Title Pre-Warming of Local Anesthetic Solutions for Intraoral Infiltration Injections Does Not Have an Effect on the Reduction of Pain and Discomfort
Clinical Question In the pediatric dental patient population requiring local anesthesia infiltration, does the warming of the cartridge pre-injection reduce the anticipated injection pain compared to using cartridges at room temperature?
Clinical Bottom Line Warming of local anesthetic cartridges does not reduce pain and discomfort during intraoral infiltration injections. This is supported by a randomized controlled clinical trial that showed that children's objective and subjective reactions to warmed and room temperature injections were not statistically different.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
12212876Ram/200244 Children undergoing dental treatment Randomized Clinical Trial
Key resultsThe children's reactions to the injections were measured objectively using the modified Behavioral Pain Scale (BPS) and subjectively using the Wong-Baker FACES Pain Rating Scale (FPS) and the Visual Analogue Scale (VAS). There was no statistically significant difference between the children’s reactions to the warm (W) and room temperature (RT) injections on any of the three parameters.
Evidence Search ("review"[All Fields] OR "review literature as topic"[MeSH Terms] OR "systematic review"[All Fields]) AND warming[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]))
Comments on
The Evidence
Validity: The randomized control trial stated that warming local anesthetic cartridges for intraoral infiltration injections has little to no advantage in reducing pain. The crossover design of this study increases its validity because all children received both types of injections, allowing the children to act as their own controls. Furthermore, the article also used appropriate methods to assess the children’s response:behavioral assessment as well as using FPS and VAS. However, the crossover deisgn could influence the results, because the first injection could have had an influence on the patient’s opinion of the second injection. This study is a lower level of evidence compared to a meta-analysis or systematic review; further, stronger studies should be performed, especially on the adult population.
Applicability Reduction of intraoral pain and discomfort during injections by various simple chairside techniques could enhance patients’ desire to seek dental care, help them to become compliant patients, and reduce the need for other pain and anxiety reduction modalities.
Specialty (Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Orthodontics) (Pediatric Dentistry) (Periodontics) (Prosthodontics) (Restorative Dentistry)
Keywords Warm anesthetic, room temperature anesthetic, pain
ID# 3140
Date of submission 04/19/2017
E-mail driggersk@livemail.uthscsa.edu
Author Kalyn Driggers
Co-author(s) e-mail
Faculty mentor Kevin Gureckis, DMD
Faculty mentor e-mail gureckis@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available