BackgroundThe current study aimed to evaluate the effectiveness of a camouflaged dental syringe in reducing dental anxiety and pain during maxillary infiltration anesthesia in children aged 6–9 years, compared to a conventional syringe.Materials and MethodsThis randomized controlled clinical trial included healthy children aged 6–9 years who attended the Department of Paediatric Dentistry at Damascus University between December 2023 and May 2024. All participants required dental treatment in the maxilla involving buccal and palatal infiltration on one side. Participants were randomly assigned to two groups: Group A received local anesthesia with a conventional syringe using the tell–show–do (TSD) technique, and Group B received anesthesia with a camouflaged syringe using the same TSD approach. Dental anxiety was assessed using the facial image (FI) scale. Dental pain was assessed using the face, legs, activity, cry, consolability (FLACC) behavioral pain scale and changes in pulse rate as a physiological indicator for both pain and anxiety. Primary outcome measures were recorded at baseline (t0), after the TSD technique (t1), and after anesthesia procedure (t2).ResultsA total of 70 children (mean age = 7.34 years) were enrolled. The FI scale scores and pulse rates increased significantly overtime in both groups (p < 0.05), indicating heightened anxiety during the procedure. However, the camouflaged syringe group showed significantly lower FI scores at t1 (p = 0.001) and t2 (p = 0.005), indicating reduced anxiety levels compared to the control group. Similarly, the camouflaged syringe group reported a significantly lower FLACC score at t2 (p = 0.021), highlighting less reported pain. However, no significant differences were found in pulse rate across time points.ConclusionsThe use of a camouflaged syringe appears to be an effective strategy for reducing dental anxiety and pain in children undergoing local anesthetic injections in the maxillary arch.Trial Registration: ClinicalTrials.gov identifier: ISRCTN51025476

Assessment of Self-Medication Behaviour in Response to Dental Pain in Two Populations, France

The prevalence of persistent opioid use following dispensed dental opioid prescriptions in Australia.

Low-level laser therapy and dental injection pain in children: A Systematic Review and Meta-analysis

Ketorolac in dental pain management: a potent nonsteroidal anti-inflammatory drug with practical limits.

Dental pain is one of the most prevalent and clinically significant concerns in dental practice, substantially impacting patient comfort, treatment compliance, and oral health related quality of life. Owing to its multifactorial pathophysiology, dental pain is often inadequately controlled by single-agent analgesic approaches, which are further constrained by dose limitations, adverse effects, and growing concerns regarding opioid use.Multimodal dental pain management has therefore emerged as an evidence-based strategy that integrates pharmacologic and non-pharmacologic interventions to target multiple pain pathways simultaneously. This literature review discusses the rationale for multimodal analgesia in dentistry with an emphasis on optimized local anesthesia techniques,non steroidal anti inflammatory drugs, acetaminophen, corticosteroids,judicious opioid sparing and opioid use when indicated.Adjunctive nonpharmacologic modalities, including behavioral and cognitive interventions,photobiomodulation,cryotherapy, transcutaneous electrical nerve stimulation, acupuncture, and virtual reality based distraction are also reviewed, acknowledging variability in the strength of clinical evidence supporting their use.

Awake bruxism (AB) is closely linked to psychological factors and commonly co-occurs with painful temporomandibular disorders (TMD). To evaluate the role of anxiety comparing the frequency of AB behaviours, as well as levels of perceived stress, pain catastrophizing and depressive symptoms among patients with painful TMD, categorised by clinical anxiety levels. A total of 72 patients diagnosed with painful TMD were enrolled and classified into two groups based on T-scores derived from the Generalised Anxiety Disorder 7-item scale [GAD-7]: elevated symptoms of anxiety group (T ≥ 61): 30 and normative anxiety (T ≤ 60): 42. T-score calculations were based on a previously studied pain-free control group. AB behaviours were recorded through Ecological Momentary Assessment (EMA), and participants completed the Perceived Stress Scale [PSS], the Pain Catastrophizing Scale [PCS] and the Patient Health Questionnaire-9 [PHQ-9], alongside lifestyle assessment. Between-group comparisons and correlation analyses were conducted to evaluate associations between anxiety and clinical, behavioural and psychosocial outcomes. Patients with elevated symptoms of anxiety exhibited higher total AB frequency (89%; 72.12%; p < 0.002), particularly increased tooth clenching (26.90%; 13.48%; p < 0.016). They also reported significantly higher clinical pain intensity (p < 0.005), as well as elevated perceived stress (p < 0.001), higher pain catastrophizing (p < 0.032), especially helplessness (p < 0.050) and rumination (p < 0.47) and more severe depressive symptoms (p < 0.002). No significant differences were seen between groups in physical activity, social engagement, alcohol drinking or smoking. These findings underscore that TMD patients with elevated clinical symptoms of anxiety exhibit significantly higher frequencies of AB, specifically tooth clenching, psychological distress and pain intensity.

