Effect of Needle Gauge on Children's Pain and Anxiety Level During Palatal Infiltration Anesthesia Injection: A Triple-Blind Randomized Controlled Trial Study

Background and Aim:Adequate intraoral anesthesia is a major prerequisite for many dental procedures. Bubble breath exercise, distraction, and play therapy technique may be used as relaxation exercises to decrease pain. This study aimed to compare the efficacy of bubble breath exercise versus topical anesthetic gel in controlling the pain of anterior maxillary infiltration.Methods:This crossover clinical trial was performed on 50 children aged 10-12 years. Subjects received a total of 100 maxillary injections (two per person) in the buccal mucosal area of canine teeth of both sides at intervals of 2 to 3 days. On one side, the injection was performed after applying 20% benzocaine gel. On the other side, a similar injection was performed after the bubble breath exercise. The injection solution was 1/4 of 1.8 mL cartridge of 2% lidocaine containing 1:200,000 epinephrine using a 30-gauge needle. The pain was measured immediately after anesthesia injection using a Visual Analogue Scale (VAS). Data analysis was carried out using SPSS Version 18.0 (IBM Inc., Chicago, IL, USA). Wilcoxon signed-rank tests were used to compare with the 10-mm visual analog scale (VAS) scores obtained from all participants. The level of significance was considered at 5% (p <0.05). The correlation between gender and pain score (VAS) for the two methods was analyzed using the Mann-Whitney U test.Results:The results showed no statistically significant difference between injection pain after topical anesthetic gel application and injection pain after bubble breath exercise (p value=0.30). Also, no statistically significant difference was found between injection pain after gel application and injection pain after bubble breath exercise in boys (p value=0.59) or girls (p value=0.32). There were statistically significant differences between boys and girls in terms of injection pain after gel application (p value=0.001) and also injection pain after e bubble breath exercise (pvalue=0.004).Conclusion:There is no significant difference between perceived injection pain after bubble breath exercise and after applying the topical anesthetic gel. Furthermore, future studies should explore the role of age, dental fear, and anxiety, previous painful experiences, the pain thresholds.

Task and user-based Entropy-Rank Sum-TPOP integration proposal for usability evaluation of web applications

Local anesthetic injections are an essential tool in dentistry, particularly in pediatric dentistry. The needle penetrating the tissue can cause stress, anxiety, and pain. Studies have shown that using touch may alleviate pain and reduce patient anxiety. Yet, this has not been tested in pediatric dental patients. Therefore, this study examined the effect of hand-holding on children undergoing local anesthetic injections. Its effect on children's pain perception was tested, with the hypothesis that pain perception would be lower for children whose hand was held by an assistant. Additionally, the study examined whether hand-holding would affect children's anxiety levels and cooperation. Fifty-five children, who underwent dental treatment within the Department of Pediatric Dentistry at Tel Aviv University, were recruited. The patients were randomly divided into two groups. In the study group, the assistant gently placed her hand on the patient's hand during the anesthetic injection. In the control group, the same treatment was performed without the hand being placed by the assistant. After the anesthetic injection, the child's pain and anxiety levels were assessed using visual analog scales (VAS). The patients' pulse was measured. The level of cooperation was evaluated using the "Frankl" scale. Interestingly, although the trends aligned with this study's hypotheses, no significant effect of hand-holding on pain, anxiety, or cooperation during anesthetic injections was found.

