Evaluation of the Effects of Computer-Controlled and Conventional Local Anesthesia on Pain and Anxiety in Children With Molar Incisor Hypomineralization: A Split-Mouth Study.
Jul 2026· International Journal of Paediatric Dentistry· 0 citations· 21 references
Medicine
TL;DR
Lower salivary cortisol levels, a physiological marker of stress, were observed in the SleeperOne group during the treatment of MIH-affected teeth.
Abstract
Background
Computer-controlled anesthesia delivery systems (CCLADs), such as SleeperOne, are available as an alternative to traditional anesthesia for the treatment of teeth with molar incisor hypomineralization (MIH).
Aim
This study aimed to evaluate the effects of the SleeperOne and the conventional local anesthesia technique on pain and anxiety in children with MIH.
Design
Twenty-eight children aged 6-12 were included in the study. Patients were divided into 2 groups (n = 28): Conventional anesthesia group and SleeperOne group. The Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) was administered to all participants prior to treatment. Pain and anxiety levels were assessed using both objective measures (pulse rate, oxygen saturation [SpO2], and salivary cortisol levels) and subjective scales (Wong-Baker Pain Rating Scale [WBS], Visual Analog Scale [VAS], and Face, Legs, Activity, Crying, Consolability Scale [FLACC]).
Results
Cortisol levels were significantly higher in the conventional anesthesia group (p < 0.001). In the after treatment values, mandibular cortisol levels in participants without hypersensitivity and total cortisol levels in participants with hypersensitivity were significantly lower in the SleeperOne anesthesia group (p = 0.009 and p = 0.017).
Conclusions
Lower salivary cortisol levels, a physiological marker of stress, were observed in the SleeperOne group during the treatment of MIH-affected teeth.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT07268157.
Pain management during local anesthesia administration is a critical factor in pediatric dentistry. This assessor-blind, parallel-group, superiority randomized controlled trial (
ClinicalTrials.gov
: NCT06011005) aimed to determine whether ethyl chloride (EC) spray applied via a cotton pellet provides superior pain reduction compared to 20% benzocaine (BC) gel during intra-oral local anesthetic injections in children.
Fifty-seven healthy children aged 7–10 years requiring routine dental local anesthesia were randomized to Group A (20% BC gel,
n
= 29) or Group B (EC spray via cotton pellet,
n
= 28). The primary outcome was physiological stress measured by change in heart rate (HR). Secondary outcomes included self-reported pain (Faces Pain Scale, FPS) and observed behavioral response (Sound-Eye-Motor scale, SEM). The outcomes assessor was blinded to the topical agent used. Between-group differences in change scores were analyzed using the Mann–Whitney
U
test with Hodges–Lehmann median differences and bootstrap 95% confidence intervals.
Both groups demonstrated slight increases in HR following the injection; however, the magnitude of change was not significantly different between the groups (BC: +4.03 bpm vs. EC: +2.14 bpm; Mann–Whitney
U p
= 0.310; 95% CI of mean difference: −1.53 to 5.35). Additionally, there were no statistically significant differences between the groups regarding self-reported pain levels (FPS change: BC +1.31 vs. EC +1.25;
p
= 0.546; 95% CI: −1.03 to 1.08) or behavioral responses (SEM change: BC +0.10 vs. EC +0.11;
p
= 0.971; 95% CI: −0.22 to 0.21).
The superiority trial did not reveal a statistically significant difference between the use of ethyl chloride spray and 20% benzocaine gel across any of the measured outcomes. Both anesthetic agents produced comparable physiological responses, self-reported experiences, and behavioral reactions during intra-oral local anesthetic injections in cooperative children aged 7–10 years.
Nagah Abdelrahman, M. Al Halabi, M. Kowash et al.· Frontiers in Dental Medicine· 0 citations
INTRODUCTION
Impacted mandibular third molar surgery (IMTMS) is one of the dental surgical procedures where pain and anxiety are frequently encountered. The aim of this study was to compare the effects of the computer-assisted local anesthesia system (CALAS) and conventional local anesthesia (CLA) on pain, anxiety, and hemodynamic changes during IMTMS.
