Management of Pre-Infiltration Anxiety with Local Anesthetic in Pediatric Dental Treatments: A Systematic Review of Randomized Controlled Trials
DOI:
https://doi.org/10.56294/saludcyt20251448Keywords:
Pediatric dentistry, Dental anxiety, Local anesthesia, Pain, ManagementAbstract
Dental anxiety is one of the main reasons why children fear visiting the dentist, making it essential to have a variety of methods to properly manage the patient. One of the procedures that generates the highest anxiety in children is the infiltration of local anesthetic prior to any dental treatment. The aim of this study was to evaluate the management of anxiety in pediatric patients before the infiltration of local anesthetics. A systematic review of randomized clinical trials published between 2017 and 2024 was conducted in the Medline/PubMed, Europe PMC, Scopus, and Web of Science databases using the search strategy: “Pediatric dentistry AND Dental Anxieties AND Local Anesthesia AND Pain AND Management.” A total of 93 studies were identified, and after applying eligibility criteria, 4 studies were analyzed. The results showed that distraction techniques using virtual reality and psychological therapies were more effective in managing anxiety in children both in the short and long term. In conclusion, virtual reality stands out for its immersive capacity and immediate effectiveness, while cognitive-behavioral therapy offers a more sustained approach over time to reduce dental fear. These interventions provide valuable tools for optimizing anxiety management in pediatric dentistry and improving the pediatric patient’s experience.
References
Khandelwal M, Shetty RM, Rath S. Effectiveness of Distraction Techniques in Managing Pediatric Dental Patients. Int J Clin Pediatr Dent. 2019;12(1):18–24. DOI: 10.5005/jp-journals-10005-1582
Singh J, Hegde S, Rao D, Panwar S, Pal S, Rathore N. Evaluación del dolor en pacientes odontológicos pediátricos durante la administración de anestesia local con y sin el uso de distracción audiovisual. Dent Res J. 2023; 20:7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/36820143/
Barbosa NB, Rodrigues BR, Madalena IR, de Menezes FCH, Lepri CP, de Oliveira MBCR, et al. Efecto del uso del carpule como herramienta de distracción pasiva visual en el miedo y la ansiedad dentales: un estudio piloto. Int J Environ Res Public Health. 2023;20(3):1793. DOI: 10.3390/ijerph20031793
Monteiro J, Tanday A, Ashley PF, Parekh S, Alamri H. Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment. Cochrane Database Syst Rev. 2020;2(2):CD011024. DOI: 10.1002/14651858.CD011024.pub2
Ratnaparkhi I, Winnier J, Shetty D, Kodical SR, Manoj R, Naik SS. Efficacy of sucrose application in minimizing pain perception related to dental injection in children aged 3 to 9 years: a randomized control trial. J Dent Anesth Pain Med. 2024;24(2):109–17. DOI: 10.17245/jdapm.2024.24.2.109
Smolarek PC, da Silva LS, Martins PRD, Hartman KDC, Bortoluzzi MC, Chibinski ACR. Evaluation of pain, disruptive behaviour and anxiety in children aging 5-8 years old undergoing different modalities of local anaesthetic injection for dental treatment: a randomised clinical trial. Acta Odontol Scand. 2020;78(6):445–53. DOI: 10.1080/00016357.2020.1757752
de Camargo Smolarek P, da Silva LS, Martins PRD, da Cruz Hartman K, Bortoluzzi MC, Chibinski ACR. The influence of distinct techniques of local dental anesthesia in 9- to 12-year-old children: randomized clinical trial on pain and anxiety. Clin Oral Investig. 2021;25(6):3831-3843. DOI:10.1007/s00784-020-03713-7.
Dixit A, Randhawa RK, Randhawa GS, Solanki P, Takvani R, Vaghela I. Comparative Analysis of Local Anesthetic Techniques for Pain Management in Pediatric Dental Procedures: A Randomized Clinical Trial. J Pharm Bioallied Sci. 2024;16(Suppl 1):S196-S198. DOI: 10.4103/jpbs.jpbs_454_23.
Thosar NR, Bane SP, Deulkar PV, Deshpande MA, Gupta S. Effectiveness of Two Different Behavior Modification Techniques for Anxiety Reduction in Children. Cureus. 2022;14(8):e28141. DOI: 10.7759/cureus.28141.