A Process for Selecting a Life Insurance Contract Abstract In the market for life insurance, individuals face many product alternatives, however, little guidance is provided in product selection other than basic descriptions of plan benefits and costs. While objective criteria are important to the purchase decision, an individual's subjective valuation of all criteria, objective and subjective, play the pivotal role. A multi-attribute life insurance contract choice model is presented to assist an individual in the problem of choosing the optimal life insurance contract conditional upon the preference set of the individual. The analytic hierarchy process is employed to structure the decision and determine the optimal life insurance contract. Introduction The selection of the best life insurance contract has been a problem confronted by researchers who have offered consumers numerical recipes to solve for the contract of best value or lowest cost. Kensicki (1974), Babbel (1978), and Babbel and Staking (1983) have used net present value analysis to measure the cost of a life insurance contract, while the interest-adjusted net payment and surrender cost indices are well known methods to evaluate a life insurance contract's projected cost.(1) There also exist a text of positive, theoretical literature that describe optimal life insurance purchasing behavior when a consumer is faced with an uncertain lifetime.(2) However, there is no decision model that integrates an individual's objectives and constraints with respect to the choice of the best life insurance product. This article posits such a decision model. The determination of an individual's optimal life insurance contract among competing contracts is resolved through the analytic hierarchy process (AHP). It is shown that the AHP, as a decision-making methodology, unifies the characteristics of life insurance contracts with an individual's preference set to create a determinate model which assists an individual in selecting a life insurance contract while considering simultaneously the ordering of all characteristics important to the individual. AHP Methodology and the Life Insurance Contract Choice Model The AHP assists an individual in a decision-making process by decomposing a problem into a hierarchic structure of objectives, criteria, and alternatives. Recently, the AHP was employed by Khaksari, Kamath, and Grieves (1989) to the asset allocation problem faced by a portfolio manager. In this article the problem introduced is the selection of the appropriate life insurance contract given a set of competing contracts from which to choose. Associated with this problem are many subjective and objective criteria important to a decision-maker. For example, the value placed on the contractual provisions within the insurance contract is subjective, while the projected interest-adjusted net payment index and cash value accumulation after n years are objective. However, comparisons among subjective and objective criteria by an individual are inherently judgmental reflecting a preference ordering after all comparisons among the criteria have been held. Thus, an individual's subjective valuation of both objective and subjective criteria is captured in the life insurance contract choice model. Multiple criteria weights are derived through the AHP by incorporating the decision-maker's judgments into an objective ratio scale through pairwise comparisons of preference orderings.(3) Structure is given to this process by the problem objective (the top level of the hierarchy), and the underlying criteria. The hierarchical structure of the multi-attribute life insurance contract choice decision is illustrated in Figure 1. In the context of life insurance contract choice, the objective is the individual's expected satisfaction with the life insurance contract which is dependent on the first level of the hierarchy: the net payment index, financial strength of the insurer, contractual features, and cash value accumulation. …

Local anesthetic injection is one of the most anxiety- provoking procedure for both children and adult patients in dentistry. A computerized system for slow delivery of local anesthetic has been developed as a possible solution to reduce the pain related to the local anesthetic injection. The present study was conducted to evaluate and compare pain perception rates in pediatric patients with computerized system and traditional methods, both objectively and subjectively. It was a randomized controlled study in one hundred children aged 8-12 years in healthy physical and mental state, assessed as being cooperative, requiring extraction of maxillary primary molars. Children were divided into two groups by random sampling - Group A received buccal and palatal infiltration injection using Wand, while Group B received buccal and palatal infiltration using traditional syringe. Visual Analog scale (VAS) was used for subjective evaluation of pain perception by patient. Sound, Eye, Motor (SEM) scale was used as an objective method where sound, eye and motor reactions of patient were observed and heart rate measurement using pulse oximeter was used as the physiological parameter for objective evaluation. Patients experienced significantly less pain of injection with the computerized method during palatal infiltration, while less pain was not statistically significant during buccal infiltration. Heart rate increased during both buccal and palatal infiltration in traditional and computerized local anesthesia, but difference between traditional and computerized method was not statistically significant. It was concluded that pain perception was significantly more during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration in both the groups.

Pain control is of great importance particularly in pediatric dentistry. The Dentalvibe® is a device that delivers vibration to the injection site in order to reduce intraoral injections' pain. The purpose of this study was to compare pain levels caused by three types of anesthesia injections and the effect of the Dentalvibe® on reducing the injection pain. The study included 40 children, and each one received six injections. The injections were divided randomly into two methods: experimental (DV): buccal and palatal infiltration on the maxilla and inferior alveolar nerve block (IANB) with vibration and traditional (TR): receiving the same previous injections without vibration. Moreover, pain was assessed using the FLACC® and Wong-Baker faces® pain scales. Then after, patients were asked about their favorite method. No statistically significant differences were observed regardless of the injection site in subjective and objective evaluation in the (TR) method. Although the pain scores in (DV) method were less than the traditional in most injections, the differences were not statistically significant. Children experienced similar levels of pain in all sites of injection using the traditional method. The Dentalvibe® did not decrease discomfort and was not accepted more by children.

