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Brit Dent J: Pain behaviour and distress in children during two sequential dental visits: comparing a computerised anaesthesia delivery system and a traditional syringe.

This randomised controlled trial compared pain on injection over sequential treatment visits between the traditional technique and the 'Wand'. Also an aim was to present the results in respect to the level of dental anxiety.127 subjects completed the study (mean age 6.4 years, SD [+ or -] 1.7, range 4-11 yrs), 87 were considered to be highly anxious and 53 to have low anxiety; based on CFFS scores of 32 and above. The Wand injections were either (i) intraligamentary, (ii) palatal or (iii) buccal- anterior middle superior alveolar. The traditional injections were i) inferior dental block, (ii) palatal or (iii) buccal-anterior middle superior alveolar. Subjects' pain (based on observation of pain related behaviour) and distress (based on Modified Venham Scale) reactions were recorded on video and scored by 2 blinded/calibrated observers over 15 secs intervals during the injection only. The subjects were also invited to self-report on the pain using a visual rating scale augmented by facial images to aid comprehension. The operators selected the tooth on which to carry out treatment before being given the computerised random allocation of the injection method but the actual treatment performed, e.g. restoration or extraction isn't reported.

The key findings were: (1) Wand injections took almost three times longer than the traditional method to administer; (2) the level of anxiety was a significant factor for pain, irrespective of analgesic technique and this was a consistent finding across all 3 measurements employed, but only at the first treatment visit; (3) irrespective of pain measure, there was no difference between the local anaesthetic techniques; (4) the low anxious subjects reported more pain at the second treatment visit.

This is an interesting and thought-provoking paper. Ideas for future studies are explored and the limitations of variation in injection site and volume are adequately discussed, though these would be difficult to control completely in any clinical study. The more anxious children may have less coping behaviours at injection and the low anxious subjects may have become sensitised to the injection leading to higher reporting of pain and distress at the next visit. Therefore, the authors suggest that children should be encouraged to expect realistic amounts of pain.

2008;505:1-5.
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Author:Versloot, J.; Veerkamp, J.S.; Hoogstraten, J.
Publication:European Archives of Paediatric Dentistry
Geographic Code:4E
Date:Jun 1, 2009
Words:366
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