Effect of the new needle-free injection system on pain perception and dental anxiety during anesthesia: randomized controlled split-mouth study

  • Melek Belevcikli (Department of Pediatric Dentistry, Faculty of Dentistry, Bulent Ecevit University) ;
  • Halenur Altan (Department of Pediatric Dentistry, Faculty of Dentistry, Necmettin Erbakan University) ;
  • Osman Demir (Department of Biostatistics, Faculty of Medicine, Gaziosmanpasa University)
  • 투고 : 2022.10.21
  • 심사 : 2022.12.12
  • 발행 : 2023.02.01


Backgrounds: Pain management is one of the most important factors affecting the success of pediatric dentistry. Therefore, new needle- and pain-free local anesthesia techniques have been developed in parallel with technological advancements. The purpose of this study is to compare the pain perception and dental anxiety levels associated with a needle-free injection system (Comfort-inTM) and the classic needle method during treatment-required infiltration anesthesia in children. Methods: This randomized controlled crossover split-mouth clinical study included 94 children who required dental treatment with local anesthesia using a dental needle or needle-free injection system for the bilateral primary molars. The Wong-Baker Scale (WBS) was used to measure pain perception at different times, and the Modified Child Dental Anxiety Scale (MCDAS) was used to measure the anxiety level of the child. A statistical software package was used to process the data. Statistical significance was set at P < 0.05. Results: There was no significant difference between the needle-free injection system and dental needle method during the induction stage for filling and pulpotomy (P > 0.05). "Pain on postoperative 1st day" was similar in both types of anesthesia (P = 0.750). Conclusions: The needle-free injection system was as effective as the dental needle method. The Comfort-inTM system was an acceptable alternative for patients during the postoperative period. Understanding how pain management may be provided during local anesthesia administration and a child's fear and anxiety regarding the dentist may lead to better dental compliance.



  1. Holmes RD, Girdler NM. A study to assess the validity of clinical judgement in determining paediatric dental anxiety and related outcomes of management. Int J Paediatr Dent 2005; 15: 169-76.
  2. Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the modified child dental anxiety scale. Psychol Rep 1998; 83: 1179-86.
  3. Makade CS, Shenoi PR, Gunwal MK. Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients. J Conserv Dent 2014; 17: 169-74.
  4. Ocak H, Akkoyun EF, Colpak HA, Demetoglu U, Yucesoy T, Kilic E, et al. Is the jet injection effective for teeth extraction? J Stomatol Oral Maxillofac Surg 2020; 121: 19-24.
  5. Arapostathis KN, Dabarakis NN, Coolidge T, Tsirlis A, Kotsanos N. Comparison of acceptance, preference, and efficacy between jet injection INJEX and local infiltration anesthesia in 6 to 11 year old dental patients. Anesth Prog 2010; 57: 3-12.
  6. Oliveira ACA, Amorim KS, Nascimento Junior EMD, Duarte ACB, Groppo FC, Takeshita WM, et al. Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial. J Appl Oral Sci 2019; 27.
  7. Munshi AK, Hegde A, Bashir N. Clinical evaluation of the efficacy of anesthesia and patient preference using the needle-less jet syringe in pediatric dental practice. J Clin Pediatr Dent 2001; 25: 131-6.
  8. Dabarakis NN, Alexander V, Tsirlis AT, Parissis NA, Nikolaos M. Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry. Quintessence Int 2007; 38: E572-6.
  9. Yildirim S, Tokuc M, Aydin MN. The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial. Clin Oral Investig 2020; 24: 4355-61.
  10. Saravia ME, Bush JP. The needleless syringe: efficacy of anesthesia and patient preference in child dental patients. J Clin Pediatr Dent 1991; 15: 109-12.
  11. Folayan MO, Idehen EE, Ufomata D. The effect of sociodemographic factors on dental anxiety in children seen  in a suburban Nigerian hospital. Int J Paediatr Dent 2003; 13: 20-6.
  12. Wogelius P, Poulsen S, Sorensen HT. Prevalence of dental anxiety and behavior management problems among six to eight years old Danish children. Acta Odontol Scand 2003; 61: 178-83.
  13. Akbay Oba A, Dulgergil CT, Sonmez IS. Prevalence of dental anxiety in 7-to 11-year-old children and its relationship to dental caries. Med Princ Pract 2009; 18: 453-7.
  14. ten Berge M, Veerkamp JS, Hoogstraten J, Prins PJ. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002; 30: 101-7.
  15. Arntz A, van Eck M, Heijmans M. Predictions of dental pain: the fear of any expected evil, is worse than the evil itself. Behav Res Ther 1990; 28: 29-41.