Topical anesthesia for stainless steel crown tooth preparation in primary molars: a pilot study

Abstract

Background: Placement of full-coverage restorations such as stainless steel crowns (SSCs) for pulpectomy treated primary molars is essential for successful outcomes. The tooth preparation process for SSCs can cause discomfort to gingival tissues since the crown should be seated 1 mm subgingivally. The purpose of this prospective trial was to compare the effectiveness of subgingival and transmucosal application of topical anesthetics on dental pain during SSC tooth preparation among 6-to 8-year-old children. Methods: A consecutive sample of 27 children, aged 6-8 years, who required an SSC after pulp therapy in primary molars were randomly divided into three groups. Group A received infiltration anesthesia before tooth preparation for SSC placement, whereas in Group B and C, only topical anesthesia was applied subgingivally and transmucosally. Wong-Bakers Faces pain rating scale (WBFPS) scores were recorded after tooth preparation. Faces, Legs, Activity, Cry and Consolability (FLACC) scores were evaluated by two blinded and calibrated investigators through video recordings of the patient during tooth preparation. Data were tabulated, and inter-group comparisons were performed using the Kruskal-Wallis and analysis of variance tests. Results: Out of the 27 participants, 48% were boys and 52% were girls, with an overall mean age of 6.83 years. Group A showed the least pain scores according to both the scales, followed by Group B and Group C. The pain intensity was statistically significant on both the pain scales with P = 0.003 for FLACC and P < 0.001 for WBFPS. Conclusion: Subgingival application of topical anesthesia reduced pain to a certain extent but not as effectively as infiltration anesthesia during SSC tooth preparation in primary molars. Transmucosal application of topical anesthesia did not reduce discomfort when compared to the other two interventions.

Efficacy of eutectic topical anesthesia in stainless steel crown procedures for primary molars: A randomized controlled trial

“…This outcome was expected since, once the patient's discomfort or pain subsided after the prick, infiltration would provide the most profound anesthesia. This is in concurrence with a study by Padminee K (2020), where infiltration anesthesia showed the lowest pain scores as compared to topical anesthetic benzocaine during the conventional SSC preparation and placement 17 . In this study, initial discomfort from infiltration anesthesia sometimes made children uncooperative or fearful.…”

“…This is in concurrence with a study by Padminee K (2020), where infiltration anesthesia showed the lowest pain scores as compared to topical anesthetic benzocaine during the conventional SSC preparation and placement. 17 In this study, initial discomfort from infiltration anesthesia sometimes made children uncooperative or fearful. Therefore, it is recommended that techniques be employed to avoid the need for additional infiltration anesthesia injections in children, which could exacerbate their anxiety and discomfort.…”

“…The required sample size was determined using the OpenEpi software (version 3.01) based on the data obtained from a previous study conducted by Padminee et al. (2015) 17 . The mean and standard deviation values from both the control group and the intervention group, for the 4–8 years age group during SSC preparation, were used to calculate the effect size ( d = 0.77).…”

“…The required sample size was determined using the OpenEpi software (version 3.01) based on the data obtained from a previous study conducted by Padminee et al (2015). 17 The mean and standard deviation values from both the control group and the intervention group, for the 4-8 years age group during SSC preparation, were used to calculate the effect size (d = 0.77). With a significance level (α) of 0.05, a desired power (1-β) of 0.80, and an allocation ratio of 1:1, it was determined that a minimum sample size of 84 participants was necessary, with 14 individuals in each group.…”

“…The findings of this study indicated that the application of topical anesthesia was not as effective as the administration of LA in reducing pain during SSC tooth preparation. It is, however, important to note that this study solely concentrated on pain perception during the preparation of mandibular primary molars 17 . Against this background, this study was conducted to compare and evaluate the effectiveness of topical anesthetic EMLA on pain scores when applied via two routes during SSC preparation and placement in maxillary and mandibular primary molars.…”