Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

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.

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.

Cryoanesthesia with ethyl chloride spray versus 5% lidocaine gel in alleviating oral local anesthetic injection pain for buccal anaesthesia: A randomized clinical (controlled) trial

Background

Numbing the area of oral mucosa with cold application prior to administration of regional anesthesia has been widely used by various dentists in alleviating pain caused by needle prick. Cryoanesthesia using Endo-ice as topical anesthesia has been studied as a replacement to prevail the fallibility of topical anaesthetics. This study aimed to evaluate and compare effectiveness of ethyl chloride spray with 5% lidocaine gel in alleviating buccal anesthesia injection pain.

Methods

Total of 90 outpatients were randomly divided into 3 groups as follows: Group 1 - cryotherapy with ethyl chloride at the anesthetic site preceding before administration of local anesthesia; Group 2 - topical application of 5% LIDOCAINE GEL preceding before administration of local anesthesia; and group 3 - control that did not receive any topical agent preceding before administration of local anesthesia. Visual analogue scale (VAS) was used to document pain immediately after injection prick.

Results

About comparison of pain scores, significant difference was found between group 1 (ethyl chloride) and group 2 (topical lidocaine) patients (P=0.001). For group 1, about 15 (50%) patients suffered from mild pain, followed by 14 (46.67%) patients suffering from moderate pain. However, majority of the 21 (70%) patients in group 2 suffered from moderate pain. All the patients in group 3 suffered from severe pain.

Conclusion

Importance of alleviating fear of needle injection phobia amongst patients is of paramount importance. Ethyl chloride was found to be more effective than topical lidocaine in alleviating needle injection pain before administration of local anesthetic injection.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Do Computerized Delivery System Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature

PURPOSE

The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures.

METHODS

This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another.

RESULTS

Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated.

CONCLUSIONS

Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.

Comparative evaluation of efficacy of external vibrating device and counterstimulation on child's dental anxiety and pain perception during local anesthetic administration: a clinical trial

Background

This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration.

Methods

This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4–11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05.

Results

Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group.

Conclusion

External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.

Blood pressure monitoring following individual carpules of anesthetic utilizing computer-controlled anesthetic delivery

To date, no study has evaluated blood pressure following administration of each carpule given for dental procedures using a computerized dental anesthesia system. Blood pressures taken prior to performing invasive periodontal procedures were compared with those readings measured following delivery of each of up to three consecutive carpules of Marcaine or Xylocaine in varying order. Pressure differences were also adjusted for age, sex, race, and whether a prescribed anxiolytic was taken beforehand. Neither systolic nor diastolic blood pressures changed significantly as compared to initial blood pressure readings. However, compared with Whites, Hispanics, and Middle Easterners, Blacks had significantly higher systolic pressure at the third carpule delivery, the cause being unknown. Blood pressure in patients being anesthetized for root planing and various periodontal surgical procedures will not increase significantly when administering up to three carpules, whether Marcaine or Xylocaine, in varying order, using controlled flow dental anesthesia, and this method may be preferable to syringes in managing dental procedural stress.

Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study

There is evidence that the Computer-Controlled Local Anesthetic Device (CCLAD) decreases the pain of oral injections. The purpose of this study was to evaluate injection pain of the inferior alveolar nerve block (IANB) using the CCLAD in an upright position versus a supine position. Additionally, we evaluated solution deposition pain with the CCLAD when compared to previous studies using a traditional syringe. One hundred ten asymptomatic subjects were randomly given IANBs using 2% lidocaine with 1:100,000 epinephrine while in an upright sitting position and supine position, at 2 different appointments, spaced at least 2 weeks apart. Each subject rated the pain for needle insertion, needle placement, and solution deposition on a Heft-Parker visual analogue scale. Pain ratings were compared between the upright and supine positions using a repeated-measures analysis of variance with post hoc testing using the Tukey-Kramer procedure. Moderate to severe pain was reported by 10% to 13% of the patients for needle insertion, 74% to 75% for full needle placement, and 8% to 10% for solution deposition. There was no significant difference between groups for phases of the injection. When comparing the injection phases within the groups, the needle placement phase of the injection was statistically more painful than both the needle insertion phase and solution deposition phase ( p = .0001). Using the CCLAD, IANB injection pain of the supine and upright positions was not statistically different. Needle placement was the most painful phase of the injection. Solution deposition pain was less with the CCLAD when compared to other studies of the IANB using a traditional syringe.

