Injection Of Local Anesthesia Research Articles

A simple technical innovation to prevent needle stick injuries among dental professionals.

Dental healthcare personnel face the potential danger of being exposed to infectious patients while administering local anesthesia injections during dental operations. This could lead to unintentional transfer of infectious diseases from patients to physicians. Although safety measures such as the One-hand-scoop technique and the use of safety syringes, plastic needle cap holders, and needles with safety caps are in place, there have been instances of needle stick injuries reported in clinics. This might be due to the lack of adherence to conventional safety measures or the impracticality of safety techniques and safety syringes. This article aims to demonstrate the utilization of dental tweezers, specifically London College tweezers or dental forceps, for the secure recapping of needles, eliminating the requirement for extra equipment or devices. After obtaining ethical approval (Approval No.: 024-01-2024) from the College of Dentistry, Dar Al Uloom University, 67 dental professionals, with consent for participation in the study, were included. They were requested to use dental tweezers/London College tweezers and dental extraction forceps such as maxillary anterior, mandibular anterior, and maxillary bayonet root forceps individually to recap the local anesthetic needles. The efficacy of these techniques was evaluated against the one-hand scoop technique for its ease, convenience, and reliability in preventing needle stick injuries. The evaluation of dental professionals regarding the ease of using dental tweezers to recap needles, compared to the one-hand scoop technique (p=0.592), maxillary bayonet root forceps (p=0.746), mandibular anterior forceps (p=0.380), and maxillary anterior forceps (p=0.808), did not yield statistically significant results. The assessment of the procedural simplicity of the one-hand scoop technique showed a satisfaction rate of over 40%, whereas the application of dental tweezers resulted in a satisfaction rate of 30%. However, the use of dental tweezers for needle recapping resulted in a satisfaction rate of over 50%, compared to a satisfaction rate of 30% for the one-handed scoop technique. There is no statistically significant difference in the assessment of the efficacy of dental tweezers and the one-hand scoop technique, bayonet root forceps, mandibular anterior forceps, maxillary anterior forceps, and dental tweezers for the needle capping technique. Therefore, dental forceps can be used instead of the one-handed scoop approach. The needle recapping procedure outlined in our study, aimed at preventing needle stick injuries, is simple to implement, and all dental specialties have convenient access to the required instruments.

Optimizing clinical O2 saturation mapping using hyperspectral imaging and diffuse reflectance spectroscopy in the context of epinephrine injection.

Clinical determination of oxygen saturation (sO2) in patients is commonly performed via non-invasive optical techniques. However, reliance on a few wavelengths and some form of pre-determined calibration introduces limits to how these methods can be used. One example involves the assessment of sO2 after injection of local anesthetic using epinephrine, where some controversy exists around the time it takes for the epinephrine to have an effect. This is likely caused by a change in the tissue environment not accounted for by standard calibrated instruments and conventional analysis techniques. The present study aims to account for this changing environment by acquiring absorption spectra using hyperspectral imaging (HSI) and diffuse reflectance spectroscopy (DRS) before, during, and after the injection of local anesthesia containing epinephrine in human volunteers. We demonstrate the need to account for multiple absorbing species when applying linear spectral unmixing in order to obtain more clinically relevant sO2 values. In particular, we demonstrate how the inclusion of water absorption greatly affects the rate at which sO2 seemingly drops, which in turn sheds light on the current debate regarding the time required for local anesthesia with epinephrine to have an effect. In general, this work provides important insight into how spectral analysis methods need to be adapted to specific clinical scenarios to more accurately assess sO2.

The Use of Local Anesthesia in Pediatric Dentistry: A Survey of Specialists' Current Practices in Children and Attitudes in Relation to Articaine.