Influence of hand grenade weight, shape and diameter on performance and subjective handling properties in relations to ergonomic design considerations

Introduction: The purpose of the present study was to record their pain sensation and to assess children`s reaction objectively and subjectively while receiving dental local anesthesia with 27- and 30-gauge needles. Methods: Forty children (24 boys and 16 girls) participated in this study. A random double-blinded crossover design was used so that each child served as his or her own control, receiving each treatment on the same sides of the same arch at different sessions. Each patient received an injection either with a 27- or 30-gauge needle during the second visit and during the third visit with the other needle. Objective and subjective evaluations were performed. Results: Children`s reactions to mandibular nerve block with 27- or 30-gauge needle regarding SEM scale and Face scale demonstrated significant difference, whereas children receiving the injection with a 27-gauge needle presented more sensation of pain objectively and subjectively. Conclusion: Significant difference was demonstrated concerning pain when 27-gauge or 30-gauge needle was used, and no difference was found in success of local anesthesia. As to these two variables, measured and reported in this study, it can be concluded that 30-gauge needle exhibit clinical advantage in inferior dental injection in children.

The effectiveness of psychosomatic in-patient treatment was evaluated using patients' subjective health ratings and objective data provided by health insurance companies. Associations between subjective and objective criteria were investigated. 318 patients participated in the study. They completed questionnaires on physical complaints, moods and everyday functioning upon hospital admission, at discharge and at one-year follow-up. Insurance companies provided data for 140 of these patients (44 %). Sick leave and the utilization of in-patient treatment were assessed for a period of two years before and two years after psychosomatic treatment. As expected, subjective health status improved. The utilization of in-patient treatment decreased in both years after treatment compared to the year before. Sick leave increased in the first year after treatment but decreased significantly below the base level in the second year after treatment. Self-efficacy expectations and being employed were found to be predictors for long-term reduction in the length of in-patient treatment. Subjective and objective criteria were only slightly correlated. Sick leave and utilization of in-patient treatment were found to increase considerably in the year before psychosomatic treatment. Therefore, pre-post differences over the entire period were only marginal. The change in subjective criteria was more immediate, while changes in some objective parameters were delayed. Both subjective and objective criteria should be included in outcome studies.

To the Editor: Researchers studying HIV risks in injecting drug users rarely assess characteristics of injection equipment. Implicit in this omission is the notion that differences in injection equipment have little or no impact on HIV risk. Needles and syringes used by drug injectors may vary in a number of attributes, including syringe volume, type of syringe, and gauge and length of needle. Several observers(1-3) have noted that syringes with detachable needles retain substantially more blood than integral cannula syringes with permanently attached needles and may thus transmit substantially more virus when shared. The bore of a 28-gauge needle is much smaller than the bore of a 25-gauge needle, thus restricting the flow of liquid and increasing the time required to rinse a syringe with a 28-gauge needle. We examined the effect of needle gauge on the minimum time required to disinfect a syringe with bleach. We compared the time required to completely fill and expel bleach twice from 1-ml insulin syringes with 25-gauge, 26-gauge, and 28-gauge needles. We selected five 1-ml insulin syringes with 25-gauge detachable needles, five 1-ml insulin syringes with 26-gauge detachable needles, and five 1-ml insulin syringes with 28-gauge permanently attached needles. Each syringe was filled to the 1-ml mark with bleach, the bleach was expelled, the syringe was refilled with bleach, and the bleach was again expelled. The process was repeated 10 times with five different syringes with each gauge needle. Cleaning time was measured using a digital stop watch that measured increments of 0.01 second. Recorded times were rounded to the nearest 0.1 second. Analysis of variance was performed to compare the time required to rinse syringes with different gauge needles. The Tukey method was used to adjust for multiple comparisons. As shown in Table 1, the mean number of seconds required to fill and expel bleach twice was 15.7 seconds with a 25-gauge needle, 19.2 seconds with a 26-gauge needle, and 26.9 seconds with a 28-gauge needle. All pairwise comparisons were significant at a family error rate of p < 0.001. Gauge of needle explained 92% of the variance in cleaning time. Our findings illustrate how a minor difference such as the gauge of the needle influences the time required to disinfect a syringe. Shapshak et al.(4) demonstrated that undiluted household bleach completely inactivates HIV in a syringe following an exposure time of 30 seconds. They also demonstrated that bleach does not completely inactivate HIV in a syringe following an exposure time of 15 seconds. Shapshak et al. used a 1-ml insulin syringe with a 25-gauge needle in their experiments. The finding that it takes a minimum of 25 seconds to rinse a syringe with a 28-gauge needle suggests that these smaller needles may inadvertently compel compliance or near-compliance with recommended exposure times, thus increasing the effectiveness of bleach disinfection. Investigators studying HIV risk behavior should include characteristics of injection equipment-type of syringe, volume of syringe, and gauge of needle-as routine items on data collection instruments.TABLE 1: Time needed to clean syringes, by gaugeWilliam A. Zule David P. Desmond Department of Psychiatry; University of Texas Health Science Center at San Antonio; San Antonio, Texas

University admissions policies throughout the country are undergoing review and revision, and universities are considering options which range from basing admissions most heavily upon criteria, such as SAT/ACT scores and/or high school rank, to favoring more holistic approaches, including individualized subjective reviews of accomplishments and characteristics reported in applications, and application essays. Variations of these approaches have been in practice at Texas A&M University for quite some time, yet little was known about how these admission practices were actually predicting the retention, academic performance, and graduation of students throughout the institution. Moreover, less was known about how accurately university-wide and/or subjective admission criteria predicted success for the students of very different colleges. This study identifies the admission criteria, which have best predicted academic success among engineering students from freshman cohorts 1997 through 2001. It specifically examines the predictive effectiveness of using objective merit-based criteria, in combination with subjective criteria, vs. using only objective admission criteria. Success outcomes of the subpopulation of students exempt from admission review due to high school rank or high SAT/ACT, are examined in relation to criteria only. The outcomes of the students who did not meet exemption criteria and were admitted due to favorable review of both and subjective admission criteria are examined in relation to criteria alone, and also in relation to and subjective criteria together. Results are observed and reported for male & female, white, Hispanic & African American subpopulations.

Benzyl alcohol is reported to be painless on injection and to provide limited dermal anesthesia. Benzyl alcohol has also been recommended as an adjuvant to lidocaine to reduce lidocaine's injection pain. There is insufficient data on pain of injection and duration of anesthesia for lidocaine containing benzyl alcohol. We conducted a randomized, placebo-controlled, double-blinded comparison of intradermal 1% lidocaine with 0.86% benzyl alcohol and plain 1% lidocaine for pain of injection and duration of anesthesia. Twenty subjects received the above two agents plus normal saline with and without 0.9% benzyl alcohol, with all solutions adjusted to 375 +/- 13 mosm/L. Lidocaine containing benzyl alcohol was 27% less painful upon injection and provided anesthesia 29% longer than plain lidocaine. Benzyl alcohol is itself an effective anesthetic and can reduce the pain of injection for lidocaine without adversely affecting its anesthetic properties.