MATERIAL AND METHODS
This prospective, randomized, split-mouth clinical trial included 40 patients with bilateral impacted mandibular third molars. CALAS and CLA were administered in separate surgical sessions at least three weeks apart. Pain was assessed using the Visual Analog Scale for Pain (VAS-P), whereas anxiety was assessed using the Visual Analog Scale for Anxiety (VAS-A), the State-Trait Anxiety Inventory (STAI-S and STAI-T), the Modified Dental Anxiety Scale (MDAS), and the Dental Fear Scale (DFS). Postoperative satisfaction was evaluated using a four-item questionnaire. Hemodynamic parameters, including respiratory rate (RR), pulse rate (PR), systolic blood pressure, diastolic blood pressure, and oxygen saturation (SpO₂), were recorded at eight predefined stages of the surgical procedure.
RESULTS
Postoperative pain and anxiety scores were significantly higher in CLA sessions than in CALAS sessions. Postoperative VAS-P and VAS-A scores were also higher in CLA applications than in CALAS applications (VAS-P: 6.62±1.59 vs 1.90±0.87; VAS-A: 6.75±1.67 vs 2.40±1.79; p<0.001 for both). Similarly, higher values were observed for STAI-S, MDAS, and other psychometric measurements in CLA applications. In the hemodynamic assessment, pulse rate (PR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed more pronounced increases during some surgical stages in CLA sessions, whereas inter-technique differences remained limited for respiratory rate (RR) and SpO₂. In the postoperative satisfaction survey, participants rated CALAS as more effective than CLA in reducing anxiety and pain (p=0.002 and p=0.001, respectively).
DISCUSSION
The findings suggest that CALAS may limit increases in pain and anxiety during IMTMS and may be associated with less pronounced physiological fluctuations during some surgical stages. Clinically, the potential advantage of CALAS appears to be related to more controlled anesthetic delivery rather than elimination of needle use. However, these findings should be interpreted cautiously because the study was based on a single-center split-mouth design with a limited sample size.
TRIAL REGISTRATION
NCT06852066.
İsmail Çalışkan, Ö. Ekici· Journal of Stomatology Oral...· 0 citations
BACKGROUND
Pediatric venipuncture is one of the most stressful invasive procedures for children, often accompanied by intense pain, fear, and anxiety. This study aimed to compare the effects of two active distraction methods-bubble blowing and a material-free cognitive distraction/positive reinforcement technique-on pain, fear, and anxiety.
METHODS
This randomized controlled parallel-group trial was conducted between April and July 2025 in the pediatric venipuncture unit of a university hospital in western Türkiye. The sample comprised 207 children who met the inclusion criteria. The experimental arm included 135 children allocated to either Positive Reinforcement (n = 72) or Bubble Blowing (n = 63), and the control group consisted of 72 children who received standard care without any additional intervention during venipuncture. Data were collected using the Wong-Baker FACES Pain Rating Scale, the Child Fear and Anxiety Scale, and a Visual Analog Scale. Children's self-reported pain, fear, and anxiety scores were used as the primary outcome data. Parametric and nonparametric tests and effect sizes were used in the analyses.
RESULTS
In the control group, postprocedural pain and anxiety scores increased significantly (p < .001), whereas the increase was attenuated in the bubble-blowing and positive reinforcement groups. Because baseline fear/anxiety scores differed between groups, ANCOVA was performed using preprocedural fear/anxiety scores as a covariate; the adjusted group effect remained statistically significant. In the positive reinforcement group, the increase in fear- anxiety scores was small and did not reach statistical significance. Bubble blowing was more effective than positive reinforcement in reducing pain.
CONCLUSION
Both distraction techniques were associated with lower postprocedural pain and psychological distress scores compared with standard care. Bubble blowing showed a stronger effect on pain outcomes, whereas the positive reinforcement group showed only a small, statistically non-significant increase in fear/anxiety scores. These findings support the integration of simple, low-cost distraction strategies into pediatric nursing practice and skills training.
TRIAL REGISTRATION
The clinical trial registration number is NCT07249723. Registered 18 November 2025 - Retrospectively registered.
S. Çaka, Elanur Cebeci, Hanife Öznur Kavi et al.· BMC Pediatrics· 0 citations
BACKGROUND
Temporomandibular disorders (TMD) is the most common cause of pain in oro-facial region that is of non-dental origin. Signs and symptoms involve pain on masticatory muscles, temporomandibular joint or both. This study aimed to compare the effectiveness of Ultrasound therapy (UST) with Low-Level Laser Therapy (LLLT) in reducing pain related to TMD.
