J Dent Anesth Pain Med.  2018 Dec;18(6):367-373. 10.17245/jdapm.2018.18.6.367.

Comparison of anxiety and pain perceived with conventional and computerized local anesthesia delivery systems for different stages of anesthesia delivery in maxillary and mandibular nerve blocks

Affiliations
  • 1Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, Delhi, India. kamal208maids@gmail.com

Abstract

BACKGROUND
Fear of local anesthesia (LA) is a significant impediment to dental care as many patients delay or avoid treatment to avert pain. Computer-controlled local anesthetic delivery system (CCLAD), with constant and controlled rate of flow, present a painless alternative. The present study aimed to compare anxiety and pain perceived with conventional and computerized systems, for different stages of anesthesia delivery when administering various nerve blocks.
METHODS
One hundred patients requiring bilateral LA participated in the study. One side was anesthetized using one system and the contralateral side was anesthetized using the other, in two separate appointments. Patients assigned anxiety scores on a 5-point scale and used the visual analogue scale (VAS) for pain determination at needle insertion, during delivery of anesthetic solution, immediately after injection, and at the end of the periodontal procedure. Each patient's preference for the delivery system of future injections was also recorded.
RESULTS
Patients reported significantly lower anxiety levels with CCLAD compared to the syringe. Significantly lower mean VAS scores for anesthesia deposition, pain immediately after, and at the end of the periodontal procedure were also noted. However, pain at needle insertion was comparable between the two systems, with no statistical significance. Overall, 64.4% patients preferred CCLAD for future anesthesia.
CONCLUSION
Lower pain perceived with CCLAD and higher preference for the system suggest that CCLAD should replace conventional syringes to allow pain-free dental treatment.

Keyword

Computer-controlled Local Anesthetic Delivery System; Local Anesthesia; Pain; Pain Perception; Visual Analogue Scale

MeSH Terms

Anesthesia*
Anesthesia, Local*
Anxiety*
Appointments and Schedules
Dental Care
Humans
Mandibular Nerve*
Needles
Nerve Block
Pain Perception
Syringes

Figure

  • Fig. 1 The visual analogue scale (VAS) used for evaluating the perceived pain among patients.

  • Fig. 2 The computer controlled local anesthetic delivery system.

  • Fig. 3 Comparison of mean anxiety scores between the computer controlled local anesthesia delivery system and conventional syringe.

  • Fig. 4 Pen-grasp used in the computer controlled local anesthesia delivery system.


Reference

1. Locker D, Sharpiro D, Lidell A. Who is dentally anxious? Concordance between measures of dental anxiety. Community Dent Oral Epidemiol. 1996; 24:346–350.
Article
2. Meechan JG, Howlett PC, Smith BD. Factors influencing the discomfort of intraoral needle penetration. Anesth Prog. 2005; 52:91–94.
Article
3. Friedman MJ, Hochman MN. A 21st century computerized injection system for local pain control. Compend Contin Educ Dent. 1997; 18:995–1003.
4. Palm AM, Kirkegaard U, Poulsen S. The wand versus traditional injection for mandibular nerve block in children and adolescents: Perceived pain and time of onset. Pediatr Dent. 2004; 26:481–484.
5. Kandiah P, Tahmassebi JF. Comparing the onset of maxillary infiltration local anaesthesia and pain experience using the conventional technique vs. the Wand in children. Br Dent J. 2012; 213:E15.
Article
6. Krochak M, Friedman N. Using a precision metered injection system to minimize dental injection anxiety. Compend Contin Educ Dent. 1998; 19:137–148.
7. Katz J, Melzack R. Measurement of pain. Surg Clin North Am. 1999; 79:231–252.
Article
8. Malamed SF. Handbook of local anesthesia. 4th ed. St. Louis: Mosby;1997. p. 191–218.
9. Goodell GG, Gallagher FJ, Nicoll BK. Comparison of a controlled injection pressure system with a conventional technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000; 90:88–94.
Article
10. Tahmassebi JF, Nikolaou M, Duggal MS. A comparison of pain and anxiety associated with the administration of maxillary local analgesia with Wand and conventional technique. Eur Arch Paediatr Dent. 2009; 10:77–82.
Article
11. Yenisey M. Comparison of the pain levels of computercontrolled and conventional anesthesia techniques in prosthodontic treatment. J Appl Oral Sci. 2009; 17:414–420.
Article
12. Yesilyurt C, Bulut G, Taşdemir T. Pain perception during inferior alveolar injection administered with the Wand or conventional syringe. Br Dent J. 2008; 205:E10.
Article
13. Nusstein J, Lee S, Reader A, Beck M, Weaver J. Anesthetic efficacy of the anterior middle superior alveolar injection. Anesth Prog. 2004; 51:80–89.
14. Asarch T, Allen K, Petersen B, Beiraghi S. Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent. 1999; 21:421–424.
15. Gibson RS, Allen K, Hutfless S, Beiraghi S. The Wand vs. traditional injection: a comparison of pain related behaviors. Pediatr Dent. 2000; 22:458–462.
16. Allen KD, Kotil D, Larzelere RE, Hutfless S, Beiraghi S. Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatr Dent. 2002; 24:315–320.
17. Fukayama H, Yoshikawa F, Kohase H, Umino M, Suzuki N. Efficacy of anterior and middle superior alveolar (AMSA) anesthesia using a new injection system: the Wand. Quintessence Int. 2003; 34:537–541.
18. Palm AM, Kirkegaard U, Poulsen S. The wand versus traditional injection for mandibular nerve block in children and adolescents; perceived pain and time of onset. Pediatr Dent. 2004; 26:481–484.
19. Nicholson JW, Berry TG, Summitt JB, Yuan CH, Witten TM. Pain perception and utility: a comparison of the syringe and computerized local injection techniques. Gen Dent. 2001; 49:167–173.
20. Hochman M, Chiarello D, Hochman CB, Lopatkin R, Pergola S. Computerized local anesthetic delivery vs. traditional syringe technique: subjective pain response. N Y State Dent J. 1997; 63:24–29.
21. Loomer PM, Perry DA. Computer-controlled delivery versus syringe delivery of local anesthetic injections for theurapeutic scaling and root planing. J Am Dent Assoc. 2004; 135:358–365.
Article
22. Price DD, Bush FM, Long S, Harkins SW. A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales. Pain. 1994; 56:217–226.
Article
Full Text Links
  • JDAPM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr