Efficacy of Cryotherapy Application on the Pain Perception during Intraoral Injection: A Randomized Controlled Trial
Lakshimi Lakshmanan, Vignesh Ravindran
Cryotherapy, Local anesthesia injection, Pain, Topical anesthesia
Citation Information :
Lakshmanan L, Ravindran V. Efficacy of Cryotherapy Application on the Pain Perception during Intraoral Injection: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2021; 14 (5):616-620.
Background: Profound local anesthetic delivery promotes successful treatment for children in terms of easing their fear, anxiety, and discomfort during dental procedures. Local anesthetic injections are the utmost anticipated or anxious stimuli in the dental operatory. Precooling the oral mucosa by application of cryotherapy before local anesthetic injections can alter the pain perception in children.
Aim and objectives: To compare the efficacy of cryotherapy application and 20% benzocaine gel at reducing pain perception during buccal infiltration in pediatric patients.
Materials and methods: In this split-mouth study, 30 pediatric patients between 7 years and 10 years of age who needed maxillary buccal infiltration of local anesthetics bilaterally for dental treatment were selected. They received cryotherapy (ice pack) on one quadrant (test group) for 2 minutes and 20% benzocaine topical gel on the contralateral quadrant (control group). A pediatric dentist blinded to the study assessed sound, eye, motor (SEM) scale based on patients’ reaction during injection (objective method), and patients were instructed to use a visual analog scale (VAS) to rate their distress during injection (subjective method). Statistical analyses were performed using Wilcoxon and Mann–Whitney U tests.
Results: The cryotherapy group had significantly reduced pain scores on the VAS scale (40.66 ± 14.60) when compared with the topical anesthetic gel group (61.33 ± 9.73). The cryotherapy group had reduced pain scores on the SEM scale as well (1.2 ± 0.1) when compared with the topical anesthetic gel group (1.6 ± 0.1), which was not statistically significant.
Conclusion: When compared with topical anesthetic gel, precooling the injection site with cryotherapy is beneficial in reducing pain before local anesthesia injection in pediatric patients.
Clinical significance: Cryotherapy application eliminates the fear of pain ascribed to injection of local anesthesia and assists in providing pertinent dental care.
Chandrashekharan J, Prabhu D, Sunayana M. Efficacy of painless injection technique-vibraject-clinical trial in Chennai, India. Int J Med Dent Sci 2014;3(1):250–255.
Aminah M, Nagar Priya, Singh P, et al. Comparison of topical anesthetic gel, pre-cooling, vibration and buffered local anesthesia on the pain perception of pediatric patients during the administration of local anesthesia in routine dental procedures. Int J Contemp Med Res 2017;4(2):400–403.
Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine administration through buffering and warming. Am J Emerg Med 1998;16(4):353–356. DOI: 10.1016/s0735-6757(98)90126-7.
Touyz LZ, Lamontagne P, Smith BE. Pain and anxiety reduction using a manual stimulation distraction device when administering local analgesia oro-dental injections: a multi-center clinical investigation. J Clin Dent 2004;15(3):88–92.
Hutchins HS, Young FA, Lackland DT, et al. The effectiveness of topical anesthesia and vibration in alleviating the pain of oral injections. Anesth Prog 1997;44(3):87–89.
Friedman MJ, Hochman MN. The AMSA injection: a new concept for local anesthesia of maxillary teeth using a computer-controlled injection system. Quintessence Int 1998;29(5):297–303.
Halar EM, DeLisa JA, Brozovich FV. Nerve conduction velocity: relationship of skin, subcutaneous and intramuscular temperatures. Arch Phys Med Rehabil 1980;61(5):199–203.
Meechan JG, Winter RA. A comparison of topical anesthesia and electronic nerve stimulation for reducing pain of intra-oral injections. Br Dent J 1996;181(9):333–335. DOI: 10.1038/sj.bdj.4809252.
Blanton PL, Jeske AH. Dental local anesthetics: alternative delivery methods. J Am Dent Assoc 2003;134(2):228–234. DOI: 10.14219/jada.archive.2003.0140.
Vongsavan K, Vongsavan N. Comparison of topical anesthetic gel and TENS in reducing pain. J Dent Res 1996;75:248.
Gibson RS, Allen K, Hutless S, et al. The wand vs. traditional injections: a comparison of pain related behaviors. Pediatr Dent 2000;22(6):458–462.
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(3):173–176. DOI: 10.4103/0970-4388.160343.
Gill CJ, Orr DL. A double-blind crossover comparison of topical anesthetics. J Am Dent Assoc 1979;98(2):213–214. DOI: 10.14219/jada.archive.1979.0476.
Martin MD, Ramsay DS, Whitney C, et al. Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy. Anesth Prog 1994;41(2):40–47.
Priyantham S, Nuvvula S. Intraoral topical anaesthesia in paediatric dentistry: review. Int J Pharm Bio Sci 2016;7(4):346–353.
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 2013;10(6):790–794.
Greenstein G. Therapeutic efficacy of cold therapy after intraoral surgical procedures: a literature review. J Periodontol 2007;78(5):790–800. DOI: 10.1902/jop.2007.060319.
DiMarco AC, O'Kelley Wetmore A. Clinical comparison: fast-acting and traditional topical dental anesthetic. Anesth Prog 2016;63(2):55–61. DOI: 10.2344/0003-3006-63.2.55.
Aminabadi NA, Farahani RM. The effect of pre-cooling the injection site on pediatric pain perception during the administration of local anesthesia. J Contemp Dent Pract 2009;10(3):43–50. DOI: 10.5005/jcdp-10-3-43.
Joseph A, Giovannitti JR, Rosenberg MB, et al. Pharmacology of local anesthetics used in oral surgery. Oral Maxillofacial Surg Clin N Am 2013;25(3):453–465. DOI: 10.1016/j.coms.2013.03.003.
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.
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft tissue injury: a systematic review of randomized controlled trials. Am J Sports Med 2004;32(1):251–261. DOI: 10.1177/0363546503260757.
Harbert H. Topical ice: a precursor to palatal injections. J Endod 1989;15(1):27–28. DOI: 10.1016/S0099-2399(89)80094-9.
Duncan JD, Reeves GW, Fitchie JG. Technique to diminish discomfort from the palatal injection. J Prosthet Dent 1992;67(6):901–902. DOI: 10.1016/0022-3913(92)90617-j.
Hameed NN, Sargod SS, Bhat SS, 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.
Kosaraju A, Vanderwalle KS. A comparison of a refrigerant and a topical anesthetic gel as pre-inection anesthetics. J Am Dent Assoc 2009;140(1):68–72. DOI: 10.14219/jada.archive.2009.0020.
Kuwahara RT, Skinner RB. EMLA versus ice as a topical anesthetic. Dermatol Surg 2001;27(5):495–496. DOI: 10.1097/00042728-200102000-00028.
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.