This study aimed to evaluate the clinical practices of local anesthesia in children. The study also sought to investigate pediatric dentists' views on articaine infiltration anesthesia and their willingness to use it to replace the inferior dental nerve block in primary molars. A cross-sectional survey was emailed to 183 registered specialists. Descriptive statistics along with chi-square and Fisher's exact tests were used for data analysis. A total of 72 responses were received. The sample consisted of 62 (86.1%) females and 10 (13.8%) males with varying levels of experience. The vast majority of respondents (98.6%) used topical anesthesia in their practice with children. The most frequently used anesthetic agent was 2% lidocaine (72.2%) followed by 4% articaine (54.2%). The entire sample indicated that they frequently find difficulties in dose calculation for their child patient. Gender and level of experience did not significantly influence specialists' practice or their knowledge of local anesthesia. More than a third (31.9%) of participants were not happy to replace the block anesthesia with articaine infiltration for the treatment of lower primary molars. The most indicated reasons for this unwillingness were lack of effectiveness (11%) and inadequate scientific evidence (11%). Most pediatric dentists used topical anesthesia with children. Lidocaine was the most commonly used injectable local anesthesia. Specialists' current practices of local anesthesia in children generally conformed well to good standards. However, inadequate knowledge regarding dose calculation was revealed. In addition, specialists' reluctance to use articaine infiltration instead of the block anesthesia was evident in the current population. Further studies, with larger sample size are encouraged.

Chromotherapy: a useful tool for managing anxiety in children

Background: Dental anxiety is a type of fear developed due to threatening stimuli. Assessing the child's level of dental anxiety is very important to successfully carry out many treatment procedures in dentistry. Needles in general can cause dental anxiety. Chromotherapy is an ancient alternative medicine practice that uses the energy of the visible spectrum of electromagnetic radiation (i.e., coloured light) to induce changes in the human body. The objective of this study was to clinically evaluate and compare the effect of chromotherapy on the level of anxiety in patients treated with infiltration under local anaesthesia. Methods: This is a randomized control trial where anxiety was assessed using heart rate and animated emoji scale (AES) in children aged 4-14 years requiring infiltration injection of local anaesthesia. Patients were divided into 4 groups: group-1 blue, group-2 pink and group-3 yellow, group 4-control. Evaluation of all parameters was carried out at three levels, i.e., pre-operative, post-chromotherapy session and infiltration after local anaesthesia. Results: This study demonstrated that patients subjected to blue, pink and yellow colour therapy had a statistically significant reduction in anxiety compared to the control group after chromotherapy. Conclusions: Chromotherapy plays an important role in managing dental anxiety in children and can be effectively incorporated into routine practice.

Low-level Laser Therapy to Alleviate Pain of Local Anesthesia Injection in Children: A Randomized Control Trial.

The aim of our study was to evaluate and compare pain perception following photobiomodulation (PBM), topical anesthesia, precooling of the injection site, and vibration during administration of local anesthesia injection in pediatric patients aged 6-13 years. In this split-mouth study, a total of 120 patients between the age group of 6 and 13 years were selected and randomly divided into three equal groups with 40 subjects in each. Pain was assessed using visual analog scale (VAS) and the Wong-Baker Faces Pain Rating Scale after the administration of local anesthesia. Behavior during the procedure was assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale filled by the operator. Pulse rate was recorded before and during the administration of local anesthesia using pulse oximeter. After the procedure, patient compliance was also recorded using validated questionnaire. The level of significance was set at p < 0.05. The study showed PBM exhibited the lowest mean scores of anxiety/pain using VAS, Wong-Baker Faces Pain Rating Scale, FLACC scale and pulse rate as compared to precooling, vibration, and topical anesthesia. The differences in pain scores recorded were found to be statistically significant. Children were not anxious about the PBM method and exhibited good compliance (p < 0.001). Photobiomodulation (PBM) was found to be effective means of reducing injection pain, demonstrating much better efficacy than other tested methods. Photobiomodulation (PBM) can be used effectively to better manage procedures that patients frequently find painful without the need for prescription drugs, which frequently have several side effects. Khan BS, Setty JV, Srinivasan I, et al. Low-level Laser Therapy to Alleviate Pain of Local Anesthesia Injection in Children: A Randomized Control Trial. Int J Clin Pediatr Dent 2023;16(S-3):S283-S287.

