Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study

  • Dasarraju, Rupak Kumar (Department of Pedodontics and Preventive Dentistry, Priyadarshini Dental College & Hospital) ;
  • SVSG, Nirmala (Department of Pedodontics and Preventive Dentistry, Narayana Dental College & Hospital)
  • Received : 2019.11.23
  • Accepted : 2020.02.09
  • Published : 2020.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Background: This study evaluated the efficacy of three intraoral topical anesthetics in reducing the injection needle prick pain from local anesthetic among children aged 7-11 years old. Methods: It is a prospective, Interventional, parallel design, single-blind, randomized clinical trial in which subjects (n=90) aged 7-11 years were included in the study based on an inclusion criteria. Subjects were divided into three groups based on computer-generated randomization with an allocation ratio of 1:1:1. Groups A, B, and C received benzocaine 20% jelly (Mucopain gel, ICPA health products Ltd, Ankleshwar, India), cetacaine anesthetic liquid (Cetylite Industries, Inc, Pennsauken, NJ), and EMLA cream (2% AstraZeneca UK Ltd, Luton, UK), respectively, according to manufacturer's instructions, for 1 minute prior to local anesthetic injection. After application of topical anesthetic agent, for all the groups, baseline pre-operative (prior to topical anesthetic administration) and post-operative scores (after local anesthetic administration) of pulse rate was recorded using Pulse oximeter (Gibson, Fingertip Pulse Oximeter, MD300C29, Beijing Choice Electronic). Peri-operative (i.e., during the administration of local anesthesia) scores were recorded using Face, Legs, Activity, Cry, Consolability (FLACC) Scale, Modified Children hospital of Eastern Ontario Pain Scale (CPS) behavior rating scale, and Faces Pain Scale (FPS-R) - Revised (For self-reported pain). Direct self-reported and physiological measures were ascertained using FPS-R - Revised and Pulse oximeter, respectively, whereas CPS and FLACC scales assessed behavioral measures. To test the mean difference between the three groups, a one way ANOVA with post hoc tests was used. For statistical significance, a two-tailed probability value of P < 0.05 was considered as significant. Results: The Cetacaine group had significantly lower pain scores for self-report (P < 0.001), behavioral, and physiological measures (P < 0.001) than the other two groups. However, there was no significant difference between the Benzocaine group and EMLA group during palatal injection prick. Conclusion: Cetacaine can be considered as an effective topical anesthetic agent compared to benzocaine 20% jelly (Mucopain gel) and EMLA cream.

