Effect of Topical Anesthesia with Lidocaine-prilocaine (EMLA) Cream and Local Pressure on Pain during Infiltration Injection for Maxillary Canines: A Randomized Double-blind Clinical Trial

Abstract

Objectives: This study compared the effect of local pressure and topical lidocaine-prilocaine (EMLA) cream on pain during infiltration injection for maxillary canine teeth. Materials and methods: A total of 140 volunteer students participated in this split-mouth design randomized clinical trial. The subjects were randomly divided into four groups (n = 35). Before administration of anesthesia, in each group, one side was randomly selected as the experimental and the opposite side as the control. In group 1, finger pressure was applied on the alveolar mucosa on the experimental side and on the tooth crown on the control side. In group 2, 5% EMLA cream and placebo; in group 3, finger pressure and 5% EMLA cream; and in group 4, 5% EMLA cream and 20% benzocaine gel were applied. In all the groups, a buccal infiltration procedure was carried out. Pain during injection was recorded with visual analog scale (VAS). Wilcoxon and McNemar tests were used for statistical analysis of the results. Statistical significance was set at p < 0.05.

Recent advances in topical anesthesia

“…Since this study, multiple studies have documented the application of EMLA cream on mucosal surfaces. In addition, several reports have noted that the use of EMLA cream reduced pain during probing, hand scaling, ultrasonic scaling, rubber-dam clamp placement, and palatine nerve block [ 18 19 20 21 22 23 24 25 ].…”

Efficacy of Topical Benzocaine in Maxilla: A Randomized Controlled Trial

“…26 Some report reduction in pain on needle penetration after 1-minute application time, 5,25 others demonstrate no significant pain reduction even after a period of 20 minutes. 28 In this study, like most other studies that used benzocaine, 5,9,25,29 the topical agent was applied for 1 minute, which is in accordance with recommendations of the ADA and FDA and has reported to be sufficient time for the agent to become effective 30 and efficacious in the maxillary mucobuccal fold. 25 The labial mucosa of maxillary anterior teeth was selected as the site of injection for ease of access and isolation in order to measure the time of topical agent application accurately and for comparison with previous studies.…”

“…31 Most previous such studies obtained pain scores from the participants for needle penetration after the injection was given and the needle was removed from the patient's oral cavity. 8,9,29 However, in this study the pain score was obtained from the participants immediately after needle penetration, prior to advancement of the needle or LA deposition. This was done to decrease the bias that the overall experience of injection or pain of needle advancement may have caused on pain perception of needle penetration.…”

Evaluation of the effect of the photobiomodulation therapy on the pain related to dental injections: A preliminary clinical trial

“…Some simple techniques, such as the compression and precooling of the injection site, have also been suggested for this purpose. 4,5 Moreover, some fundamental advances have been made in anesthetic injection techniques in recent years, such as the use of computerized injection systems, which aim to reduce anesthetic injection pain and improve the patient's comfort. However, further studies are required to develop painless anesthetic injection techniques that can be applied for widespread use in dental offices.…”