ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Patients Experience Less Pain with Controlled-Delivery Injection Devices Than With Conventional Syringes
Clinical Question In patients needing local anesthesia for dental treatment, does a controlled-delivery injection device cause less pain upon injection than a conventional anesthetic syringe?
Clinical Bottom Line Using a controlled-delivery injection device for dental-related local anesthetic injections is of value in reducing the discomfort during injection when compared to a conventional anesthetic syringe. The use of a controlled-delivery injection device can be a technique that leads to a better behavioral response from pediatric patients, and can also provide less painful palatal infiltration injections.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26156277Yogesh Kumar/2015120 pediatric patientsRandomized Controlled Trial
Key resultsA total of 110 of the 120 pediatric patients (average age 9) that initiated the study completed it. The patients were randomly split; one group received the computerized anesthetic technique first and a week later received conventional syringe anesthetic, and the other group was vice versa. Patients showed a significant decrease (p<0.002) in pain perception with the computerized anesthetic technique. In addition, there was also a decrease in disruptive behavior (P<0.001), and the patients' pulse rate was significantly increased with the conventional syringe anesthetic (P=0.04).
#2) 26551372Mittal/2015100 pediatric patientsRandomized Controlled Trial
Key resultsOne hundred ‘cooperative’ pediatric patients of an average age of 9 years were randomly split into two groups; one group received palatal and buccal injections using the conventional technique, the other group received the same injections using the controlled-delivery technique with The Wand. A visual analog scale (VAS) was used along with a Sound, Eye, and Motor (SEM) scale. Patients experienced significantly less pain as measured by the subjective (VAS) scale in the palatal injection with the controlled-delivery technique (p<0.05); however, difference in pain with the buccal injection was not statistically significant (P>0.05). Using the objective (SEM) scale both the palatal and buccal injections using the controlled-delivery technique were statistically significantly less painful (P<0.05). Heart rate increased in both delivery techniques but the difference between groups was not statistically significant (P>0.05).
#3) 27733872Sivaramakrishnan/2016165 children and adults Systematic Review of Randomized Controlled Trials
Key resultsSix articles were found acceptable to be included in the systematic review, and all were for maxillary injections. Among the articles included, there were many differences in study execution; one study was split mouth, one was cross-over, and the other four were parallel studies. Different methods of measuring pain perception were used and include psychological attributes, visual analog scale, and electric pulp testing. In addition, three studies focused on children, while the rest focused on adults. Due to the ‘heterogenity’ of the articles chosen a synthetic meta-analysis was not an option; however, the computer-controlled local anesthetic delivery (CCLAD) was found to perform better in each of the individual studies included in the systematic review.
Evidence Search (computerized[All Fields] AND ("local anaesthesia"[All Fields] OR "anesthesia, local"[MeSH Terms] OR ("anesthesia"[All Fields] AND "local"[All Fields]) OR "local anesthesia"[All Fields] OR ("local"[All Fields] AND "anesthesia"[All Fields]))) AND ("2012/03/29"[PDat] : "2017/03/27"[PDat])(local[All Fields] AND ("dental anaesthesia"[All Fields] OR "anesthesia, dental"[MeSH Terms] OR ("anesthesia"[All Fields] AND "dental"[All Fields]) OR "dental anesthesia"[All Fields] OR ("dental"[All Fields] AND "anesthesia"[All Fields])) AND ("computers"[MeSH Terms] OR "computers"[All Fields] OR "computer"[All Fields])) AND ("2012/04/22"[PDat] : "2017/04/20"[PDat])
Comments on
The Evidence
Validity: To prevent behavioral issues in the studies, cooperative pediatric patients were chosen who needed dental treatment. In order to avoid differences in anesthetic delivering technique, in the studies reviewed, the same dentist performed all of the injections. In addition to subjective measurements of pain, for both studies on children, objective measurements and heart rates were also measured to avoid observer bias. In the randomized controlled trial by Yogesh Kumar/2015, blinding of the patients was not done; however an independent examiner was present to ‘code’ the children’s behavior. Perspective: Two of the studies selected were randomized controlled trials and one was a systematic review. In the future a meta-analysis on controlled delivery technique vs. conventional anesthetic technique would positively impact the validity of the results.
Applicability Local anesthesia delivery is a common factor causing anxiety among patients in the dental office. If the use of controlled delivery techniques during local anesthetic delivery is significantly less painful than traditional methods, patients’ anxiety levels will decrease and compliance will increase during the procedures.
Specialty/Discipline (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords Local anesthetic delivery, controlled-delivery anesthesia techniques, Calaject, The Wand, computer-controlled delivery anesthesia techniques
ID# 3222
Date of submission: 04/26/2017spacer
E-mail rodriguezh3@livemail.uthscsa.edu
Author Hevony Rodriguez
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Juanita Lozano-Pineda, DDS, MPH
Faculty mentor/Co-author e-mail pinedaj@uthscsa.edu
Basic Science Rationale
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