Comparison of Conventional Syringe with Camouflaged Syringe and Vibration-assisted Syringe for Pain and Fear Perception during Local Anesthetic Administration in Children: A Split-mouth Randomized Controlled Trial
Nehal Ahmad, Mahendra K Jindal, Neha Agrawal, Pranshu Varshney
Keywords :
Camouflaged syringe, Fear, Local anesthesia, Pain, Vibration-assisted syringe
Citation Information :
Ahmad N, Jindal MK, Agrawal N, Varshney P. Comparison of Conventional Syringe with Camouflaged Syringe and Vibration-assisted Syringe for Pain and Fear Perception during Local Anesthetic Administration in Children: A Split-mouth Randomized Controlled Trial. Int J Clin Pediatr Dent 2024; 17 (11):1241-1247.
Aim and background: Although local anesthesia (LA) eliminates pain and instills a positive dental attitude, the physical appearance of its syringe is highly fear provoking and often intolerable. Therefore, the purpose of this study was to evaluate the pain and fear perception in camouflaged syringe (CS) and vibration-assisted syringe (VA) when compared with conventional syringe and with each other (VACS) during local anesthetic administration in pediatric patients aged between 6 and 12 years.
Materials and methods: Eighty-five subjects were randomly assigned into three groups: CS group (n = 7), VA group (n = 26), and VACS group (n = 27). Physiological and psychometric scale readings were noted before and after injection. The primary outcome was to assess the change in patients’ fear and pain levels using CS and VA vs conventional injection techniques, using the above scales. The secondary outcome was to learn the preference for a particular injection technique by the subjects.
Results: Based on the changes seen in the physiological and psychometric scales, pain and fear control was better in CS in the CS group (p < 0.00 for heart rate, VAS, and SEM score), vibration-assisted syringe in the VA group (p < 0.00 for VAS and SEM score), and vibration-assisted syringe in the VACS group (p < 0.00 for VAS score). The majority preference was CS in the CS group (64%), vibration-assisted syringe in the VA group (60%), and CS in the VACS group (52%).
Conclusion: VA followed by CS is better than the conventional syringe in terms of reducing pain and fear perceived during LA administration. Children preferred CS over VA or the conventional syringe.
Clinical significance: Children's disruptive behavior due to dental fear and pain often results in difficulty in providing effective dental treatment, which is frequently caused by the syringe used in LA delivery. Thus, techniques used to minimize this fear and pain are essential to provide safe, efficient, and quality dental care to children.
Trial registration: The trial was registered with the Clinical Trial Registry of India (CTRI/2023/11/059505).
Sreenivasagan S, Sneha P, Ravi P, et al. To assess the prevalence of dental anxiety and assess the efficacy of vibraject and to assess prevalence of dental phobia. Dentistry 2018;8(1):4–9.
Porritt J, Marshman Z, Rodd HD. Understanding children's dental anxiety and psychological approaches to its reduction. Int J Paediatr Dent 2012;22(6):397–405.
Jamil F, Khan SY, Jindal MK. Effectiveness of audiovisual distraction technique and filmed modeling on anxiety and fear in pediatric dental patients. Int J Clin Pediatr Dent 2023;16(4):598–602.
Rayen R, Muthu, MS, Chandrasekhar R, et al. Evaluation of physiological and behavioral measures in relation to dental anxiety during sequential dental visits in children. Indian J Dent Res 2006;17(1):27–34.
Faghihian R, Rastghalam N, Amrollahi N, et al. Effect of vibration devices on pain associated with dental injections in children: a systematic review and meta-analysis. Aust Dent J 2021;66(1):4–12.
Ungor C, Tosun E, Dayisoylu EH, et al. The effects of vibration on pain and anxiety during local anesthesia administration. JSM Dent 2014;2(1):1–4.
Melwani AM, Srinivasan I, Setty JV, et al. A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6-11-year-old children during local anesthesia administration—a novel approach. J Dent Anesth Pain Med 2018;18(1):35–40.