Evaluating Child Behavior and Preference Toward NumBee and Traditional Syringe (a Randomized Clinical Trial)

BACKGROUND: Local anesthetics are the gold standard for pain control in dentistry. Most patients still view the “needle” as a source of anxiety and disruptive behavior rather than relief. The patient’s cooperation and comfort level will increase with the administration of painless local anesthetic injection using appropriate technique. The purpose of this study was to assess the patient cooperation and behavior after receiving local anesthesia injection and to compare patients’ acceptance and preference of needleless NumBee anesthetic delivery device to conventional dental syringe. MATERIALS AND METHODS: 30 non-fearful 6-8-year-olds who had never been to the dentist were selected for the study using a split-mouth design. They underwent a simple class I restoration on both mandibular permanent first molar teeth in two separated dental visits. The Frankl behavior rating scale was used to assess patient behavior following injection. Patients expressed their preference and acceptance of the used syringes by answering a questionnaire. RESULTS: After injection by either method, 25 patients had Frankl behavior rating score of 4. Patients that had a negative response with the traditional method, showed a score of 2, following NumBee injection (p=0.035). CONCLUSION: Patients accepted both methods, and NumBee may induce less fear, with minimum stinging and unpleasant taste.

A Randomised Split-Mouth Clinical Trial to Assess the Efficacy of Oroquiver: An Affordable Vibrotactile Device for Dental Injections

Introduction: Injection pain is a common concern among patients, including those receiving dental injections. Local Anaesthesia (LA) is a crucial procedure in dentistry to ensure painless treatment. Vibration stimuli have shown promise in raising the pain threshold, managing orofacial pain, musculoskeletal pain, and relieving dental pain. However, many vibrotactile devices available in the market are not affordable for common dentists. Aim: To compare pain perception in patients undergoing bilateral extractions using OroQuiver-assisted LA administration versus conventional LA administration. Materials and Methods: A randomised split-mouth clinical trial was conducted with 17 patients undergoing simultaneous bilateral extractions. LA was administered with and without OroQuiver on the right and left-sides, respectively. Pain assessment was performed using Wong Baker’s Facial Rating Scale and a questionnaire sheet comparing patient comfort following LA administration on both sides. Results: There was a significant difference in the Visual Analog Scale (VAS) score for pain experienced during LA injections using the vibrotactile device (4.29±1.1) compared to the conventional method (7.2±1.5). None of the patients reported discomfort with the device. The device reduced anxiety towards dental injections in 14 patients, and 16 patients indicated they would recommend the device to others. Conclusion: OroQuiver effectively reduced injection-related pain regardless of the type of nerve block administered. It is a costeffective, easily maneuverable, feasible, sterilizable, and reusable device that effectively reduces LA injection-related pain.

Facial Blanching As An Unusual Complication After The Injection of Local Anesthesia: A Clinical Report

Facial blanching is a complication related to local anesthesia in dentistry. Anatomical variation, intravascular injection, rapid local anesthetic injection, decreased blood flow with the vasopressor effect of epinephrine, ortho-retrograde movement of the solution, incorrect positioning of the needle, and neurological origin may cause this phenomenon, the etiology of which is not fully known. Most of the blanching cases reported in the literature are related to injection of the inferior alveolar nerve block. Also, intra-extraoral clinical photography is limited. Supraperiosteal infiltration anesthesia is a safe and easy technique that is frequently used in daily practice in dental clinics. This unique case report describes partial blanching of the face and gingiva after supraperiosteal infiltration of vasoconstrictor containing local anesthetic into the maxilla. In addition, the clinical-anatomical relationship of facial-mucosal blanching with the injection site, literature information, and clinical management with this complication are explained.

Hemodynamic changes following injection of local anesthesia with vasoconstrictor agent in controlled hypertensive patients

