Evaluation of the Injection Pain with the Use of Vibraject during Local Anesthesia Injection for Children: A Randomized Clinical Trial

Pain Relief in Dental Local Anaesthesia with Vibrational Devices: Much Ado about Nothing? A Scoping Review

“…Sites for injections, when the information is specified, are palatal [ 33 ] infraorbital [ 33 ], upper posterior buccal [ 32 , 33 , 37 ], inferior alveolar nerve block [ 33 , 36 , 37 ], and posterior palatal [ 37 ]. The vibrational devices used are a modified battery-powered shaver (Windmere Corp., Miami, FL) [ 32 ], DentalVibe ® Injection Comfort system (BING Innovations, FL, USA) [ 29 , 33 , 34 , 36 ], Buzzy ® (MMJ Labs, Atlanta GA, USA) [ 31 , 35 ], and Vibraject (Vibraject ® MiltexInc LLC., York, PA, USA) [ 37 ]. One study shows the photo of the device used but does not give a trade name or provide information about its origin [ 30 ].…”

“…The response of the subjects involved in the trials is evaluated according to objective or subjective scales of measurement of stress, discomfort, and pain. In addition to heart rate and pO 2 saturation [ 30 , 35 , 36 ], the most used scales were Iowa Cancer Pain Relief Initiative scale [ 32 ], VAS (visual analogue scale) [ 33 , 37 ], Wong–Baker score pain scale [ 35 , 36 ], FLACC (Faces, Legs, Activity, Cry, Consolability) score [ 30 , 31 , 35 , 37 ], RMS Pictorial Scale (RMS-PS) [ 31 ], and sound, eye, motor (SEM) scale [ 36 ]. Except for one study, according to which there are no differences compared to premedication with anaesthetic gel [ 36 ], all the others agree in stating that vibration (and where expected, also cold gel pack) reduces the perception of anxiety and pain related to the injection of the local anaesthetic, also aided by the noise of the vibrational device as a distracting element at the moment of injection.…”

“…The biological mechanisms underlying this advantageous method in the field of local anaesthesia would be different from those underlying local vibrational stimulation in orthodontics, which are well documented and recognized [ 22 , 24 , 38 , 39 ]. From the first study reported in this review, which uses a device with another modified intended use to transfer the vibration at the injection site [ 32 ], to the most recent ones mentioned [ 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 ], in which dedicated devices are used, about twenty years have passed, and undoubtedly also the biological mechanisms to prove its effectiveness are better known. It would seem that “intermittent micro-sonic oscillations to the brain’s neurological pain sensors, closing the pain gate, blocking the pain of injections and is also more useful for paediatric patients and those who have a phobia of intraoral injection or pain as there is an audible distraction (70–75 db) provided” [ 34 ].…”

“…The Face, Legs, Activity, Cry, and Consolability (FLACC) scale is one of the most commonly and widely used behavioural observation pain scales [ 44 ]. It is also the most frequently used scale used in the studies included in this review [ 30 , 31 , 35 , 37 ]. Although developed and validated to evaluate postoperative pain, this scale is currently applied to assess acute pain in multiple settings, including in the emergency department, and it is considered an appropriate observational tool in acute pain assessment in the paediatric population.…”