이 연구의 목적은 도포마취제로서 5% EMLA cream과 20% Benzocaine gel의 구강 내 주사침 자입 및 마취제 주입시 전/구치부 전정부와 구개부에서의 작용시간과 동통 감소 효과를 평가하기 위함이다. 두 가지 도포마취제는 양측성 무작위 단일 맹검법 분할 디자인으로 평가되었다. Phase I은 전/구치부 전정부와 구개부에 도포마취제를 도포한 후 각각의 도포마취제의 작용시간을 평가하였다. Phase II는 Phase I에서 측정된 시간을 기초로 각각의 도포마취제를 부위별로 적용하여 주사침 자입 및 마취제 주입시 동통 감소 효과를 평가하였다. 평가를 위해 100-mm modified visual analog scale(VAS)를 이용하여 주관적인 동통 수치를 기록하였고, 맥박산소측정기(Pulse oximeter)를 사용하여 주사침 자입 및 마취제 주입 전후의 맥박수를 관찰하여 객관적인 동통 감소 효과를 비교하였다. Phase I 실험결과 두 가지 도포마취제는 전치부가 구치부보다, 구개부가 전정부보다 더 긴 작용시간을 보였다. 전치부 구개부를 제외한 모든 부위에서 EMLA cream이 Benzocaine gel보다 더 빠른 작용시간을 보였다. Phase II 실험결과 마취제주입시 부위별 그룹에 따른 VAS Score를 보면 전치부와 구치부 구개부에서 EMLA cream이 Benzocaine보다 동통 감소 효과에 있어 유의한 차이를 보였다(p<.05). 결론적으로 EMLA cream은 Benzocaine보다 전정부와 구개부 모두에서 빠른 작용시간과 더 좋은 유지력을 나타냈다. 또한 EMLA cream은 Benzocaine보다 주사침 자입시 전치부 구개부를 제외한 모든 부위에서, 마취제 주입시 전치부와 구치부 구개부에서 Benzocain 에 비해 더 좋은 동통 감소 효과를 보였다. The objective of this study was to determine the effectiveness of topical 5% EMLA cream versus 20% Benzocaine gel in reducing pain from intra oral needle insertion alone as well as injection of anesthetic. The 2 topical anesthetics were tested against each other bilaterally using a randomized, controlled, single blinded, split mouth design. Phase I was conducted to find out the rapidity of onset action of the two agents on anterior/posterior vestibules and anterior/posterior palatal mucosa. Phase II was conducted to evaluate the efficacy of the two topical anaesthetic agents in reducing the pain of intraoral injections. The agents were left in anterior/posterior vestibules and anterior/posterior palatal mucosa for the amount of time recorded in phase I. Subjects recorded pain on a 100-mm modified visual analog scale(VAS). A pulse oximeter was used to recorded the preoperative and postoperative pulse rates. In phase I of the study, two topical agents showed the longer onset of action at anterior part and vestibules than posterior part and palatal mucosa. EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. In phase II of the study, the VAS grading of the pain for anesthetic administration showed EMLA cream was significantly(P<.05) better in elimination or reducing the pain on the anterior/posterior palatal mucosa. In conclusion, EMLA cream showed the rapidest onset of action compared to benzocaine gel except on anterior palatal mucosa. EMLA cream was found to be superior to Benzocaine gel with regards to pain reduction for anesthetic administration especially on anterior and posterior palatal mucosa.

The present study seeks to draw together the scattered literature on perceived career success and to develop a theoretical framework which concerns 'striving to know and feel good about oneself as a primary goal of adult life. Results of a longitudinal study of perceived career success involving some 3000 subjects are presented. A LISREL analysis was performed on model variables contrasting the importance of two aspects of Raynor's theory of personality functioning and change (1982), subjective and objective criteria in determining the dependent variable ‘perceived success’. It was hypothesized that subjective criteria, for example being satisfied in one's job, would be a more important determinant of perceived success than objective criteria such as attainment. The parameter estimates which were obtained supported the overall thrust of the hypothesized model. However, support was not found for a number of hypothesized relationships, such as sizable effects of external constraints on subjective and objective factors and the effects of attainment on work satisfaction. The results are discussed in terms of the sample of men and women used in the study and in terms of further development of a career success theory.

Priority setting is an integral part of the community health assessment process since it helps direct the allocation of limited public health resources among competing needs. There is a recognized need for a systematic mechanism to prioritize community health issues in objective, data-driven, quantifiable measures. This exploratory study examined the extent to which data-driven objective criteria were considered important to public health officials in North Carolina and, specifically, the extent to which they chose between objective and subjective criteria in establishing public health priorities. The differences between the health officers' practice (criteria they actually used) and their preferences (criteria thought to be important) were also assessed. It was found that NC health directors generally used subjective criteria more often than objective criteria when deciding on the most important health issues in their communities. A considerable segment of the respondents, however, considered objective criteria more important, even though subjective criteria were the dominant influence in their actual practice of priority setting. Our preliminary results suggest that officers' education and tenure may influence their practice and preferences. Perceived and real barriers to the use of data-driven objective criteria for priority setting are an important topic for future public health research.