Local anesthesia is considered the most commonly used in dentistry. Vasoconstrictors are added to its composition to maximize its advantages. However, it is considered a tourniquet and acts on beta 1 and 2 receptors. This causes augmentation of heart rate and blood pressure. This study aimed to evaluate the safety of vasoconstrictors during simple tooth extraction in controlled hypertensive patients by monitoring the changes in blood pressure, heart rate and oxygen saturation. A prospective clinical study was carried out in a control group (normotensive patients n=60) and study group (hypertensive patients) (n=60). The following hemodynamic parameters (blood pressure [diastolic and systolic], heart rate and oxygen saturation) were monitored at four different time points (before infiltration of local anesthesia (R1), after 3 minutes of local anesthesia (R2), immediately after extraction (R3) and 25 minutes after local anesthesia infiltration (R4). One carpule of local anesthesia for each patient was provided in the form of lidocaine 2% with adrenaline as vasoconstrictor 1/100,000; (3) Results: Mean heart rate increased from one to four beats per minute in all groups, but the increment was lesser in hypertensive group. The increase of systolic blood pressure in hypertensive patients during (R2, R3 and R4) was significantly lower than in the normotensive group (p&lt;0.001). The diastolic blood pressure reading fell in the hypertensive group more than in the normotensive group during (R2, R3 and R4). No changes in oxygen saturation were recorded between both groups; (4) Conclusions: no adverse effects in well-controlled hypertensive patients were seen during simple tooth extraction. One carpule of local anesthesia with 1\100,000 adrenaline does not induce blood pressure augmentation in hypertension patients included in this study. The changes in heart rate were within the safe limits. Keywords: local anesthesia, adrenaline, vasoconstrictors, hypertensive patients, hemodynamic changes.

Loop Excision for Precancers of the Uterine Cervix: Local or General Anaesthetic?

In Germany, treatment of HSIL or AIS of the uterine cervix by loop excision is performed almost exclusively under general anaesthesia (GA). International studies and guidelines show high acceptance of local anaesthesia (LA) due to hermeneutic, medical, and economic factors. We performed an observational comparative study aiming to prove advantages of local anaesthesia within the German health system. In a prospective observational study, patients diagnosed with HSIL or AIS of the uterine cervix were treated at the Institute for Cytology and Dysplasia, Berlin, by loop excision in 2021. We started with a feasibility study : 303 patients diagnosed with HSIL/AIS of the uterine cervix and her colposcopist answered an electronic questionnaire with respect to loop excision under LA. Since we found a high acceptance for LA in patients and colposcopists, we initiated a comparative study LA vs. GA: 322 patients underwent loop excision and selected their mode of anaesthesia: n=206 LA vs. n=116 GA. 114 patients of the feasibility study had to undergo loop excision and became part of the comparative study (n=79 for the LA group, n=35 for the GA group). All patients received a standardised questionnaire to document their pain score within 24h after treatment on a visual analogue scale, i.e. VAS, between 0 and 100. 178 patients of the LA group and 80 patients of the GA group completed and returned the questionnaire and form the cohort for our comparison of LA vs. GA. With 191 of these 258 patients, i.e. 74%, a telephone survey was performed to ask for patient satisfaction and the rates of recurrence after a mean interval of 1 year post surgery. We postulate that there will be no clinically relevant significant difference in satisfaction and postoperative pain between patients in the LA group and the GA group. In the feasibility study , 90% (272 of 303) of patients diagnosed with HSIL or AIS were considered eligible for LA by their colposcopists. 75% (227 of 303) of patients were open to loop excision under LA. In the comparative study , 63 of 206 women of the LA group were interviewed preoperatively: 89% would accept a pain score above 20 during the procedure, 33% a pain score above 50 and 11% of max. 20. Postoperatively, the median VAS pain score for loop excision under local anaesthesia was 13.1 in 178 patients, and pain during injection of local anaesthesia was 20.9 (p<0.001). The VAS pain score 20 minutes post surgery did not differ significantly between 178 patients after local anaesthesia versus 80 patients after general anaesthesia (p=0.09). The surgeons estimated the patient's pain significantly less than the patients themselves with an underestimate of -14.63 points on the VAS (p<0.001). Within 7 days following loop excision under LA, 95.5% of 178 patients would choose local anaesthesia as their preferred method for a potential repeat loop excision, 8.8% of which would like additional painkillers, and 4.5% would choose general anaesthesia.In a telephone follow-up survey of 133 women from the LA group after a mean of 12 months post surgery, 97% were "satisfied" or "very satisfied" with the treatment carried out. For patient satisfaction and postoperative pain, no clinically relevant significant difference was seen between the LA and the GA group.The rate of secondary bleeding (6.7% vs. 8.1%, p=0.72), recurrence of HSIL/AIS (3.6% vs. 5.2%, p=0.62), and the distribution of the histopathological R status (R0 89.5% vs. 81.1%, p=0.73; R1 5.3% vs.12.2%, p=0.57, Rx 4.1% vs. 5.4%, p=0.65) showed no significant difference when comparing the LA group versus the GA group. Following loop excision under local anaesthesia, more than 95% of patients would choose this method again for repeat surgery. One year post surgery, 97% of the patients were "satisfied" or "very satisfied" with the treatment under local anaesthesia. Offering local anaesthesia for loop excision to patients should be mandatory and included in current guidelines.