Keywords

References

  1. Kleinknecht RA, Klepac RK, Alexander LD. Origins and characteristics of fears in dentistry. J Am Dent Assoc 1973; 86: 842-8. https://doi.org/10.14219/jada.archive.1973.0165
  2. Hoist A, Evers H. Experimental studies of new topical anesthetics on the oral mucosa. Swed Dent J 1985; 9: 185-91.
  3. Nutter DP. Good clinical pain practice for pediatric procedure pain: neurobiologic considerations. J Calif Dent Assoc 2009; 37: 705-10.
  4. American Academy of Pediatric Dentistry. Guideline on Use of Local Anesthesia for Pediatric Dental Patients. Pediatr Dent 2016; 38: 204-10.
  5. Kreider KA, Stratmann RG, Milano M, Agostini FG, Munsell M. Reducing children's injection pain: lidocaine patches versus topical benzocaine gel. Pediatr Dent 2001; 23: 19-23.
  6. Wu SJ, Julliard K. Children's preference of benzocaine gel versus the lidocaine patch. Pediatr Dent 2003; 25: 401-5.
  7. Shehab LA, Basheer B, Baroudi K. Effectiveness of lidocaine Denti $patch^{(R)}$ system versus lidocaine gel as topical anesthetic agent in children. J Indian Soc Pedod Prev Dent 2015; 33: 285-90. https://doi.org/10.4103/0970-4388.165664
  8. Primosch R, Rolland-Asensi G. Comparison of topical EMLA 5% oral adhesive to benzocaine 20% on the pain experienced during palatal anesthetic infiltration in children. Pediatr Dent 2001; 23: 11-4.
  9. Abt E. Topical anesthetics are more effective in diminishing pain from needle stick insertion alone compared to reducing pain from insertion with anesthetic injection. J Evid Based Dent Pract 2010; 10: 160-1. https://doi.org/10.1016/j.jebdp.2010.05.010
  10. Martin MD, Ramsay DS, Whitney C, Fiset L, Weinstein P. Topical anesthesia: differentiating the pharmacological and psychological contributions to efficacy. Anesth Prog 1994; 41: 40-7.
  11. Gill CJ, Orr DL 2nd. A double-blind crossover comparison of topical anesthetics. J Am Dent Assoc 1979; 98: 213-4. https://doi.org/10.14219/jada.archive.1979.0476
  12. Keller BJ. Comparison of the effectiveness of two topical anesthetics and a placebo in reducing injection pain. Hawaii Dent J 1985; 16: 10-1.
  13. Kinchloe JE, Mealiea WL Jr, Mattison GD, Seib K. Psychological measurement on pain perception after administration of a topical anesthetic. Quintessence Int 1991; 22: 311-5.
  14. Tugla F, Mutlu Z. Four types of topical anesthetic agents; evaluation of clinical effectiveness. J Clin Pediatr Dent 1999; 23: 217-20.
  15. Chan SK, Karmakar MK, Chui PT. Local anesthesia outside the operating room. Hong Kong Med J 2002; 8: 106-13.
  16. Golan H. A Topical Anesthetic for Periodontal Procedures. Inside dentistry 2009. Available from https://www.dentalaegis.com/id/2009/02/a-topical-anesthetic-for-periodontal-procedures.
  17. American Dental Association: ADA Guide to Dental Therapeutics. 1st ed. ADA Pub Chicago, 1998; pp 10-6.
  18. Munshi AK, Hegde AM, Latha R. Use of EMLA: is it an injection free alternative? J Clin Pediatr Dent 2001; 25: 215-9. https://doi.org/10.17796/jcpd.25.3.hn62713500418728
  19. Riba H, Al-Zahrani S, Al-Buqmi N, Al-Jundi A. A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl scale. EC Dent Sci 2017; 16: 269-75.
  20. Tsze DS, von Baeyer CL, Bulloch B, Dayan PS. Validation of self-report pain scales in children. Pediatrics 2013; 132; e971-9. https://doi.org/10.1542/peds.2013-1509
  21. Nilsson S, Finnstrom B, Kokinsky E. The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years. Paediatr Anesth 2008; 18: 767-74. https://doi.org/10.1111/j.1460-9592.2008.02655.x
  22. Varlinkova KN, Kabaktchieva R. Reaction of 5 and 6 year old children to local anesthesia during dental treatment. J of IAMB-Annual proceeding (Scientific papers) 2008, book2.
  23. Touyz LZ, Lamontagne P, Smith BE. Pain and anxiety reduction using a manual stimulation distraction device when administering local analgesia oro-dental injections: a multi-center clinical investigation. J Clin Dent 2004; 15: 88-92.
  24. Aminabadi NA, Farhani RM, Balayi Gajan E. The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients. J Contemp Dent Pract 2008; 9: 33-40.
  25. Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine administration through buffering and warming. Am J Emerg Med 1998; 16: 353-6. https://doi.org/10.1016/S0735-6757(98)90126-7
  26. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: rate of administration and buffering. Ann Emerg Med 1998; 31: 36-40. https://doi.org/10.1016/S0196-0644(98)70278-1
  27. Masters JE. Randomised trial of pH buffered lignocaine with adrenaline in outpatient operations. Br J Plast Surg 1998; 51: 385-7. https://doi.org/10.1054/bjps.1997.0293
  28. Champion G, Goodenough B, Von Baeyer C, Thomas W. Measurement of pain by self-report. Progress in pain research and management 1998; 10: 123-60.
  29. Ship II, Williams AF, Osheroff BJ. Development and clinical investigation of a new oral surface anesthetic for acute and chronic oral lesions. Oral Surg Oral Med Oral Pathol 1960; 13: 630-6. https://doi.org/10.1016/0030-4220(60)90496-5
  30. Adriani J, Zepernick R, Arens J, Authement E. The comparative potency and effectiveness of topical anesthetics in man. Clin Pharmacol Ther 1964; 5: 49-62. https://doi.org/10.1002/cpt19645149
  31. Prescribing information of cetacaine liquid. Available from http://www.cetacaine.com/dental/about/prescribing-information.
  32. Christensen GJ. Buying guide : Significant anesthesia without injection for minimally painful procedures. Cliniciansreport 2009;2:1-6. Available from https://www.cliniciansreport.org/products/dental-reports/in-office-cad-cam-ceramic-furnace-for-dentists-june-2009-volume2-issue-6.php.
  33. Haasio J, Jokinen T, Numminen T, Rosenberg PH. Topical anesthesia of gingival mucosa by 5% eutectic mixture of lignocaine and prilocaine or by 10% lidocaine spray. Br J Oral Maxillofac Surg 1990; 28: 99-101. https://doi.org/10.1016/0266-4356(90)90131-4
  34. Holst A, Evers H. Experimental studies of new topical anesthetics on the oral mucosa. Swed Dent J 1985; 9: 185-91.
  35. Abu Al-Melh M, Andersson L, Behbehani E. Reduction of pain from needle stick in the oral mucosa by topical anesthetics: a comparative study between lidocaine/prilocaine and benzocaine. J Clin Dent 2005; 16: 53-6.
  36. Demare P, Regla I. Synthesis of two local anesthetics from toluene: an organic multistep synthesis in a project-oriented laboratory course. J Chem Educ 2012; 89: 147-9. https://doi.org/10.1021/ed100838a
  37. Fukayama H, Suzuki N, Umino M. Comparison of topical anesthesia of 20% benzocaine and 60% lidocaine gel. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002; 94: 157-61. https://doi.org/10.1067/moe.2002.124858
  38. Dhawan P, Dhawan G. Topical anesthetics: How effective are they. Int J Dent Clinic 2011: 3: 11-3.
  39. Nayak R, Sudha P. Evaluation of three topical anesthetic agents against pain: a clinical study. Indian J Dent Res 2006; 17: 155-60. https://doi.org/10.4103/0970-9290.29871
  40. Cocaine topical anesthetic. 2016 Dec [2016 Dec 7]. Available from https://www.drugs.com/pro/cetacainetopical-anesthetic.html
  41. Primosch RE, Robinson L. Pain elicited during intraoral infiltration with buffered lidocaine. Am J Dent 1996; 9: 5-10.

Cited by

  1. Auto-controlled Syringe vs Insulin Syringe for Palatal Injections in Children: A Randomized Crossover Trial vol.21, pp.6, 2020, https://doi.org/10.5005/jp-journals-10024-2864
  2. Comparison of Two Standard Scales for Pain Perception during Local Anesthetic Injection in Children vol.32, pp.1, 2020, https://doi.org/10.30699/jidai.32.1.2.37