Alanazi KJ, Pani S, AlGhanim N. Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: a split mouth randomised crossover study. Eur Arch Paediatr Dent 2019;20(2):79–84.
Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161(9):1976–1982.
Chaudhry K, Shishodia M, Singh C, et al. Comparative evaluation of pain perception by vibrating needle (VibrajectTM) and conventional syringe anesthesia during various dental procedures in pediatric patients: a short study. Int Dent Med J Adv Res 2015;1(1):1–5.
Midha V, Midha V, Dua R, et al. Auxiliary aids to alleviate pain and anxiety during local anesthesia administration: a comparative study. Int J Clin Pediatr Dent 2021;14(1):104–108.
Shilpapriya M, Jayanthi M, Reddy VN, 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(1):173–176.
Suohu T, Sharma S, Marwah N, et al. A comparative evaluation of pain perception and comfort of a patient using conventional syringe and buzzy system. Int J Clin Pediatr Dent 2020;13(1):27–30.
Birnie KA, Noel M, Parker JA, et al. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol 2014;39(8):783–808.
Canbulat N, Ayhan F, Inal S. Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients. Pain Manag Nurs 2015;16(1):33–39.
Ujaoney S, Mamtani M, Thakre T, et al. Efficacy trial of camouflage syringe to reduce dental fear and anxiety. Eur J Paediatr Dent 2013;14(4):273–278.
Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. J Indian Soc Pedod Prev Dent 2007;25(1):177–182.
Hegde KM, Neerja R, Srinivasan I, et al. Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6–11 years: a crossover split-mouth study. J Dent Anesth Pain Med 2019;19(3):143–149.
Al-Hareky M, Al-Humaid J, Bedi S, et al. Effect of a vibration system on pain reduction during injection of dental anesthesia in children: a randomized clinical trial. Int J Dent 2021;21(1):1–8.
Faul F, Erdfelder E, Lang A, et al. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175–191.
Faul F, Erdfelder E, Buchner A, et al. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41(4):1149–1160.
Pozos-Guillén A, Chavarría-Bolaños D, Garrocho-Rangel A. Split-mouth design in paediatric dentistry clinical trials. Eur J Paediatr Dent 2017;18(1):61–65.
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.
Mohamed MA, Abuelniel GM, Yousry YM. Effectiveness of vibration- assisted syringe versus conventional syringe on pain and anxiety perception during local anesthetic injection in children: randomized clinical trial. Adv Dent J 2023;5(2):243–254.
Sokolowski CJ, Giovannitti JA Jr, Boynes SG. Needle phobia: etiology, adverse consequences, and patient management. Dent Clin North Am 2010;54(4):731–744.
Bagher SM, Felemban OM, Alsabbagh GA, et al. The effect of using a camouflaged dental syringe on children's anxiety and behavioral pain. Cureus 2023;15(12):1–9.
Padminee K, Hemalatha R. Comparing conventional syringe with camouflage syringe by evaluating behavior and anxiety in 6-10 year old children while administering local anaesthesia—a cross over trial with split mouth study design. Int J Dent Sci Innov Res 2019;2(3):381–389.
Bilsin E, Gungormus Z, Gungormus M. The effıcacy of external cooling and vibration on decreasing the pain of local anesthesia injections during dental treatment in children: a randomized controlled study. J Perianesth Nurs 2019;35(1):44–47.
Razdan P, Aggarwal M, Deshpande I, et al. Comparative evaluation of pain perception by vibration anesthesia and precooling of anesthesia site during anesthesia in pediatric patients undergoing dental procedures - an in vivo study. Ann Rom Soc Cell Biol 2021;25(6):3248–3253.
Babaji P, Chauhan PP, Rathod V, et al. Evaluation of child preference for dentist attire and usage of camouflaged syringe in reducing anxiety. Eur J Dent 2017;11(4):531–536.
Saad N, Agamy R, Abdellatif A. Effect of vibration of the syringe on anxiety and pain during local anesthesia injection in children. Egypt Dent J 2019;63(4):1475–1484.