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VOLUME 9 , ISSUE 6 ( September, 2008 ) > List of Articles


The Efficacy of Distraction and Counterstimulation in the Reduction of Pain Reaction to Intraoral Injection by Pediatric Patients

Naser Asl Aminabadi, Rmain Mostofi Zadeh Farahani, Esrafil Balayi Gajan

Citation Information : Aminabadi NA, Farahani RM, Gajan EB. The Efficacy of Distraction and Counterstimulation in the Reduction of Pain Reaction to Intraoral Injection by Pediatric Patients. J Contemp Dent Pract 2008; 9 (6):33-40.

DOI: 10.5005/jcdp-9-6-33

License: CC BY-NC 3.0

Published Online: 01-09-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.



The aim of this clinical investigation was to determine the efficacy of distraction and counterstimulation in the reduction of pain during the administration of local anesthetics in pediatric dental patients.

Methods and Materials

A total of 78 healthy children (male: 40, female: 38) ages four to five years (mean age: 4.72 years old) without any history of previous intraoral injection were included in the present study. The subjects had at least one carious primary molar. The subjects were randomly allocated into three groups. Group SA received topical anesthesia followed by an inferior alveolar nerve block (simple anesthesia). Group C+SA received counter stimulation using intraoral and extraoral finger vibration in addition to the Group SA protocol. Group CD+SA incorporated verbal distraction in addition to topical and local anesthesia and counterstimulation. A sound, eye, and motor (SEM) scale was used for quantification of pain reaction. Data were analyzed using an analysis of variance (ANOVA).


The SEM values for Groups SA, C+SA, and CD+SA was 8.25, 5.07, and 3.41, respectively. According to the SEM scale a severe pain reaction was observed in Group SA but not in the other groups. The pain reaction for Group SA was significantly higher than the two other groups (P<0.05). Moreover, the subjects in Group CD+SA exhibited significantly less pain compared to those in Group C+SA.


Both distraction and counterstimulation are effective in reducing pain reaction in a clinical setting. However, it may be more plausible to use both techniques simultaneously to achieve more favorable results with reference to a reduced pain reaction in pediatric dental patients.


Aminabadi NA, Farahani RMZ, Balayi Gajan E. The Efficacy of Distraction and Counterstimulation in the Reduction of Pain Reaction to Intraoral Injection by Pediatric Patients. J Contemp Dent Pract 2008 September; (9)6:033-040.

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  1. Recommended by the JASP subcommittee on Taxonomy. Pain 1979; 6(3):249.
  2. Reducing the pain of local anesthesia. Cutis. 1994; 53(4):167-70.
  3. Comparison of plain, warmed, and buffered lidocaine for anesthesia of traumatic wounds. Ann Emerg Med 1995; 26(2):121-5.
  4. Comparison of room temperature and body temperature local anaesthetic solutions. Br J Plast Surg 1991; 44(2):147-8.
  5. Neutralized lidocaine with epinephrine for local anesthesia. J Dermatol Surg Oncol 1989; 15(10):1081-3.
  6. Pain reduction in local anesthetic administration through pH buffering. Ann Emerg Med 1988; 17(2):117-20.
  7. Buffered versus plain lidocaine as a local anesthetic for simple laceration repair. Ann Emerg Med 19(12):1387-9, 1990.
  8. Stability of buffered lidocaine and epinephrine used for local anesthesia. J Dermatol Surg Oncol 1991; 17(5):411-4.
  9. Application of local anesthetics in dermatologic surgery. Dermatol Surg 2002; 28(2):143-8.
  10. Local anesthesia for dermatologic surgery. New York: Churchill Livingstone, 1991,1-92.
  11. Local anesthesia in dermatologic surgery. J Am Acad Dermatol 1988; 19(4):599-614.
  12. Iontophoretic administration of lidocaine anesthesia in office practice. An appraisal. J Dermatol Surg Oncol 1992; 18(11):937-40.
  13. Biofeedback, cognitive-behavioral methods, and hypnosis in dermatology: is it all in your mind? Dermatol Ther 2003; 16(2):114-22.
  14. Sensory mechanism of the spinal cord. New York, Plenum Press, 1991.
  15. Comparative study of perceived pain and nociceptive flexion reflex in man. Pain 1979; 3:69-80.
  16. Pain mechanisms: a new theory. Science. 1965; 150(699):971-9.
  17. From the gate to the neuromatrix. Pain. Suppl 6:S121-6. 1999.
  18. Folk Medicine and the sensory modulation of pain. In: Wall PD, Melzack R. Eds Textbook of Pain. London: Churchill Livingstone; 1994;1209-1217.
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