Iontophoresis-Infused Deep Topical Anesthesia and Injectable Local Anesthesia for Dental Procedures Among Pediatric Patients: Performances and Consequences.

Exploring routes of needle-free anesthesia has drawn particular attention to the iontophoretic technique. Iontophoresis has a wide range of applications in dentistry, treating hypersensitivity, oral ulcers, non-invasive procedures of deep topical anesthesia, etc. Hence, this research was performed for a comparative assessment of topical anesthesia spray infused via iontophoresis and local anesthesia (LA) infiltration for dental procedures among 5-12-year-old patients. A split-mouth, randomized clinical trial was undertaken over two years among study subjects aged 5 to 12 years. They were randomly assigned to one of two groups: the first (Group A - iontophoresis group) received topical anesthesia spray (Lidayn®; Pyrax Polymers, Roorkee, India) applied by iontophoresis, and the second (Group B - LA infiltration group) received local infiltration of 2% lignocaine solution (LignoTer®; Lusture Pharma, Ahmedabad, India), where primary teeth extraction or pulpectomy was performed. The Wong-Baker Facial Pain Rating Scale (WBFPRS) was used for a subjective assessment immediately following anesthesia. The mean value of current intensity for the extraction procedure was 9.43±0.95 mA, and the duration of application was 1.85±0.80 minutes. The mean value of current intensity for pulpectomy was 9.07±1.34 mA, and the time was 2.40±0.74 minutes. In inter-group comparison, WBFPRS scores were lower in Group A (1.96±1.64) compared to Group B (3.62±1.11), which was statistically significant with p=0.001. Compared to local infiltration, iontophoresis as a non-invasive approach for topical anesthesia was more well-received by pediatric patients.

Anesthetic Effect of 2% Amitriptyline Versus 2% Lidocaine: A Comparative Evaluation.

Introduction A common dental problem is the fear of pain during needle prick for giving local anesthesia (LA). The needle prick pain during dental procedures oftenvaries with sex andage. Perception of pain depends on various factors, which can be psychological and biological. This perception of pain may change the behavior of patients toward dental treatments. Traditionally, lidocaine gel formulation was utilizedbefore the parenteral dosage form. The lidocaine gel formulation is considered the drug of choice for LA in dental surgery. Currently, amitriptyline has been utilized in dental practice because of its beneficial pharmacology. Hence, the present study has been undertaken to compare the anesthetic ability of amitriptyline as an intraoral topical anesthetic agent with lidocaine gel. Methods This study was a comparative clinical study between two medications' anesthetic properties. This study included 120 patients indicated for bilateral orthodontics (the subdivision of dentistry that emphasizes identifying necessary interventions for the malocclusion of teeth) procedures. All the subjects were divided into amitriptyline and lidocaine groups. Both anesthetic gels wereapplied at separate sites before the injection of LA. The time of the onset of anesthesia was noted and analyzed. Patients were selected on the basis of inclusion and exclusion criteria. Individuals aged 18 to 30 years who were systemically healthy and orthodontically indicated for bilateral premolar extraction were included in this study. Again, patients with a history of neurological disorders and allergies to amitriptyline and lidocaine were excluded fromthe current study. Results Significant differences emerged between groups at five and 10 minutes, with amitriptyline-inducedpartial numbness (36.7% and 6.7%). At 40 and 45 minutes, both groups showed varied partial and complete numbness, with amitriptyline leading to partial recovery (23.3% and 73.3% complete numbness, 23.3% partial recovery) and lidocaine resulting in partial recovery (81.7%). When comparing the visual analog scale (VAS) scores, both groups exhibited a similar simultaneous effect at 15 minutes. Nonetheless, amitriptyline displayed significantly lower scores at 25 and 35 minutes (p < 0.001) in comparison to lidocaine. Similar observations were made when controlling for pain intensity. Conclusion It was concluded that amitriptyline holds both anesthetic and analgesic properties. Nevertheless, this study was unable to generalize the study findings because of the small sample size and being a single-center study. However, the VAS scores of anesthetic and analgesic pharmacodynamics properties of amitriptyline were statistically significantly lower than lidocaine, particularly at 25 and 35 minutes. Additionally, amitriptyline-induced anesthetic and analgesic pharmacology, especially pharmacokinetics properties, depends on the location and pattern of pain.