Vidigal EA, Abanto J, Leyda AM, Berti GO, Aillón IEV, Corrêa MSNP, Bönecker M. Comparison of two behavior management techniques used during mandibular block anesthesia among preschool children: a randomized clinical trial. Eur Arch Paediatr Dent. 2021;22(5):773-781. DOI: 10.1007/s40368-021-00617-2
Leyda-Menéndez AM, Vidigal EA, Abanto J, Ribelles-Llop M. Efficacy of two behavioural management techniques during inferior alveolar nerve block administration in pre-school children: a randomised clinical trial. Eur Arch Paediatr Dent. 2023;24(1):85-93. DOI: 10.1007/s40368-022-00758-y
Schibbye R, Hedman-Lagerlöf E, Kaldo V, Dahllöf G, Shahnavaz S. Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental or Injection Phobia: Randomized Controlled Trial. J Med Internet Res. 2024;26:e42322. DOI: 10.2196/42322
Ramírez-Carrasco A, Butrón-Téllez Girón C, Sanchez-Armass O, Pierdant-Pérez M. Effectiveness of Hypnosis in Combination with Conventional Techniques of Behavior Management in Anxiety/Pain Reduction during Dental Anesthetic Infiltration. Pain Res Manag. 2017;2017:1434015. DOI: 10.1155/2017/1434015
Dempsy Chengappa MM, Prashanth AK. Evaluation of efficacy of computer-controlled local anaesthetic delivery system vs traditional injection system for minor pediatric surgical procedures in children. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S89-S95. DOI: 10.1016/j.mjafi.2020.08.010
Remi RV, Anantharaj A, Praveen P, Prathibha RS, Sudhir R. Advances in pediatric dentistry: new approaches to pain control and anxiety reduction in children - a narrative review. J Dent Anesth Pain Med. 2023;23(6):303-315. DOI: 10.17245/jdapm.2023.23.6.303
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34. DOI: 10.1016/j.jclinepi.2009.06.006
Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. [Internet]. BMJ. 2011;343:d5928. DOI: 10.1136/bmj.d5928
Sterne, J.A.C.; Savovi´c, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.-Y.; Corbett, M.S.; Eldridge, S.M.; et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ 2019, 366, l4898. DOI: 10.1136/bmj.l4898
Midha V, Midha V, Dua R, Garewal R, Kochhar AS, Kochhar GK. Auxiliary Aids to Alleviate Pain and Anxiety during Local Anesthesia Administration: A Comparative Study. Int J Clin Pediatr Dent. 2021;14(1):104-108. DOI: 10.5005/jp-journals-10005-1935
Chiu HHC, Lam PPY, Yiu CKY. The Impact of Minimal Intervention Dentistry on Patient-Reported and Observation-Based Outcomes in the Pediatric Population: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2023;11(16):2241. DOI: 10.3390/healthcare11162241
Libonati A, Nardi R, Gallusi G, Angotti V, Caruso S, Coniglione F, Marzo G, Mattei A, Tecco S, Paglia L. Pain and anxiety associated with Computer-Controlled Local Anaesthesia: systematic review and meta-analysis of cross-over studies. Eur J Paediatr Dent. 2018;19(4):324-332. DOI: 10.23804/ejpd.2018.19.04.14
Chandran LS, Issac JS, Girija P, Thomas PT, Shirli AD, Jalal SA. Effectiveness of Two Types of Distraction Techniques in the Management of Pain and Anxiety during Dental Treatment in 6-9-year-old Children. Int J Clin Pediatr Dent. 2024;17(3):291-296. DOI: 10.5005/jp-journals-10005-2794
Venkiteswaran A, Tandon S. Role of Hypnosis in Dental Treatment: A Narrative Review. J Int Soc Prev Community Dent. 2021;11(2):115-124. DOI: 10.4103/jispcd.JISPCD_320_20.
Almarzouq SSFS, Chua H, Yiu CKY, Lam PPY. Effectiveness of Nonpharmacological Behavioural Interventions in Managing Dental Fear and Anxiety among Children: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2024;12(5):537. DOI: 10.3390/healthcare12050537
Al Tuwirqi AA. Eye-Tracking Technology in Dentistry: A Review of Literature. Cureus. 2024;16(2):e55105. DOI: 10.7759/cureus.55105
Kohli N, Hugar SM, Soneta SP, Saxena N, Kadam KS, Gokhale N. Psychological behavior management techniques to alleviate dental fear and anxiety in 4-14-year-old children in pediatric dentistry: A systematic review and meta-analysis. Dent Res J (Isfahan). 2022;19:47. Disponible en: https://pubmed.ncbi.nlm.nih.gov/35915712/
Jälevik B, Sabel N, Robertson A. Can molar incisor hypomineralization cause dental fear and anxiety or influence the oral health-related quality of life in children and adolescents?-a systematic review. Eur Arch Paediatr Dent. 2022;23(1):65-78. DOI: 10.1007/s40368-021-00631-4
Radhakrishna S, Srinivasan I, Setty JV, D R MK, Melwani A, Hegde KM. Comparison of three behavior modification techniques for management of anxious children aged 4-8 years. J Dent Anesth Pain Med. 2019;19(1):29-36. DOI: 10.17245/jdapm.2019.19.1.29
Heena A, Malik M, Chauhan P, Arora P, Singh K, Moniya M. Comparison of different behaviour management techniques while administering injectable la with minimum pain perception and anxiety in children. J Clin Exp Dent. 2024;16(8):e1021-e1026. DOI: 10.4317/jced.61736
Parakh H, Thosar N. Evaluation and comparison of the effectiveness of kaleidoscope and virtual reality goggles to reduce dental anxiety in young children undergoing administration of local anesthesia. F1000Res. 2024;12:546. DOI: 10.12688/f1000research.134041.4
Felemban OM, Alshamrani RM, Aljeddawi DH, Bagher SM. Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial. BMC Oral Health. 2021;21(1):321. DOI: 10.1186/s12903-021-01678-x.
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