Title Research indicates Reduction of Pain upon Inferior Alveolar and Infraorbatial injection Using Vibrating Intraoral Local Anesthetic Devices
Clinical Question In patients with fear of dental injections, do vibrating intraoral local anesthetic devices reduce pain upon injection compared to classic local anesthetic devices?
Clinical Bottom Line Although research shows reduction of discomfort in patients receiving local anesthetic via vibrating intraoral devices, more research needs to be done on a larger group of patients and more measurable pain scale.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
25810837Nasehi/201599 adult patients requiring bilateral local anesthetic injections.Randomized Controlled Trial
Key resultsThe split-mouth study evaluated anticipated and actual pain for inferior-alveolar, palatal, long buccal, and infraorbital injections given via an intraoral vibration device. Actual pain upon injection was significantly less than anticipated pain for inferior alveolar (P < 0.001) and infraorbital (P = 0.002) injections using the vibrating device, whereas there was no significant difference between anticipated and actual pain with the standard syringe. The study showed the vibration device was effective and easy to use to alleviating clinical pain encountered during local anesthetic injection.
Evidence Search ("pain"[MeSH Terms] OR "pain"[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 ("injections"[MeSH Terms] OR "injections"[All Fields] OR "injection"[All Fields]) AND ("vibration"[MeSH Terms] OR "vibration"[All Fields])
Comments on
The Evidence
Validity: Nasehi/2015 included 99 subjects but it is unclear whether or not the investigators did a power analysis to arrive at this number. There is no way to know if this is a sufficient number of subjects to show a significant difference between the two techniques. However, the split-mouth design of the study increases the statistical power. This study did use a VAS to record the patient’s pain experience; this is a validated tool to record pain. Perspective: Further studies are merited that compare the effectiveness of various vibrating injection systems available on the market.
Applicability Many patients avoid the dentist because of anxiety and fear of the pain associated with local anesthetic injections. Vibrating intraoral local anesthetic devices are believed to decrease pain sensation via the gate-control theory. The theory proposes that tactile stimulation, vibration, or touch activate A-beta non-nociceptive fibers, which override pain signals. According to the research, vibrating devices can reduce pain in certain injections but, In the end, the individual clinician needs to decide if the reduction in pain merits the expense of purchasing the device.
Specialty (Public Health) (Oral Medicine/Pathology/Radiology) (Endodontics) (General Dentistry) (Oral Surgery) (Pediatric Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords Pain, local anesthesia, injection, vibration, visual analog scale
ID# 3207
Date of submission 04/03/2017
E-mail castilloan@livemail.uthscsa.edu
Author Autumn Casitllo, BS
Co-author(s) e-mail
Faculty mentor Kelly C. Lemke, DDS
Faculty mentor e-mail lemkek@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