Assessment of Pain Perception in Paediatric Patients on Application of Cooled and Uncooled Topical Anaesthetic Gel before Infiltration Anaesthesia - A Pilot Study

Abstract

BACKGROUND Topical anaesthesia is fundamental in enhancing pain control during the process of dental injections. The study compared the effect of cooled and uncooled topical anaesthetic gel before infiltration anaesthesia in assessing pain perception in paediatric patients undergoing dental treatment procedures. METHODS This is a split-mouth study where 16 children aged between 8 and 10 years who required bilateral local anaesthesia administration for various dental procedures were selected. Before infiltration anaesthesia, topical anaesthetic gel cooled to 40 C was applied on one side in the first visit followed by application of uncooled gel on the contralateral side in the subsequent visit. The patients were asked to individually rate their pain experience on each side using the Wong-Baker Faces Pain Rating Scale (WB-FPRS). Anxiety was assessed using pulse oximeter and FLACC scale (face, legs, activity, cry, and consolability). Data was analysed statistically using the paired ‘t’-test and a P value less than or equal to 0.05 was considered as statistically significant. RESULTS Patients reported less pain on Wong-Baker Faces Pain Rating Scale by using cooled topical anaesthetic gel. Discomfort and anxiety levels were also seen to be low when assessed using pulse oximeter and FLACC Scale for the same group (P < 0.05). CONCLUSIONS Cooling the soft tissue site with anaesthetic gel helped reduce pain perception during infiltration in children and was seen to be a more feasible technique. Hence this technique can be used as a successful adjunct to the local anaesthesia administration prior to dental procedures. KEY WORDS Anaesthesia, Cooling, Topical Gel, Injection, Pain

Effect of Cooled Topical Anesthetic Gel on Pain Perception During Administration of Local Anesthesia: A Clinical Trial

“…The result of our study in accordance to the study conducted by Prathyusha P. et al in 2021. 17 Gadheri et al also suggest that cooling the injection site prior to infiltration anaesthesia in the buccal mucosa for a minimum of 1 minute, reduced the pain perception in paediatric patients. 21…”

“…By activating pain pathways of inhibition and stimulating myelinated "A" fibres, the lower temperature successfully raises a person's pain threshold. 17 Also, it is thought that locally chilling the tissues will decrease or stop the transmission of pain signals as well as delay neuromuscular transmission. A decrease in the activity of the muscular tissue's spindles also results in a drop in muscle tone.…”