Comparison of anxiety and pain perceived with conventional and computerized local anesthesia delivery systems for different stages of anesthesia delivery in maxillary and mandibular nerve blocks

Background

Fear of local anesthesia (LA) is a significant impediment to dental care as many patients delay or avoid treatment to avert pain. Computer-controlled local anesthetic delivery system (CCLAD), with constant and controlled rate of flow, present a painless alternative. The present study aimed to compare anxiety and pain perceived with conventional and computerized systems, for different stages of anesthesia delivery when administering various nerve blocks.

Methods

One hundred patients requiring bilateral LA participated in the study. One side was anesthetized using one system and the contralateral side was anesthetized using the other, in two separate appointments. Patients assigned anxiety scores on a 5-point scale and used the visual analogue scale (VAS) for pain determination at needle insertion, during delivery of anesthetic solution, immediately after injection, and at the end of the periodontal procedure. Each patient's preference for the delivery system of future injections was also recorded.

Results

Patients reported significantly lower anxiety levels with CCLAD compared to the syringe. Significantly lower mean VAS scores for anesthesia deposition, pain immediately after, and at the end of the periodontal procedure were also noted. However, pain at needle insertion was comparable between the two systems, with no statistical significance. Overall, 64.4% patients preferred CCLAD for future anesthesia.

Conclusion

Lower pain perceived with CCLAD and higher preference for the system suggest that CCLAD should replace conventional syringes to allow pain-free dental treatment.

Single tooth anesthesia versus conventional anesthesia: a cross-over study

OBJECTIVES

The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment.

MATERIALS AND METHODS

Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001).

RESULTS

The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections.

CONCLUSION

The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters.

CLINICAL RELEVANCE

Single Tooth Anesthesia could be an efficacious alternative to conventional procedures.

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index

AIM

The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology.

METHODS

Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients.

RESULTS

A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$.

CONCLUSIONS

Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

Association between Anxiety and Pain in Dental Treatment: A Systematic Review and Meta-analysis

Accumulating evidence has revealed that dental anxiety (DA), as a dispositional factor toward the dental situation, is associated with the state anxiety (SA) and pain related to dental procedures. However, conclusions from individual studies may be limited by the treatment procedures that patients received, the tools used to assess DA, or the treatment stages when anxiety or pain was assessed. It is unclear whether DA, at the study level, accounts for the variance in pretreatment SA. The impact of DA and SA on pain at different treatment stages has not been systematically investigated. To address these questions, we present novel meta-analytical evidence from 35 articles (encompassing 47 clinical groups) that investigated DA in a clinical group. Subgroup analyses revealed that the studies of surgical and nonsurgical procedures did not significantly differ in either DA or pretreatment SA. Furthermore, metaregressions revealed DA as a significant predictor that explained the variance in SA assessed before and during treatment but not after treatment. The findings suggest that patient DA has a significant impact on patient SA. Metaregressions revealed DA as a significant predictor that explained the variance in expected pain, pain during treatment and posttreatment pain. In contrast, pretreatment SA was a significant predictor that explained the variance in expected pain. The findings reveal that DA has a consistent impact on pain through the entire period of dental treatment. Altogether, the findings highlight the role of DA as an overall indicator for anxiety and pain, across different types of dental procedures or treatment stages. We conclude that anxiety should be assessed as a critical step not only in anxiety management for high-DA patients, but also in pain control for all dental patients.

Effectiveness of benzocaine in reducing deep cavity restoration and post-extraction stress in dental patients

Objectives:

To investigate the effectiveness of topical anesthetic, 20% benzocaine in relieving pain and stress in patients following deep cavity restoration and extraction of teeth under local anesthesia (LA).

Methods:

A prospective clinical trial was conducted from October 2014 until April 2015 at Taibah University, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. Forty-five patients were included in the 20% benzocaine group, and 46 in the normal saline group. Evaluation of the dental stress was made pre-operatively and immediately post-operative treatment using the visual analogue scale (VAS). Furthermore, discomfort of the injections were recorded by the patients after each treatment on standard 100 mm VAS, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm).

Results:

There were statistically significant differences between the mean stress scores for patients in the benzocaine and normal saline groups post-operatively (p=0.002). There were significant differences between the mean pain scores for patients in the post buccal injection (p=0.001), post palatal injection (p=0.01), and the post inferior alveolar nerve block groups (p=0.02). Buccal, palatal, and inferior alveolar nerve block injections were more painful for patients in the normal saline group than the benzocaine group.

