This clinical study tested and compared two ways (cold-base technique or "cryoanesthesia" and conventional benzocaine gel) to reduce pain from dental injections in children. Researchers worked with 28 children between 6 and 12 years old who needed injections on both sides of the lower jaw for dental treatment. Each child received cryoanesthesia on one side and 20% benzocaine gel on the other side, in different appointments, and the team measured pain, behavior, heart rate, and blood oxygen levels.
Objective: To evaluate and compare pain perception during inferior alveolar nerve block puncture in pediatric patients using cryoanesthesia versus conventional topical benzocaine anesthesia. Methods: A split-mouth randomized controlled clinical trial was conducted with 28 patients aged 6 to 12 years requiring bilateral inferior alveolar nerve blocks for bilateral lower arch dental treatment. Each participant received both anesthetic techniques in a randomized order on separate appointments, with treatment allocated to contralateral mandibular hemiarches. Primary and secondary outcome measures included pain intensity (Visual Analog Scale), heart rate, oxygen saturation, and behavioral response (FLACC scale).
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
28
After topical anesthesia (either technique), the clinician proceeded with conventional inferior alveolar nerve block using standardized technique: 1. Patient positioned recumbent in dental chair with mouth held open. 2. Palpation of ipsilateral mandibular condyle by clinician's non-dominant hand. 3. Cheek retracted with non-dominant hand to improve visualization. 4. Long needle (27-gauge, 32 mm) inserted at horizontal level of contralateral mandibular canine, directed toward insertion of lateral pterygoid muscle below maxillary tuberosity. 5. Needle advanced to contact medial mandibular wall (lingual surface). 6. Aspiration performed to rule out intravascular needle placement. 7. Injection of local anesthetic solution (1.8 mL of 2% lidocaine with 1:100,000 epinephrine). 8. Needle carefully withdrawn following injection completion.
After topical anesthesia (either technique), the clinician proceeded with conventional inferior alveolar nerve block using standardized technique: 1. Patient positioned recumbent in dental chair with mouth held open 2. Palpation of ipsilateral mandibular condyle by clinician's non-dominant hand 3. Cheek retracted with non-dominant hand to improve visualization 4. Long needle (27-gauge, 32 mm) inserted at horizontal level of contralateral mandibular canine, directed toward insertion of lateral pterygoid muscle below maxillary tuberosity 5. Needle advanced to contact medial mandibular wall (lingual surface) 6. Aspiration performed to rule out intravascular needle placement 7. Injection of local anesthetic solution (1.8 mL of 2% lidocaine with 1:100,000 epinephrine) 8. Needle carefully withdrawn following injection completion
Pediatric Dentistry Postgraduate Program, Faculty of Denttistry
San Luis Potosí City, S.l.p., Mexico
Pain perception
Pain intensity was assessed using a validated instrument: Wong-Baker FACES® Pain Rating Scale (Visual Analog Scale): Immediately following completion of infiltration anesthesia injection, the participant was asked to indicate the level of pain experienced using the face scale (0 = no hurt to 10 = hurts worst).
Time frame: Baseline: At the time of the anesthetic injection (or needle puncture) at the oral mucosa.
Heart Rate
Continuous pulse oximetry monitoring was conducted using a calibrated pulse oximeter (typical brands: Nellcor or equivalent) with appropriate pediatric finger probe or reusable sensor. Measurement unit: Pulses per minute (ppm) for heart rate (HR), which were recorded at two time points: 1. Baseline measurement: Immediately before topical anesthetic application, with the participant in a calm resting state. 2. During anesthetic infiltration: Recorded during active injection of local anesthetic solution into the infiltration site (oral mucosa).
Time frame: Periprocedural: During the injection anesthetic procedure, from the anesthetic solution injection to the removal of the needle (approximately 45 seconds)
Oxygen saturation
Percentage of blood's hemoglobin carrying oxygen (normally 95-100%). Continuous pulse oximetry monitoring was conducted using a calibrated pulse oximeter (typical brands: Nellcor or equivalent) with appropriate pediatric finger probe or reusable sensor. Measurement units: SpO2 percentage (%), which was recorded at two time points: 1. Baseline measurement: Immediately before topical anesthetic application, with the participant in a calm resting state. And 2. During infiltration measurement: During active injection of local anesthetic solution into the infiltration site.
Time frame: Periprocedural: During the injection anesthetic procedure, from the needle puncture to the removal of the needle (approximately 45 seconds).
Patient's behavioral response
Observable emotional and physiological reactions to the anesthetic injection through the FLACC (Facial expression, Legs, Activity, Cry, and Consolability) scale. Values: 0-10 (0 = relaxed, calm; 10 = severe distress).
Time frame: Periprocedural: 45 seconds, from the anesthetic injection to the removal of the needle.
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