Bansal N, Saha S, Jaiswal JN, Samadi F. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. Int J Clin Pediatr Dent 2014;7(2):71-76.

Supplemental pulpal anesthesia for mandibular teeth

Clinical pulpal anesthesia is dependent on the interaction of three major factors. (1) the dentist (2) the patient and (3) local anesthesia. Many patients fear endodontic treatment due to a concern about pain. Although pain treatment is well managed in many endodontic patients, there exists a group of patients who do not receive adequate local anesthesia. The purpose of this review article is to discuss the possible reasons for pulpal anesthetic failures and also to focus on the measures for developing effective approaches for the same.

Advanced techniques and armamentarium for dental local anesthesia

Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis.

Speed of Injection Influences Efficacy of Inferior Alveolar Nerve Blocks: A Double-Blind Randomized Controlled Trial in Volunteers

This randomized double-blind crossover trial investigated the efficacy and discomfort associated with slow (60 seconds) and rapid (15 seconds) inferior alveolar nerve blocks (IANB) using 2.0 ml of 2% lidocaine with 1:80,000 epinephrine in securing mandibular first molar, premolar and lateral incisor pulp anesthesia in 38 healthy adult volunteers. Episodes of maximal stimulation (80 microA) without sensation on electronic pulp testing were recorded. Injection discomfort was self-recorded by volunteers on 100 mm visual analogue scales. Data were analyzed by McNemar, Friedman, Wilcoxon Signed Ranks, and paired t tests. Slow IANB produced more episodes of no response to maximal pulp stimulation than rapid IANB in molars (220 episodes versus 159, p < 0.001), premolars (253 episodes versus 216, p = 0.003) and lateral incisors (119 episodes versus 99, p = 0.049). Slow IANB was more comfortable than rapid IANB (p = 0.021).

A Survey of Pain, Pressure, and Discomfort Induced by Commonly Used Oral Local Anesthesia Injections

Intraoral local anesthesia is essential for delivering dental care. However, it is often perceived by some patients as the most painful and in some instances as the only painful part of the treatment, leading in extreme cases to avoidance of dental care. The present study measured the variables of pain, pressure, and discomfort caused by 4 commonly used local anesthesia injections: local infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament injections. Patients were asked to grade pain, discomfort, and pressure on a visual analog scale as associated with needle insertion, operator finger position in the mouth, and pressure at injection. The inferior alveolar injection was graded to be the most painful followed by periodontal ligament and then mental nerve block injections. The periodontal ligament injections yielded the highest pressure scores. The inferior alveolar block injection yielded significantly more discomfort than local infiltration and mental nerve block injections when comparing finger and needle position. Local infiltration in the anterior maxillary region yielded the highest needle insertion and finger position discomfort scores. The present study suggests that the dental operator should be aware of local anesthesia injection pain, pressure, and discomfort together with efficacy of technique.