Background: Dental injections are among the most aversive procedures in pediatric dentistry. Hence, any effort aimed at reducing injection pain in children is valuable. Few studies have examined the effect of acupressure on injection pain in pediatric dentistry. Objective: To investigate the effect of acupressure at the LI4 point on the injection pain of local anesthesia in children. Design, Setting, and Participants: This is a randomized, triple-blind, crossover clinical trial. Children were randomly allocated into two groups. One group received acupressure at LI4 in the first session and sham acupressure in the second session, while the other group received the interventions in the reverse order. Local anesthesia was administered after the acupressure treatment. Pain intensity was assessed using the Face, Legs, Activity, Cry, Consolability scale (FLACC) and the Faces Pain Scale-Revised (FPS-R). Interventions: Acupressure and sham acupressure. Main Outcome and Measures: The main outcome measure was the pain level during injection. Results: Twenty-four children participated (11 boys, 13 girls) with a mean age of 7.16 ± 1.34 years. The mean pain level assessed by FLACC was reduced with acupressure, but the reduction was not statistically significant. Pain reduction with acupressure assessed by FPS-R was also not significant. Randomizations: Flip of a coin. Conclusion: In this study, there was no significant difference in pain levels between the acupressure and sham acupressure group. Consequently, the reduction of dental injection pain through acupressure was not observed. Furthermore, research in the field of dentistry, exploring various acupoints, is necessary to draw more conclusive results.

Self-Prescribed Analgesic Use for Acute Dental Pain Among Saudi Adults: A Cross-Sectional Study

Impact of therapeutic play and music therapy on dental anxiety and pain perception in pediatric patients: a clinical study.

The conventional method of removing caries lesions is an anxiety-inducing process that often necessitates the administration of local anesthesia and the extensive removal of tooth structure. Therefore, minimally invasive procedures are required to preserve tooth structure and minimize discomfort. The aim of the study was to compare 3 minimally invasive treatments for the management of dental caries, evaluating factors such as treatment time, the need for anesthesia, reported adverse events, and restorative material follow-up. A clinical trial was conducted on 45 children aged 7-8 years with active caries in primary molars. The samples were divided into 3 groups based on the applied treatment: 38% silver diamine fluoride (e-SDF®) group; BRIX3000® group; and CeraBur® group. The duration of treatment was recorded using a stopwatch. Adverse events, including tooth pain irritations, lesions, spots, and discolorations, were reported by parents within 2 weeks. The durability of the restorative material, namely glass ionomer cement (GIC), was assessed after 3 months. The χ2 and Kruskal-Wallis tests were conducted to analyze the data. The values were considered statistically significant at p ≤ 0.05. A significant difference in the duration of caries removal procedure was noted between the 3 treatment methods based on the median values (e-SDF®: 471 s, CeraBur®: 171 s, BRIX3000®: 1,173 s) (p < 0.001). Post hoc pairwise comparisons indicated significant differences in duration of the procedure between the CeraBur® and BRIX3000® groups, as well as between the e-SDF® and BRIX3000® groups (p < 0.001). The need for local anesthesia varied significantly between the 3 methods (p = 0.021). A significant difference was observed in the incidence of postoperative complications among the 3 methods, with the rate of adverse events equaling 9 (60.0%) in the e-SDF® group and 2 (13.3%) in the remaining groups (p = 0.013). A 3-month follow-up revealed a borderline significant difference in GIC integrity among the 3 methods (p = 0.052). Caries excavation using BRIX3000® required a longer duration compared with e-SDF® and CeraBur®. Silver diamine fluoride was found to be a simple, minimally invasive approach for caries management and was effective in reducing the need for local anesthesia during treatment. Further research is required to evaluate patient satisfaction and restoration outcomes over longer follow-up periods.