MATERIALS AND METHODS
Forty-six patients with TMD (Myalgia of masseter and temporalis, and arthralgia of TMJ) were included in this study. Patiens were assigned into Group A (LLLT) and Group B (UST). Numerical Rating Scale (NRS) and maximum mouth opening were measured over five sessions.
RESULTS
Both groups showed significant reductions in NRS scores and improvements in maximum mouth opening (p < 0.05), with no significant differences between groups.
CONCLUSION
Based on obtained data, both LLLT and UST were associated with reductions in pain in patients with TMJ arthralgia and myalgia of the masseter and temporalis muscles.
A. Shrestha, I. Maharjan, P. Regmee et al.· Cranio· 0 citations
Highlights What are the main findings? The findings suggest that interligamentary anesthesia using a Computer-Controlled Local Anesthesia Delivery System provides less painful injections compared to the conventional inferior alveolar nerve block. It has demonstrated effectiveness as a viable alternative for the extraction of mandibular primary molars. What are the implications of the main findings? By promoting the use of CCLADS, pediatric dentists can address the negative behaviors children may exhibit towards dental treatment, fostering a more positive dental environment and encouraging future visits. The findings provide valuable clinical evidence supporting the adoption of advanced anesthesia techniques, enabling pediatric dentists to make informed decisions that enhance care quality and patient satisfaction. Abstract Background/Objectives: The study evaluates pain perception in children aged 5–9 during dental extractions, comparing intraligamentary anesthesia (ILA) delivered with a Computer-Controlled Local Anesthetic Delivery System (CCLADS) vs. the traditional inferior alveolar nerve block (IANB). Methods: A randomized clinical trial with 60 healthy, cooperative children measured pain both subjectively using the Wong–Baker Faces Pain Rating Scale (WBFPRS) and objectively using the Sound-Eye-Motor (SEM) scale. Results: Results showed significantly lower mean pain scores with CCLADS during anesthesia administration: WBFPRS was 2.0 ± 2.2 vs. 6.9 ± 2.6 for IANB (p < 0.001). Objective SEM scores during anesthesia delivery were also lower with CCLADS (3.7 ± 0.8) compared with IANB (5.7 ± 1.2) (p < 0.001). During the extraction itself, SEM scores did not differ significantly between groups. Conclusions: The authors conclude that ILA via CCLADS reduces discomfort during anesthesia without compromising anesthetic effectiveness.
Lamia AlGhamdi, O. Felemban, K. Baghlaf et al.· Healthcare· 0 citations
Background: Erich's arch bar fixation can be discomforting for patients, as it can increase heart rate, blood pressure, and anxiety. Due to its simple and cost effective nature , music therapy is being considered as a method to help calm patients during surgical procedures.Aim: To evaluate the effects of music therapy on pain, anxiety, procedural time and vital parameters for patients undergoing intermaxillary fixation. Settings and Design: A prospective, randomized controlled study was conducted in the oral and maxillofacial surgery outpatient department.Methods: Fifty-eight patients underwent intermaxillary fixation under local anaesthesia. They were randomized into two groups where music group (n=29) listened to calming music with wireless headphones during the procedure and control group (n=29) did not. Vital signs like blood pressure, heart rate, breathing rate, and oxygen levels were measured throughout. Pain was assessed with a visual analogue scale; anxiety was measured with a Likert scale. Statistical significance was set at P < 0.05.Results: Patients in the music group showed more stable vital signs, with a smaller increase in blood pressure and heart rate (p = 0.001). The study showed reduction in pain (2.59 vs. 4.28), decreased anxiety scores (1.41 vs. 3.41) and shortened surgical duration (61.14 vs. 75.38 minutes, p = 0.001). Effects of music on the breathing rate and oxygen levels were insignificant.Conclusion: Listening to music effectively reduces pain and anxiety during intermaxillary fixation with enhanced patient comfort and stability, besides being a safer, simpler and an affordable modality.
Raja Sethupathy Cheeman, Tapati Biswas, Rinku K. George et al.· PAIN, JOINTS, SPINE· 0 citations