Effect of precooling on pain during local anesthesia administration in children: a systematic review

Abstract

This study was conducted to determine how precooling reduces the subjective reported pain and objective pain and to evaluate the effectiveness of precooling the injection site before administration of local anesthesia in children. Electronic databases (PubMed, Ovid SP, Cochrane Central Register of Controlled Trials) were searched for publications from 1980 to 2020. Studies were screened for titles and abstracts, followed by full-text evaluation of included reports. Six studies were included in this systematic review. The primary outcome evaluated was the pain perception or the subjective pain reported by the child receiving the injection. The secondary outcome evaluated was objective pain evaluated in each study. Among 5 studies that evaluated child reported pain scores on a visual analogue scale (VAS), 4 studies reported lower scores in the precooling group and one study reported a higher VAS score in the precooling group than in children treated with 20% benzocaine topical anesthesia. Among 6 studies that evaluated the pain reaction of children by Sound Eye Motor (SEM) score, 4 studies reported a lower SEM score in the precooling group, one study reported no significant difference between the precooling and control groups, and one study reported higher SEM scores in the precooling group than in children treated with 20% benzocaine topical anesthesia. Within the limits of this systematic review, evidence suggests that precooling the injection site with ice can be an effective adjunct to topical anesthesia in reducing both subjective and objective pain during local anesthesia administration in children.

The effect of vibratory stimulus on pain perception during intraoral local anesthesia administration in children: a systematic review and meta-analysis

“…The source of the vibratory stimulus was standardized in all studies (dental vibe), except one study where a modified electric toothbrush was used [ 14 ]. The site of local anesthesia administration was not similar in all the studies, few studies evaluated block injections (IANB) only[ 12 16 ], and few studies evaluated the combination of infiltrations and block injections. Pain reaction was also not measured in a few studies[ 10 11 13 ].…”

“…Effective pain control during the administration of dental injections is very important as it reinforces the trust of the child in the dentist, thereby paving the path for a smooth treatment delivery. Pain perceived during local anesthesia administration in children is mitigated by many methods, such as application of topical anesthetics [ 2 ], use of a camouflage syringe [ 3 4 ], active distraction methods such as deep breathing [ 5 ], WITAUL (writing in the air using legs) [ 6 ], eye movement distraction [ 7 ], usage of audiovisual glasses [ 8 ], buffering the local anesthetic solution [ 9 10 ], warming the local anesthetic solution [ 11 ], and pre-cooling the injection site [ 12 ]; these are few measures to reduce pain perception during local anesthesia administration.…”

Computer-Controlled Local Anesthesia Complication: Surgical Retrieval of a Broken Dental Needle in Noncooperative Autistic Paediatric Patient

“…The pain perceived during local anesthesia administration in children is mitigated by various methods such as application of topical anesthetics [ 3 ], camouflaging of the syringe [ 5 ], distraction with audiovisual glasses [ 11 ], and counterstimulation. Vibration, pressure application, and precooling are different types of counterstimulatory measures to reduce pain perception during local anesthesia administration [ 12 ]. The new generations of dental anesthesia devices, which are designed to minimize unpleasant sensations during administration of local anesthetic, are computer-controlled local anesthesia devices.…”

Extraction of Maxillary Teeth Without a Palatal Injection: A Randomized Control Trial

“…There are many techniques have been used to reduce pain on palatal injection such as, topical pressure, topical anesthesia, topical cooling, TENS, CCLADS and papillary approach palatal anesthesia (19) . However, the number of adjunctive techniques and the different modern injection modalities were recommended to alleviate the palatal injection pain and discomfort, none of them have earned universal clinicians approval, some of them even time consuming, complex requiring-specific apparatus, expensive, and palatal injection is still painful and is relatively poorly tolerated by patients (5)(6)(7)(8)(9)(10) . Indeed, in addition to its abundance of nerve supplies, the palatal mucosa is compact, thick, and firm to its essential periosteum, such that injections into the palate are often extremely painful (5) .…”

“…The most commonly used is the application of Eutectic Mixture of Local Anesthetics (EMLA) topical anesthetics prior to the injection (6) . Even though other methods like, pressure administration, Computer Controlled Local Anesthesia Delivery Systems (CCLADS), palate topical cooling, and Transcutaneous Electrical Nerve Stimulation (TENS) are mentioned in the literature but it is not universally accepted (7)(8)(9)(10)(11)(12) . Researches claimed that Articaine obviated the need for routine palatal injections on account of its better diffusion throughout hard and soft tissues than other local anesthetic agents (13) .…”