Title Electric Nerve Stimulation Is an Effective Alternative to Topical Anesthesia for Pain Reduction upon Administration of Local Anesthetic
Clinical Question In pediatric and adolescent dental patients undergoing local anesthesia, does the use of transcutaneous electrical nerve stimulation (TENS) compared with topical anesthetic agents reduce perceived pain and discomfort during anesthetic administration?
Clinical Bottom Line For pediatric and adolescent dental patients undergoing administration of local anesthesia, the use of transcutaneous electrical nerve stimulation (TENS) compared with no intervention or conventional topical anesthetics resulted in significantly reduced procedural pain and improved patient comfort. Across three randomized clinical trials, TENS consistently demonstrated superior short-term pain control, suggesting it is an effective, safe, and practical adjunct for managing dental pain in young patients.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
34824494Patil/202160 healthy children aged 6 to 12 years requiring local anesthesia for dental proceduresRandomized Controlled Trial
Key resultsSixty children aged 6–12 years were divided into four groups to compare pain control methods during local anesthetic injections: TENS, vibrating device, EMLA cream, and 2% lignocaine gel. The TENS group felt the least pain, with an average Wong–Baker score of 2.4 and a FLACC score of 1.47. Pain was slightly higher with the vibration device (3.2 and 1.80), followed by EMLA cream (4.13 and 2.27), and highest with lignocaine gel (6.4 and 5.4). The differences between all groups were statistically significant (p < 0.05), showing that TENS provided the most effective and comfortable pain control for children during local anesthesia. Full access to data will be needed to verify statistical significance in this particular study.
39781389Goyal/2024Pediatric patients between 4 and 8 years of age who needed LA for dental treatment were selectedRandomized Controlled Trial
Key results75 pediatric patients aged 4–8 years were assigned to receive cryotherapy, 2% benzocaine gel, or TENS prior to local anesthesia. The study found that both cryotherapy and TENS significantly reduced perceived pain compared to the topical gel group. The cryotherapy group reported a mean VAS score of 3.80, compared to 4.08 in the gel group, while the TENS group demonstrated lower FLACC scores (2.84 vs. 3.72, p = 0.003). Although the numerical difference in VAS was relatively small, it reached statistical significance and was clinically meaningful in the pediatric setting, where even minor reductions in discomfort can improve cooperation and reduce anxiety. The authors concluded that TENS and cryotherapy are effective, noninvasive alternatives for managing injection-related pain in children.
40186639Saxena/2025Children aged 12-16 undergoing bilateral orthodontic extractionsDouble blinded/randomized clinical trial (split mouth)
Key results104 adolescents aged 12–16 years undergoing bilateral orthodontic extractions were treated with either TENS or photobiostimulation (PBST) before local anesthesia. The results demonstrated significantly lower pain scores across all procedural stages for the TENS group. Mean WBPRS scores were 2.30 ± 2.7 for needle insertion, 2.11 ± 2.8 for anesthesia administration, and 1.92 ± 2.6 for extraction, compared to 5.03 ± 3.1, 4.84 ± 2.7, and 3.23 ± 5.1, respectively, in the PBST group (p < 0.01 for all). Additionally, anesthesia onset was significantly faster with TENS (96.15 ± 13.9 seconds) than with PBST (155.38 ± 91 seconds, p < 0.05). These reductions of approximately two to three points on pain scales are both statistically and clinically significant, underscoring TENS as a superior modality for pain control and procedural efficiency in adolescent orthodontic patients.
34824494Singh/202460 children aged 6–12 years, all requiring dental treatment with local anesthesia (either maxillary infiltration or inferior alveolar nerve blockRandomized Controlled Trial
Key resultsIn this study of 60 children aged 6–12 years, all three groups (vibration–precooling, TENS, and conventional) started with similar ages and anxiety levels before treatment (p > 0.05). During the injection, both the vibration–precooling device and TENS clearly reduced pain compared to the regular method. On the FLACC pain scale, scores were lowest with TENS (1.45 ± 0.60) and vibration–precooling (1.7 ± 0.66), and highest with the conventional method (2.45 ± 0.94), showing a highly significant difference (p < 0.001). The SEM behavior scores were also better with vibration (3.7 ± 0.92) and TENS (4.0 ± 0.79) than with the conventional method (4.3 ± 0.8), with a significant difference between vibration and the conventional method (p < 0.05). Children said they were most comfortable with the vibration–precooling device on the VAS scale (2 ± 0.73) compared to TENS (1.5 ± 0.51) and the regular method (1.3 ± 0.73), also a significant difference (p = 0.014). The pulse rate during injection was lowest with TENS (89.45 ± 14.56) and highest with the regular method (99.4 ± 16.66), meaning TENS helped keep kids calmer (p < 0.05). Oxygen levels stayed about the same in all groups (p > 0.05). Overall, both TENS and the vibration–precooling device made injections much less painful and stressful than the regular method, with TENS giving slightly better relaxation results.
Evidence Search “Electric Nerve Stimulation AND Local Anesthesia”
Comments on
The Evidence		 Across the four studies, the overall evidence shows moderate to high methodological quality supporting the use of nonpharmacologic pain-reduction methods, particularly transcutaneous electrical nerve stimulation (TENS), during pediatric dental procedures. All trials were randomized clinical studies involving children or adolescents, and each used validated pain-assessment tools such as the Visual Analog Scale (VAS), Wong-Baker Pain Rating Scale (WBPRS), and FLACC scale. The inclusion of control or comparator groups (for example, topical anesthetics, photobiostimulation, or sham interventions) and the use of split-mouth designs helped minimize bias and reduce variability between patients. Several studies also used partial blinding, improving internal validity. Despite these strengths, some limitations were noted—most studies had small sample sizes, short observation periods that focused only on immediate procedural pain, and possible placebo or expectation effects due to the sensory nature of TENS and similar interventions. Additionally, the narrow age ranges and limited types of dental procedures studied slightly reduce how broadly the findings can be applied. Nonetheless, across all trials, the results consistently show that TENS significantly decreases short-term pain and anxiety compared with topical or no-intervention controls, offering a safe, effective, and evidence-based nonpharmacologic option for improving comfort in pediatric dental patients.
Applicability Across the four studies, the findings are directly relevant to pediatric and adolescent dental practice. The research included children and teens aged 4–16 years undergoing common procedures such as local anesthesia administration and extractions, representing realistic clinical scenarios where managing pain and anxiety is essential. Interventions like transcutaneous electrical nerve stimulation (TENS), cryotherapy, and photobiostimulation were shown to be noninvasive, safe, and well-tolerated, offering effective pain control without the pharmacologic side effects associated with sedation or local anesthetics. These approaches are especially valuable for young patients who fear needles or medication. However, generalizability remains limited due to practical challenges such as the need for specialized equipment, clinician training, patient cooperation, and variability in dental office resources. Moreover, most studies assessed only short-term procedural pain, with little evidence on long-term discomfort or applications in adult or orthodontic procedures. Taken together, the evidence supports that TENS and related nonpharmacologic techniques are feasible, low-risk, and beneficial adjuncts for reducing procedural pain in pediatric dentistry, though larger and more diverse clinical trials are needed to confirm their broader effectiveness and integration into standard dental care.
Specialty (Orthodontics) (Pediatric Dentistry)
Keywords Electric Nerve Stimulation AND Local Anesthesia
ID# 3594
Date of submission 10/24/2025
E-mail irwinc2@livemail.uthscsa.edu
Author Chase Irwin
Co-author(s)
Co-author(s) e-mail
Faculty mentor Dr. Sandra Andari
Faculty mentor e-mail andari@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
spacer
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)
None available