Assessment of the Knowledge and Management Method of Dentists in Yazd City about Ocular Complications after Injection of Local Anesthesia in Year 2021

Introduction: Local anesthesia is a routine part of all dental procedures that can cause complications. One of the most important side effects of intraoral anesthesia is ocular disorders. The aim of this study was to investigate the knowledge and proper management of dentists in Yazd City regarding ocular complications following local anesthesia injection.&#x0D; Methods: In this cross-sectional descriptive study, 193 dentists working in Yazd City were included in the study based on census sampling and they completed a questionnaire, which was consisted of two parts: demographic information and questions referring the knowledge and practice; data were analyzed using SPSS 16 software and ANOVA and T-test and Pearson correlation coefficient.&#x0D; Results: Mean knowledge score of the participantswas 1.21 ± 0. 6 with a variation range of 0 to 2. The mean awareness score of women was higher than of men, and a statistically significant difference was observed (P-value≤0.05). There was no significant relationship between awareness score and level of education, work experience and age (P-value≥0.05). Only 13.1% of general dentists and 25% of specialists had experienced ocular complications after intraoral anesthesia injection.&#x0D; Conclusion: Dentists of Yazd City had an average knowledge about ocular complications following local anesthesia injection and due to the great importance of prevention and management of ocular complications following local anesthetic injection, it seems necessary to hold retraining courses on this topic and how to manage it.

Anatomical proposal of local anesthesia injection for median nerve block in treating hyperhidrosis with botulinum neurotoxin.

Hyperhidrosis, causing excessive sweat, can be treated with Botulinum neurotoxin injection. Botulinum toxin, an effective and safe treatment for hyperhidrosis, unfortunately involves significant pain due to multiple injections. This study aims to propose a more efficient and less painful approach to nerve blocks for relief, by identifying optimal injection points to block the median nerve, thereby enhancing palmar hyperhidrosis treatment. This study, involving 52 Korean cadaver arms (mean age 73.5years), measured the location of the median nerve relative to the transverse line at the pisiform level to establish better nerve block injection sites. In between the extensor carpi radialis and palmaris longus, the median nerve was located at an average distance of 47.39 ± 6.43mm and 29.39 ± 6.43mm from the transverse line at the pisiform level. To minimize discomfort preceding the botulinum neurotoxin injection, we recommend the optimal injection site for local anesthesia to be located 4cm distal to the transverse line of the pisiform, within the tendons of the palmaris longus and flexor carpi radialis muscles.

Peri-operative Hemodynamic changes and Anxiety in patients undergoing surgical and LASER assisted periodontal therapies- A randomised clinical trial

Objectives: Hemodynamic changes, such as changes in blood pressure, heart rate, and hypoxia, are observed during surgical procedures and may be related to pre-operative anxiety. As a result, the current study aims to compare the hemodynamic changes, hypoxia, and anxiety in LASER assisted periodontal therapy and surgical periodontal therapy for pocket reduction.&#x0D; Methods: This single blinded randomized controlled observational clinical trial included 30 patients with Stage II,III and Grade B,C periodontitis randomly allocated to surgical periodontal therapy (SurPT) and LASER assisted periodontal therapy(LAPT) groups. The systolic blood pressure(SBP), diastolic blood pressure(DBP), Pulserate(PR), oxygen saturation (SpO2) were assessed before injection of local anaesthesia (LA), after LA, during and at the end of procedure. Pre-operative anxiety(POA) was assessed using Amsterdam pre-operative anxiety and information scale(APOAI) before starting the procedure. Statistical analysis was done using student t-test for intergroup and repeated measures of ANOVA for intragroup analysis.&#x0D; Results: SBP and HR were significantly greater in SurPT group at all time intervals compared to LAPT group (P