Conclusion:

This investigation has demonstrated that post-operative stress associated with deep cavity restoration and dental extractions under LA can be reduced by the application of topical anesthetic (20% benzocaine) at the operative site for intra-oral injections.

Computer-controlled local anesthetic delivery for painless anesthesia: a literature review

Local anesthesia is administered to reduce pain during dental treatments, but may itself cause pain and contribute to increased dental fear. Computer-controlled local anesthetic delivery (CCLAD) is one the method to reduce patient pain during local anesthesia; it is a device that slowly administers anesthetics by using a computerized device to control the injection speed. This literature review aims to provide an objective assessment of the usefulness of CCLAD for controlling pain by reviewing papers published to date that have used CCLAD.

Comparative evaluation of passive, active, and passive-active distraction techniques on pain perception during local anesthesia administration in children

Local anesthesia forms the backbone of pain control techniques and is necessary for a painless dental procedure. Nevertheless, administering a local anesthetic injection is among the most anxiety-provoking procedures to children. This study was performed to compare the efficacy of different distraction techniques (passive, active, and passive-active) on children's pain perception during local anesthesia administration. A total of 90 children aged four to nine years, requiring inferior alveolar nerve block for primary molar extraction, were included in this study and randomly divided into three groups according to the distraction technique employed during local anesthesia administration. Passive distraction group: the children were instructed to listen to a song on headphones; Active distraction group: the children were instructed to move their legs up and down alternatively; and Passive-active distraction group: this was a combination between both techniques. Pain perception during local anesthesia administration was evaluated by the Sounds, Eyes, and Motor (SEM) scale and Wong Baker FACES® Pain Rating Scale. There was an insignificant difference between the three groups for SEM scale and Wong Baker FACES Pain Rating Scale at P = 0.743 and P = 0.112 respectively. The examined distraction techniques showed comparable results in reducing pain perception during local anesthesia administration.

Success rate of IR midazolam sedation in combination with C-CLAD in pediatric dental patients-a prospective observational study

Objective. To evaluate the success rate of intra-rectal (IR) midazolam in combination with nitrous oxide/oxygen (N₂O) sedation in young uncooperative dental patients when the local anesthesia is delivered by a computerized controlled local anesthetic delivery (C-CLAD).

Study Design. This observational study consisted of 219 uncooperative children (age: 4.3 ± 1.69 y) who received IR midazolam (0.4 mg/kg) and N₂O to complete their dental treatment. Measured variables included: child’s pain disruptive behavior during delivery of anesthesia by C-CLAD (CHEOP Scale), child behavior during treatment (Houpt scale), dental procedure performed, and side effects that appeared during treatment.

Results. There was a high level of cooperation (mean score: 6.69 ± 2.1) during administration of local anesthesia. Good-to-excellent behavior was shown by 87% of the children during treatment. Planned treatment was completed by 184 (92%) patients. No statistically significant changes were noticed in the oxygen saturation levels before and after treatment. Children with side effects included 3 (1.3%) with nistagmus, 5 (2.3%) with diplopia, and 18 (8.2%) with hiccups. Three consecutive sedations decreased the overall behavior score by 5.7% compared to the first appointment (p < .05).

Conclusions. IR midazolam-N₂O sedation in combination with C-CLAD is very effective for delivery of dental treatment to young uncooperative children.

Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the Wand in children

AIM

This prospective, randomised, parallel, controlled study was conducted firstly to compare the onset of local anaesthesia (LA) when using the conventional technique versus the Wand computer-controlled LA and secondly to assess the pain experience in children.

METHOD

Thirty children were randomly allocated to the treatment group (Wand) or the control group (conventional). Lidocaine 2% with adrenaline (1:80,000) was given as a buccal infiltration. The onset of pulpal anaesthesia was tested using an analytic electric pulp tester (EPT). The pain experience during the LA was recorded using a modified visual analogue score (VAS).

RESULTS

Median time for the onset of LA was 6.30 minutes for the control and 7.25 minutes for the Wand group. Mean pain experience score for the control group was 9.78% as opposed to 8.46% in the Wand group. Statistical analysis showed that there was no statistically significant difference in the onset of LA (p = 0.486) and the pain experience (p = 0.713) between the two groups.

CONCLUSION

When placing a buccal infiltration on upper first permanent molars, the onset of LA and the pain experience was no different using the Wand and the conventional technique.