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VOLUME 21 , ISSUE 6 ( June, 2020 ) > List of Articles

ORIGINAL RESEARCH

Auto-controlled Syringe vs Insulin Syringe for Palatal Injections in Children: A Randomized Crossover Trial

Pushpalatha Tummakomma, Aishwarya Arya Gangili, Abdul Rehman Ahmed Khan, Mohammed Khurramuddin, Usha Purumandla

Citation Information : Tummakomma P, Gangili AA, Khan AR, Khurramuddin M, Purumandla U. Auto-controlled Syringe vs Insulin Syringe for Palatal Injections in Children: A Randomized Crossover Trial. J Contemp Dent Pract 2020; 21 (6):604-608.

DOI: 10.5005/jp-journals-10024-2864

License: CC BY-NC 4.0

Published Online: 04-11-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Aim: This study aims to evaluate and compare the efficacy of auto-control syringe (ACS) and insulin syringe (IS) for palatal local anesthesia administration in children. Materials and methods: The study was a double-blind, randomized, and crossover trial, comprising 80 children requiring palatal anesthesia bilaterally (total 160 injections). Palatal anesthesia on one side was delivered with ACS in one appointment and contralaterally with IS in the second appointment. One-week washout period was given between first and second appointments. Each child acted as his own control. Each injection technique subjective and objective pain scores were measured twice (during needle prick and during actual deposition of local anesthesia). Subjective and objective evaluation of pain was measured with Wong-Baker FACES pain rating scale (WB-FPS) and the face, leg, activity, cry, and consolability scale (FLACC), respectively. After concluding second appointment, child was asked about their preference between both ACS and IS. Statistical evaluation was performed using Chi-square test. Results: Child reported less pain score for needle prick with IS as opposed to ACS (p value = 0.000416). There was no significant difference between dentist-reported pain scores between any group for both needle prick and local anesthesia administration. There is no significant difference between child reported pain score during administration of local anesthesia between two groups. Irrespective of pain scores, most of the children (96.5%) preferred IS. Conclusion: For palatal local anesthesia administration in children, both IS and auto-controlled syringe have similar efficacy. Clinical significance: Insulin syringe can serve as an economical alternative to the expensive auto-controlled syringe for palatal injections in children.


