Effect of a Vibration System on Pain Reduction during Injection of Dental Anesthesia in Children: A Randomized Clinical Trial

Abstract

Background. The ‘‘gate control’’ theory suggests pain can be reduced by simultaneous activation of larger diameter nerve fibers using appropriate coldness, warmth, rubbing, pressure, or vibration. This study investigated the efficacy of a device combining cold and vibration, for needle-related procedural pain in children. Methodology. A total of 51 children aged 5–12 years participated in this randomized controlled clinical trial. Half of the children were in the control group and received maxillary buccal infiltration, by injecting 1.8 ml of 2% lidocaine with 1 : 100,000 adrenaline using topical anesthesia 20% benzocaine gel for 15 seconds, while the other half were in the test group and received the same anesthesia using a commercially available external cold and a vibrating device. A face version of Visual Analogue Scale (VAS) was used as a subjective measure to assess the child’s pain experience. The parents were requested to evaluate the child’s ability to tolerate pain using a behavioral/observational pain scale. Sound, Eyes, and Motor (SEM) scale and Faces, Legs, Activity, Cry, and Consolability (FLACC) scale were used to record the child’s pain as perceived by the external evaluator. T-test or Mann–Whitney U-test was used for scale variables, paired sample T-test or Wilcoxon rank t-test was used for before and after data, and chi-square was used for categorical variable, based on the results of normality test. Results. The results showed a statistically significant reduction in pain after the injection for the test group compared with control using VAS scale (mean = 6.68 (1.09) and 8.42 (0.50); p = 0.001 ) and FLACC scale (mean = 5.92 (1.05) and 8.16 (0.54); p = 0.002 ), but not when using SEM scale (mean 3.22 (0.42) and 4.24 (2.74); p = 0.08 ). Conclusions. Combined external cold and vibrating devices can be an effective alternative in reducing experienced pain and fear in children undergoing infiltration dental anesthesia. This study was registered with clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001).

The combined effect of extraoral vibratory stimulus and external cooling on pain perception during intra-oral local anesthesia administration in children: a systematic review and meta-analysis

“…The details of the excluded articles are listed in Table 1 . Seven studies were included in the final analysis [ 31 32 33 34 35 36 37 ]. The search results are presented as a flowchart in Fig.…”

“…Characteristics of the included studies: All published studies from 2018-2021 are shown in Table 2 . Five of the seven studies followed a parallel-arm design [ 31 32 34 35 36 ], and two used the split-mouth design [ 33 37 ]. A total of 391 children, aged 4-12 years, received different dental injections, including infiltrations (both maxillary and mandibular) [ 34 36 ], maxillary infiltration alone [ 37 ], mandibular infiltration alone [ 32 ], infiltration and blocks [ 35 ], or inferior alveolar nerve block alone [ 33 ].…”

“…A total of 391 children, aged 4-12 years, received different dental injections, including infiltrations (both maxillary and mandibular) [ 34 36 ], maxillary infiltration alone [ 37 ], mandibular infiltration alone [ 32 ], infiltration and blocks [ 35 ], or inferior alveolar nerve block alone [ 33 ]. Extraoral vibration and precooling were compared with no extraoral vibration and no precooling in 5 studies [ 31 32 33 36 37 ]. Extraoral vibration and precooling were compared with counter stimulation in one study [ 34 ].…”

“…Only extraoral vibration was performed in one study [ 35 ]. Extraoral vibration and cooling were delivered using the BUZZY device in 5 studies [ 31 32 34 36 37 ]. A custom device was used to deliver vibration in two studies [ 33 35 ].…”

“…A custom device was used to deliver vibration in two studies [ 33 35 ]. Pain perception was evaluated in six studies [ 31 32 34 36 37 ]. Of these, four studies used the The Wong Baker faces pain rating scale (WB-FPRS) alone [ 32 36 37 ], and one study used the Visual Analog Scale (VAS) only [ 31 ].…”