Previous studies have identified an association between dental anxiety and pain perception; however, the nature of this relationship in the context of oral implant surgery, particularly with respect to pain perception across multiple time points, remains unclear. This study aimed to examine the association between dental anxiety and peak pain perception following oral implant surgery. We conducted a prospective observational study involving 332 patients undergoing oral implant surgery. Pain perception was evaluated using a Visual Analogue Scale at five time points: preoperatively (T0), intraoperatively (T1), and at 6 h (T2), 24 h (T3), and 7 days postoperatively (T4). Dental anxiety was assessed with the Modified Dental Anxiety Scale. Logistic regression analysis was conducted to investigate the association between dental anxiety and peak pain perception. A generalized additive model was used to identify nonlinear associations, and a segmented logistic regression model was employed to identify break points. The mean score for pain perception increased from 0.26 ± 0.87 at T0 to 4.36 ± 1.70 at T2, then gradually decreased to 2.55 ± 1.34 at T3 and 0.55 ± 0.80 at T4, where T2 was the time point of peak pain intensity. Logistic regression analysis revealed that the odds ratio (OR) for the association between dental anxiety and pain perception was 1.38 (95% CI: 1.26, 1.53), indicating a 38% increase in the likelihood of pain perception for each one-unit increase in dental anxiety score. A nonlinear relationship was observed, with a break point identified at a dental anxiety score of 14.01. Below this threshold, the odds of pain perception increased substantially with increasing anxiety (OR = 1.51, 95% CI: 1.34, 1.69; p < 0.001). However, beyond this point, the level of anxiety was not associated with pain perception risk (OR = 0.91, 95% CI: 0.76, 1.07; p > 0.05). A nonlinear relationship was observed between dental anxiety and pain perception following oral implant surgery. Even at subclinical levels, elevated anxiety was associated with an increased likelihood of pain perception. These findings highlight the importance of early identification and management of dental anxiety to improve postoperative pain control. Further research is warranted to evaluate the clinical utility of integrating anxiety assessment into preoperative care.

Background/Objectives: Neck pain is highly prevalent among dentists and has been linked to occupational exposure and cervical degeneration. However, the relationship between cervical MRI findings and symptoms remains inconsistent. This study aimed to explore MRI-based cervical structural profiles in active dentists and examine their associations with neck pain, disability, and participant characteristics. Methods: A cross-sectional study was conducted in 57 practicing dentists. Participants reported neck pain and completed the Numeric Pain Rating Scale and the Neck Disability Index (NDI). Cervical MRI scans were assessed by an experienced musculoskeletal radiologist. An exploratory hierarchical cluster analysis (complete linkage, Euclidean distance) was applied using MRI degenerative variables to identify structural profiles, followed by bivariate comparisons with clinical and occupational factors. Results: Degenerative MRI findings were common (disc bulging, 66.7%; disc herniation, 54.4%). Two MRI-based profiles were identified, one characterized by a higher burden of degenerative findings (including disc and facet changes) (70.2%), and another with fewer/milder degenerative features (29.8%). Neck pain and NDI scores ≥ 20 were more frequent in the higher-degeneration profile (p = 0.001 and p = 0.004, respectively). Age showed a non-linear pattern, with younger dentists reporting pain despite milder MRI changes, whereas older dentists showed more degeneration with fewer symptoms. Conclusions: In this exploratory study, individual MRI findings were not independently associated with neck pain, while a higher overall burden of degenerative changes tended to co-occur with greater symptom reporting and disability. These findings should be interpreted as hypothesis-generating and warrant confirmation in larger, longitudinal studies.

Periapical actinomycosis is an uncommon infection that may lead to osteomyelitis, especially in immunocompromised individuals like those with uncontrolled diabetes mellitus. This case involves a 22-year-old male with type 1 diabetes who presented with recurrent dental abscesses, pain, and tooth mobility. Imaging revealed extensive periapical lesions in the anterior mandible. Biopsy identified Actinomyces spp., MRSA, and Streptococcus viridans. Due to severe bone destruction, the patient underwent full-mouth extractions, marginal mandibulectomy, and mandibular reconstruction using a microvascular iliac crest flap. A postoperative mandibular fracture necessitated further resection and reconstruction with a custom titanium plate. Vestibuloplasty with a split-thickness skin graft improved soft tissue adaptation, and two implants were placed in the parasymphysis region to support an overdenture. The aggressive infection, worsened by diabetes, required a multidisciplinary approach. The iliac crest flap offered structural support and enabled early prosthetic rehabilitation. This case highlights the need for early diagnosis and integrated treatment to achieve functional and aesthetic success.

Aim: This cross-sectional study aimed to evaluate and compare parents’ and children’s preferences for full-coverage restorative treatment options of primary molars, including stainless steel crowns (SSCs), zirconia crowns (ZCs), and BioFlx crowns. Additionally, the study evaluates the influence of providing a brief overview of the advantages and disadvantages of each full-coverage restorative treatment option on parental preference. Methods: The study was conducted at the pediatric dental clinics at King Abdulaziz University Faculty of Dentistry (KAUFD) in Jeddah, Saudi Arabia, from January to May 2024. Healthy Arabic-speaking children aged 6–12 years attending KAUFD for routine dental treatment, along with at least one parent who agreed to participate, were included. Three typodont models with a SSC, a ZC, and a BioFlx crown were prepared and cemented by an expert pediatric dentist. The participating children and their parents were simultaneously and independently shown the prepared typodont models and asked to indicate which treatment option they preferred most. Subsequently, a trained pediatric dentist presented a brief overview of the advantages and disadvantages of each treatment option to the parents. Then, parents were asked to re-evaluate their preferences. The threshold for significance was set at p < 0.05. Results: A total of 172 children and their parents were included. The most preferred full-coverage restorative treatment among children was SSC (39.0%), while among parents, ZC (60.5%) was the most preferred. After providing a brief overview, the most preferred option among parents was SSC (39.5%), with ZC and BioFlx crowns being equally preferred (30.2%). Significantly more children with no history of dental pain or discomfort (49.1%) (p = 0.023) or with a history of previous dental treatment involving SSC (40.2%) (p = 0.045) preferred SSC. The ZC was significantly more preferred by parents of female children (70.65%) (p = 0.027) and by parents of children with a history of dental treatment (60.6%) (p = 0.018). Conclusions: The study revealed that parental demands and expectations often differ from those of their children, leading to notable differences between children’s and parents’ preferences. After a brief overview, parental preference shifted from ZC to SSC, highlighting the importance of effective communication and education when making treatment decisions for pediatric patients.