The use of virtual reality hypnosis for prostate cancer patients during transperineal biopsy/gold seed implantation: A needs assessment study

BackgroundPatients having radiation therapy treatment to the prostate may require invasive preparation procedures under local anesthesia (LA), such as the insertion of gold seeds into the prostate or targeted biopsies. These procedures can induce pain and anxiety for some patients. Virtual Reality Hypnosis (VRH) is the combination of a 360-degree video display with audio and mental guides for relaxation and distraction during medical procedures. The objective of this research was to assess the level of patient interest in the use of VRH during gold seed insertion and biopsy, and to identify a subset of patients that would be most likely to benefit from the use of VRH. MethodsThis single arm, prospective pilot study included patients who were receiving biopsy and/or gold seed insertion using a 2-step LA procedure. Participants were asked to complete a questionnaire about their level of knowledge and interest in VRH before and after their procedure. At the same time, pain and anxiety levels were collected before and after the procedure, as well as during each LA step and at the mid-seed drop/biopsy core extraction. A visual analogue scale for pain and the National Comprehensive Cancer Network's Distress Thermometer were used to verbally rate pain and distress respectively. Descriptive statistics and Pearson's correlation coefficient were calculated for all variables of interest. Results24 patients were recruited and 1 had their procedure cancelled, so a total of 23 patients completed this study. 74% of patients (n=23) agreed to try VRH before their procedures, whereas 65% of patients (n=23) were willing to try VRH after the procedure. Pain scores were highest at deep LA injection (mean= 5.48, SD= 2.56) and distress scores were also highest at deep LA injection (mean= 4.28, SD= 2.92). After the procedure, 83% of participants with pain scores above the mean at deep LA injection and 80% with anxiety scores above the mean at deep LA injection agreed that they would be willing to try VRH. ConclusionsPatients with higher pain and distress scores had more interest in trying VRH with the standard LA for gold seed insertion/biopsy procedures. Patients with a history of lower pain tolerance or who express having experienced high levels of pain during previous biopsies will be the target population for using VRH in future trials to determine feasibility and effectiveness.

Investigating 3D-printed disk compressing against skin for pain relief in intradermal infiltration anesthesia: a randomized controlled trial

BackgroundPain intensity may be varied during the needle advancing through different skin layers, injection into the intradermal layer may exclude mixed pain from deeper planes. This study aimed to investigate whether compressing a three-dimensional (3D)-printed disk against the skin may relieve pain associated with intradermal injection of local anesthetic which mimics the skin test procedure.MethodsAfter institutional review board approval, 3D-printed disks with projections were designed for this study. Enrolled patients were randomized to receive either a disk compressing against the axillary skin during the intradermal injection of local anesthesia (compressing disk group) or an intradermal injection of local anesthesia without any compression (no compressing disk group). The primary outcomes were pain intensity (100-mm visual analog scale) and satisfaction (5-point Likert scale) as assessed by patients.ResultsNinety patients with American Society of Anesthesiologists I–II physical status receiving intradermal local anesthesia prior to an ultrasound-guided axillary approach were included. Eighty-seven patients completed the study, with 44 and 43 patients in disk and no disk groups, respectively. Pain scores were significantly different (P < 0.001) in compressing disk (median, 10; IQR, 5–20) and no compressing disk (median, 30; IQR, 20–40) groups. The median satisfaction score was 5 in both groups. No complications occurred during follow-up.ConclusionCompressing a 3D-printed disk against the skin may reduce intradermal needle pain and offers an effective alternative for nerve block induction.

Comparative study of two different computer-controlled local anesthesia injection systems in children: a randomized clinical trial.