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  1. Carter AE, Carter G, Boschen M, et al. Pathways of fear and anxiety in dentistry: a review. World J Clin Cases 2014;2(11):642–653. DOI: 10.12998/wjcc.v2.i11.642.
  2. Berge KG, Agdal ML, Vika M, et al. High fear of intra-oral injections: prevalence and relationship to dental fear and dental avoidance among 10- to 16-yr-old children. Eur J Oral Sci 2016;124(6):572–579. DOI: 10.1111/eos.12305.
  3. Rajwar AS, Goswami M. Prevalence of dental fear and its causes using three measurement scales among children in New Delhi. J Indian Soc Pedod Prev Dent 2017;35(2):128–133. DOI: 10.4103/JISPPD.JISPPD_135_16.
  4. McArdle BF. Painless palatal anesthesia. J Am Dent Assoc 1997;128(5):647. DOI: 10.14219/jada.archive.1997.0265.
  5. Al-Melh MA, Andersson L. Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(5):e16–e20. DOI: 10.1016/j.tripleo.2006.11.033.
  6. Dasarraju RK, SVSG N. Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study. J Dent Anesth Pain Med 2020;20(1):29–37. DOI: 10.17245/jdapm.2020.20.1.29.
  7. Johnson J, Primosch RE. Influence of site preparation methods on the pain reported during palatal infiltration using the wand local anesthetic system. Am J Dent 2003;16(3):165–169.
  8. Hindocha N, Manhem F, Bäckryd E, et al. Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa – a randomized cross-over study. BMC Anesthesiol 2019;19(1):227. DOI: 10.1186/s12871-019-0902-8.
  9. Hameed N, Sargod S, Bhat S, et al. Effectiveness of precooling the injection site using tetrafluorethane on pain perception in children. J Indian Soc Pedod Prev Dent 2018;36(3):296–300. DOI: 10.4103/JISPPD.JISPPD_222_17.
  10. Ghaderi F, Banakar S, Rostami S. Effect of pre-cooling injection site on pain perception in pediatric Dentistry: “a randomized clinical trial”. Dent Res J (Isfahan) 2013;10(6):790–794.
  11. Shilpapriya M, Jayanthi M, Reddy V, et al. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children. J Indian Soc Pedod Prev Dent 2015;33(3): 173–176. DOI: 10.4103/0970-4388.160343.
  12. Ghorbanzadeh S, Alimadadi H, Zargar N, et al. Effect of vibratory stimulation on pain during local anesthesia injections: a clinical trial. Restor Dent Endod 2019;44(4):e40. DOI: 10.5395/rde.2019.44.e40.
  13. Raslan N, Masri R. A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvibe® on injection pain in children. Int J Paediatr Dent 2018;28(1):102–110. DOI: 10.1111/ipd.12313.
  14. Sattayut S. Low intensity laser for reducing pain from anesthetic palatal injection. Photomed Laser Surg 2014;32(12):658–662. DOI: 10.1089/pho.2014.3770.
  15. Asokan A, Rao A, Mohan G, et al. A pain perception comparison of intraoral dental anesthesia with 26 and 30 gauge needles in 6-12-year-old children. J Pediatr Dent 2014;2(2):56–60. DOI: 10.4103/2321-6646.137690.
  16. Primosch RE, Brooks R. Influence of anesthetic flow rate delivered by the wand local anesthetic system on pain response to palatal injections. Am J Dent 2002;15(1):15–20.
  17. Kwak E-J, Pang N-S, Cho J-H, et al. Computer-controlled local anesthetic delivery for painless anesthesia: a literature review. J Dent Anesth Pain Med 2016;16(2):81–88. DOI: 10.17245/jdapm.2016.16.2.81.
  18. Phero JA, Nelson B, Davis B, et al. Buffered versus non-buffered lidocaine with epinephrine for mandibular nerve block: clinical outcomes. J Oral Maxillofac Surg 2017;75(4):688–693. DOI: 10.1016/j.joms.2016.09.055.
  19. Brignardello-Petersen R. Warming up anesthetic solution reduces pain after infiltration in the anterior zone in volunteers not receiving dental treatment. J Am Dent Assoc 2018;149(10):e139. DOI: 10.1016/j.adaj.2018.03.018.
  20. Kolli NKR, Nirmala SVSG, Nuvvula S. The effectiveness of articaine and lidocaine single buccal infiltration versus conventional buccal and palatal injection using lidocaine during primary maxillary molar extraction: a randomized control trial. Anesth Essays Res 2017;11(1):160–164. DOI: 10.4103/0259-1162.186589.
  21. Vafaei A, Rahbar M, Dadkhah R, et al. Children's pain perception and behavioral feedback during local anesthetic injection with four injection site preparation methods. Maedica (Buchar) 2019;14(4): 343–349. DOI: 10.26574/maedica.2019.14.4.343.
  22. Lathwal G, Pandit IK, Gugnani N, et al. Efficacy of different precooling agents and topical anesthetics on the pain perception during intraoral injection: a comparative clinical study. Int J Clin Pediatr Dent 2015;8(2):119–122. DOI: 10.5005/jp-journals-10005-1296.
  23. Wiswall AT, Bowles WR, Lunos S, et al. Palatal anesthesia: comparison of four techniques for decreasing injection discomfort. Northwest Dent 2014;93(4):25–29.
  24. Jayasuriya NSS, Weerapperuma ID, Amarasinghe M. The use of an iced cotton bud as an effective pre-cooling method for palatal anaesthesia: a technical note. Singapore Dent J 2017;38:17–19. DOI: 10.1016/j.sdj.2017.07.001.
  25. Deepika A, Rao CR, Vinay C, et al. Effectiveness of two flavored topical anesthetic agents in reducing injection pain in children: a comparative study. J Clin Pediatr Dent 2012;37(1):15–18. DOI: 10.17796/jcpd.37.1.h4jl152t334j3802.
  26. Kreider KA, Stratmann RG, Milano M, et al. Reducing children's injection pain: lidocaine patches versus topical benzocaine gel. Pediatr Dent 2001;23(1):19–23.
  27. Primosch RE, Rolland-Asensi G. Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anesthetic infiltration in children. Pediatr Dent 2001;23(1):11–14.
  28. Bhalla J, Meechan JG, Lawrence HP, et al. Effect of time on clinical efficacy of topical anesthesia. Anesth Prog 2009;56(2):36–41. DOI: 10.2344/0003-3006-56.2.36.
  29. Gupte T, Modi UA, Gupte S, et al. Determination of onset of action and efficacy of topical lignocaine anesthesia in children: an in Vivo study. Int J Clin Pediatr Dent 2019;12(3):178–181. DOI: 10.5005/jp-journals-10005-1615.
  30. Feda M, Amoudi NA, Sharaf A, et al. A comparative study of children's pain reactions and perceptions to AMSA injection using CCLAD versus traditional injections. J Clin Pediatr Dent 2010;34(3):217–222. DOI: 10.17796/jcpd.34.3.3201l74255560520.
  31. Thoppe-Dhamodhara YK, Asokan S, John BJ, et al. Cartridge syringe vs computer controlled local anesthetic delivery system: pain related behaviour over two sequential visits - a randomized controlled trial. J Clin Exp Dent 2015;7(4):e513–e518. DOI: 10.4317/jced.52542.
  32. Mittal M, Kumar A, Srivastava D, et al. Pain perception: computerized versus traditional local anesthesia in pediatric patients. J Clin Pediatr Dent 2015;39(5):470–474. DOI: 10.17796/1053-4628-39.5.470.
  33. Langthasa M, Yeluri R, Jain AA, et al. Comparison of the pain perception in children using comfort control syringe and a conventional injection technique during pediatric dental procedures. J Indian Soc Pedod Prev Dent 2012;30(4):323–328. DOI: 10.4103/0970-4388.108931.
  34. Baghlaf K, Alamoudi N, Elashiry E, et al. The pain-related behavior and pain perception associated with computerized anesthesia in pulpotomies of mandibular primary molars: a randomized controlled trial. Quintessence Int 2015;46(9):799–806. DOI: 10.3290/j.qi. a34553.
  35. Alamoudi NM, Baghlaf KK, Elashiry EA, et al. The effectiveness of computerized anesthesia in primary mandibular molar pulpotomy: a randomized controlled trial. Quintessence Int 2016;47(3):217–224. DOI: 10.3290/j.qi.a34977.
  36. Kandiah P, Tahmassebi JF. Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the wand in children. Br Dent J 2012;213(9):E15. DOI: 10.1038/sj.bdj.2012.988.
  37. Tahmassebi JF, Nikolaou M, Duggal MS. A comparison of pain and anxiety associated with the administration of maxillary local analgesia with wand and conventional technique. Eur Arch Paediatr Dent 2009;10(2):77–82. DOI: 10.1007/BF03321604.
  38. Versloot J, Veerkamp JS, Hoogstraten J. Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe. Br Dent J 2008;205(1):E2. DOI: 10.1038/sj.bdj.2008.414; discussion 30-31.
  39. Al Amoudi N, Feda M, Sharaf A, et al. 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 2008;33(2):97–102. DOI: 10.17796/jcpd.33.2.d666m2l43334274p.
  40. Klein U, Hunzeker C, Hutfless S, et al. 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) 2005;72(3):119–125.
  41. Prabhu S, Faizel S, Pahlajani V, et al. Making nasopalatine blocks comfortable: a randomised Prospective clinical comparison of pain associated with the injection using an insulin syringe and a standard disposable 3 mL syringe. J Maxillofac Oral Surg 2013;12(4):436–439. DOI: 10.1007/s12663-012-0412-4.
  42. Kour G, Masih U, Singh C, et al. Insulin syringe: a gimmick in pediatric dentistry. Int J Clin Pediatr Dent 2017;10(4):319–323. DOI: 10.5005/jp-journals-10005-1458.
  43. Gibson RS, Allen K, Hutfless S, et al. The wand vs. traditional injection: a comparison of pain related behaviors. Pediatr Dent 2000;22(6): 458–462.
  44. Asarch T, Allen K, Petersen B, et al. Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent 1999;21(7): 421–424.
  45. Versloot J, Veerkamp JS, Hoogstraten J. Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children. Eur J Oral Sci 2005;113(6):488–493. DOI: 10.1111/j.1600-0722.2005.00252.x.
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