The effects of virtual reality and external cooling and vibration (Buzzy®) on dental anxiety and pain during inferior alveolar nerve block in children: a randomized clinical trial

The Effect of Damask Rose Essential Oil Aromatherapy on Dental Anxiety and Pain on Children Undergoing Local Anesthesia: A Randomized Clinical Trial

Occurrence and predictors of severe pain one week after root canal treatment: the national dental PBRN PREDICT endodontic study.

IntroductionThe delay in children going to the dentist is a significant factor contributing to the deterioration of their dental problems. Additionally, the soothing scent of vanilla, reminiscent of ice cream, and the pleasant aroma of orange can enhance relaxation during dental procedures.ObjectiveThe present study aimed to determine and compare the effects of aromatherapy with orange and vanilla essential oils on pain and dental anxiety in children undergoing dental procedures.MethodsThe present study was a randomized controlled trial with three parallel groups, two interventions, and a control group. One hundred and twenty-six children undergoing dental procedures were invited to study. Each group received either vanilla, orange, or placebo essence during their dental procedures. Pain, anxiety levels were assessed.ResultsBoth vanilla and orange aromatherapy effectively reduced dental pain and dental anxiety in children undergoing dental procedures. Vanilla aromatherapy reduced dental pain (P < .01, ES = 4.67) and dental anxiety (P < .001, ES = 7.05), while orange aromatherapy also significantly reduced dental pain (P < .01, ES = 3.23) and dental anxiety (P < .001, ES = 4.36). Comparisons between the two aromatherapies showed that vanilla was more effective than orange in reducing dental pain (P < .01, ES = 1.70) and dental anxiety (P < .001, ES = 2.74).ConclusionVanilla and orange aromatherapy effectively reduced dental pain and anxiety in children undergoing dental procedures. Therefore, further studies are recommended to investigate the effects of these aromatherapy interventions on children with other oral or dental conditions, aiming to provide more effective supportive care. Caregivers, especially dental clinic nurses, can consider recommending vanilla and orange aromatherapy as supportive measures to help reduce pain and distress during dental treatments.

Dental prescribing is a crucial component of general dental practices, enabling the management of pain, control of infection, and promotion of postoperative recovery. Analgesics, antibiotics, and antiseptic mouthwashes are frequently prescribed as short-term adjuncts to definitive dental treatments, such as extractions, endodontic, and periodontal therapies. These medications can significantly affect cardiovascular, renal, hepatic, metabolic, and the microbiome beyond the oral cavity. In this review, we aim to summarize the systemic health effects of three medication classes frequently prescribed by general dentists and discusses their mechanisms, clinical implications, and stewardship opportunities. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for dental pain, but even a brief course can affect renal function, blood pressure, and gastrointestinal integrity in susceptible patients. Acetaminophen is an important analgesic for mild to moderate dental pain though its cumulative dosing may increase the risk of hepatotoxicity. Opioids are historically prescribed after tooth extractions, endodontic and periodontal surgeries, but they offer no advantage over non-opioid analgesics and contribute to opioid misuse in the community. Gabapentinoids are emerging as lower-risk opioid alternatives in patients who cannot use NSAIDs or acetaminophen, but their use also requires caution. Antibiotics continue to be prescribed for conditions that are not clinically indicated but may increase the risks of antimicrobial resistance, gut microbiome dysbiosis, and Clostridioides difficile infection. Mislabeling of penicillin allergies is widespread and may promote the use of higher-risk alternatives such as clindamycin. Antiseptic mouth rinses, particularly chlorhexidine, can effectively reduce oral microbial load but may disrupt nitrate-reducing oral bacteria and alter nitric oxide-mediated vascular function. General dental practitioners should integrate systemic health awareness when prescribing these medications to ensure safety and advance antimicrobial and pharmacologic stewardship in daily practices.