To compare pain perception associated with two computer-controlled local anesthesia devices, the WAND™ STA (Milestone Scientific Inc., Livingston, NJ, USA) and the Calaject (Rønvig dental MFG, Daugaard, Denmark) in young children. A split-mouth randomized clinical trial comprising 30 patients, aged 6-12years, received randomly, in two separate sessions, a local anesthesia injection in the maxillary using either the wand STA or the Calaject. Pain perception was evaluated using the patient's heart rate, an 11-point numerical scale (NRS), and the Sound, Eye, and Motor (SEM) body movements. Statistical difference was set at p = 0.05. Repeated measures analysis of variance were conducted to compare the mean pulse for Calaject and STA at different times. It was followed by univariate analysis and Bonferroni multiple comparisons tests. Wilcoxon tests were performed to compare NRS, SEM, and injection duration between Calaject and STA. There was no significant statistical difference between Calaject and STA in pulse rate before injection (p = 0.720), during injection (p = 0.767), and after injection (p = 0.757). The mean NRS score was significantly greater with STA in comparison with Calaject (p = 0.017). The mean SEM score was also significantly greater with STA in comparison with Calaject (p = 0.002). However, the mean duration was significantly longer with Calaject (p = 0.001). Calaject was more effective than STA in reducing pain perception associated with periapical injection in young children.

Assessment of pain in paediatric dental patients during administration of local anesthesia with and without the use of audiovisual distraction

Infants and children who experience pain in early life, show long-term changes in terms of pain perception and related behaviors. Local anesthesia is integral to the practice of painless dentistry but the pain of injection itself is deterrent to successful administration of local anesthesia and can be a most anxiety-provoking procedure. Distraction as a behavior management technique is successfully known to reduce pain and manage children's dental behavior by diverting their attention away from painful stimuli during invasive dental procedure. This study aimed to compare the pain associated with local anesthetic injection delivered with and without the use of distraction as a behavior management technique in 6-8-year-old children. In this randomized, clinical, in vivo study with a split-mouth design we compared the pain of 30 children (6-8-year-old), requiring dental treatment necessitating the use of local anesthesia bilaterally in either of their maxillary and mandibular arches. Treatment was done in two visits, 1 week apart. Children were randomly assigned to receive the distraction (iPad) at one visit while no distraction in other visits. Two different pain assessment scales were used: Wong-Baker faces pain scale (FPS) and FPS-Revised. The Chi-square test was used for statistical analysis. P ≤ 0.05 was considered to be statistical significance. Children who received local anesthesia with audiovisual distraction had lower pain rating scores than those who received local anesthesia with no distraction. Audiovisual distraction significantly reduces pain associated with injection of local anesthesia.

Evaluation of the effectiveness of photobiomodulation therapy as an alternative method to local anesthesia injection in pediatric dentistry.

The idea of receiving local anesthesia (LA) via an injection is a major source of dental fear and anxiety. In children, dental anxiety is considered the main reason for avoiding dental treatments. Moreover, there are potential complications during/after LA administration. Thus, it is necessary to search for painless, low-risk, and nonpharmacological anesthetic approaches. This study was performed to evaluate the effectiveness of photobiomodulation (PBM) therapy as an alternative method to LA injection for conventional restorative treatments in pediatric patients. This was a split-mouth randomized clinical study. The study included 15 children between 6 and 12 years old. Each child had 2 similar contralateral caries lesions in the first permanent molars in the same jaw, total (30) teeth. For each child, one tooth was treated under conventional LA injection and the other was treated under PBM-based anesthesia. The Wong-Baker's Faces Pain Scale was used for reporting the pain and discomfort levels at the end of the treatments. Data statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20. Mann-Whitney U-test was used to compare between the groups. The PBM-based anesthesia group recorded a mean pain score of 2.27 ± 1.28. The conventional LA group recorded a mean pain score of 1.73 ± 0.7. The difference between the groups was not statistically significant (P = 0.168). PBM-based anesthesia may be an optional alternative to LA injection for conventional restorative treatments in children with dental anxiety, needle phobia, or special needs, and it deserves further studies and improvement.