Evaluating the Preemptive Analgesic Effect of Photo‐biomodulation Therapy on Pain Perception During Local Anesthesia Injection in Children: A Split‐mouth Triple‐blind Randomized Controlled Clinical Trial

Abstract

To evaluate the impact of photobiomodulation therapy (PBMT) on injection pain perception and compare it with a topical oral anesthetic gel. A total of 30 patients of 6 to 9 years-old seeking pulpotomy treatment of maxillary secondary primary molars of both sides were considered for this split-mouth triple-blind randomized clinical trial. On one side of the maxilla, the low-level laser (diode laser, 808 nm, 250 mW; 16.25 J; 32.5 J cm À2 ) was irradiated upon the buccal gingiva of the tooth, while a Benzocaine 20% topical anesthetic gel was applied on the other side. A gel with the same taste (strawberry) was applied for the placebo. The Wong-Baker Faces Pain Rating Scale was used to evaluate the injection pain and postoperation pain at two timestamps, 1 h and 24 h after treatment. Patients' heart rate was also evaluated. Paired t, Wilcoxon signed-rank test, McNemar and Friedman tests were used for statistical analyses. Results demonstrated that PBMT could significantly decrease the injection pain perception and heart rate alternations compared to the topical anesthetic gels (P = 0.000). However, no significant differences were documented between the two methods concerning the 1-h (P = 0.26) and 24-h (P = 1.00) postoperation pain. PBMT can be an effective nonpharmacological technique for controlling injection pain.

Effects of photobiomodulation with different application parameters on injection pain in children: a randomized clinical trial

“…It was determined that not only the wavelength, but also many other factors, conditions, and parameters have an influence on the therapeutic effects, including irradiance, fluence, treatment timing, and pulsing [7,17,27]. When the studies related to injection pain are examined, it is seen that some of them have been performed in adults (only six) [8-10, 29] and a few of them have been performed in children (only three) [5,19,20]. It was seen that there are differences in research protocols in terms of sample size, anesthesia application region, laser type used, application method, and parameters.…”

“…One of the specific differences in the research protocol in injection pain studies is the usage of topical anesthesia when evaluating the effect of PBM. When examining studies in children, while the usage of topical anesthesia is seen in the study of Uçar et al [5], it is seen that the study of Shekarchi et al [19] has only evaluated the effect of PBM alone, and while two studies reported a positive effect, significance was obtained in the only study by Shekarchi et al [19]. The difference in results can be attributed to the fact that the use of topical anesthesia may have overshadowed the actual effectiveness of PBM, and also that the difference in the laser parameters used may also preclude a complete comparison.…”

“…However, blindness could not be achieved with the placebo and control groups since the laser operator was aware of its sound, application time, and light effect. Nevertheless, this problem was attempted to be overcome in a similar manner to the methodologies of previous studies by Shekarchi et al [19] and Tuk et al [10] by choosing the laser operator and injection operator as different persons.…”

“…[5] and Shekarchi et al [19] found a positive effect, while Amrutha-Varshini et al [20] obtained a negative effect. The results of the studies are inconsistent due to the differences in biostimulative effects produced by the laser parameters which show diversity.…”

“Optoanesthesia”: The Application of Transcranial Photobiomodulation to General Anesthesia

“…With respect to regional analgesia, the local analgesic effects of PBM have been used in dental surgery to reduce injection pain [37] [38], and a positive analgesic outcome was noted [39]. Local anesthetic effects of PBM during pediatric dental procedures have also been confirmed [40].…”