Journal of South Asian Association of Pediatric Dentistry

Register      Login

VOLUME 4 , ISSUE 2 ( July-September, 2021 ) > List of Articles


Local Anesthesia in Pediatric Dentistry: A Literature Review on Current Alternative Techniques and Approaches

Sainath R Elicherla, Varada Sahithi, Kanamarlapudi V Saikiran, Mahesh Nunna, Ramasubba R Challa, Sivakumar Nuvvula

Keywords : Children, Dental anxiety, Local anesthesia, Recent trends

Citation Information : Elicherla SR, Sahithi V, Saikiran KV, Nunna M, Challa RR, Nuvvula S. Local Anesthesia in Pediatric Dentistry: A Literature Review on Current Alternative Techniques and Approaches. J South Asian Assoc Pediatr Dent 2021; 4 (2):148-154.

DOI: 10.5005/jp-journals-10077-3076

License: CC BY-NC 4.0

Published Online: 26-08-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Prevalence of pain and dental anxiety plays a crucial part in pediatric dentistry. These factors cause a delay in pursuing dental treatment, which in turn increases early childhood caries. Anxiety and fear that arise before and during local anesthesia administration persist as barriers for children experiencing dental treatment. Although local anesthesia plays a significant role in managing pain for children, researchers continue to search for various comfortable methods to alleviate the pain during local anesthetic administration. Thus, the present overview aims to educate pediatric dentists concerning newer local anesthetic delivery devices and several approaches in alleviating dental anxiety and pain in children.

  1. Treede RD. The international association for the study of pain definition of pain: as valid in 2018 as in 1979, but in need of regularly updated footnotes. Pain Rep 2018;3(6):643–645. DOI: 10.1152/ajplegacy.1975.229.6.1510.
  2. Muller CE, Junior MF, Dadalto EC, et al. Prevalence of odontogenic pain and associated factors in children treated at a pediatric dental emergency service. Revista Odonto Ciencia 2017;32:115–120.
  3. Boeira GF, Correa MB, Peres KG, et al. Caries is the main cause for dental pain in childhood: findings from a birth cohort. Caries Res 2012;46(5):488–495. DOI: 10.1159/000339491.
  4. Al Absi M, Rokke PD. Can anxiety help us tolerate pain? Pain 1991;46(1):43–51. DOI: 10.1016/0304-3959(91)90032-S.
  5. Milgrom P, Coldwell SE, Getz T, et al. Four dimensions of fear of dental injections. J Am Dent Assoc 1997;128(6):756–766. DOI: 10.14219/jada.archive.1997.0301.
  6. Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med 2016;16(4):237–244. DOI: 10.17245/jdapm.2016.16.4.237.
  7. Casamassimo PS, Fields HW, McTigue TJ, et al. Pediatric dentistry, infancy through adolescence. 5th ed., St Louis, Mo: Elsevier Saunders; 2013. pp. 93, 398.
  8. Berge MT, Veerkamp JS, Hoogstraten J, et al. Childhood dental fear in the Netherlands: prevalence and normative data. Community Dent Oral Epidemiol 2002;30(2):101–107. DOI: 10.1034/j.1600-0528.2002.300203.x.
  9. Milgrom P, Weinstein P, Getz T. A Patient Management Handbook, in Treating Fearful Dental Patients. 2nd ed., Seattle: University of Washington Continuing Dental Education; 1995. pp. 9–91.
  10. Ogle OE, Mahjoubi G. Local anesthesia: agents, techniques, and complications. Dent Clin North Am 2012;56(1):133–148. DOI: 10.1016/j.cden.2011.08.003.
  11. Malamed SF. Clinical action of specific agents. In: Handbook of Local Anesthesia. 6th ed., St. Louis: CV Mosby; 2013. p. 52.
  12. Kumar M, Chawla R, Goyal M. Topical anesthesia. J Anaesthesiol Clin Pharmacol 2015;31(4):450–456. DOI: 10.4103/0970-9185.169049.
  13. Boyce RA, Kirpalani T, Mohan N. Updates of Topical and Local Anesthesia Agents. Dent Clin North Am 2016;60(2):445–471. DOI: 10.1016/j.cden.2015.12.001.
  14. Tadicherla S, Berman B. Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag 2006;2(1):99–113.
  15. Sethna NF, Verghese ST, Hannallah RS, et al. A randomized controlled trial to evaluate S-Caine patch for reducing pain associated with vascular access in children. Anesthesiology 2005;102(2):403–408. DOI: 10.1097/00000542-200502000-00025.
  16. Nishanthi R, Pradeep D, Vignesh R. Non-injectable local anesthesia. Drug Invent Today 2018;10:3875–3879.
  17. Dasarraju RK, Svsg N. Comparative efficacy of three topical anesthetics on 7-11-year-old children: a randomized clinical study. J Dent Anesth Pain Med 2020;20(1):29–37. DOI: 10.17245/jdapm.2020.20.1.29.
  18. Sriram G. Advances in local anaesthesia: a paediatric overview. Indian J Dent Adv 2014;6:1605–1607.
  19. Galui S, Biswas R, Pandey N, et al. A new horizon in needle-less anesthesia: intranasal tetracaine/oxymetazoline spray for maxillary dental anesthesia - An overview. J Oral Res Rev 2020;12(2):101–105. DOI: 10.4103/jorr.jorr_33_19.
  20. Hersh EV, Saraghi M, Moore PA. Intranasal tetracaine and oxymetazoline: a newly approved drug formulation that provides maxillary dental anesthesia without needles. Curr Med Res Opin 2016;32(11):1919–1925. DOI: 10.1080/03007995.2016.1238352.
  21. Hersh EV, Pinto A, Saraghi M, et al. Double-masked, randomized, placebo-controlled study to evaluate the efficacy and tolerability of intranasal K305 (3% tetracaine plus 0.05% oxymetazoline) in anaesthetizing maxillary teeth. J Am Dent Assoc 2016;147(4):278–287. DOI: 10.1016/j.adaj.2015.12.008.
  22. Capetillo J, Drum M, Reader A, et al. Anesthetic efficacy of intranasal 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) in maxillary teeth. J Endod 2019;45(3):257–262. DOI: 10.1016/j.joen.2018.12.003.
  23. Ciancio SG, Marberger AD, Ayoub F, et al. Comparison of 3 intranasal mists for anesthetizing maxillary teeth in adults: a randomized, double-masked, multicenter phase3 clinical trial. J Am Dent Assoc 2016;147(5):339–347. DOI: 10.1016/j.adaj.2015.11.009.
  24. Malamed SF. What's new in local anesthesia? Anesth Prog 1992;39(4-5):125–131.
  25. Logothetis DD. Anesthetic buffering: New advances for use in dentistry. RDH 2013. 62–66.
  26. Goodchild JH, Donaldson M. Novel direct injection chairside buffering technique for local anesthetic use in dentistry. Compend Contin Educ Dent 2019;40:1–10.
  27. Guo J, Yin K, Roges R, et al. Efficacy of sodium bicarbonate buffered versus non-buffered lidocaine with epinephrine in inferior alveolar nerve block: a meta-analysis. J Dent Anesth Pain Med 2018;18(3):129–142. DOI: 10.17245/jdapm.2018.18.3.129.
  28. Afsal MM, Khatri A, Kalra N, et al. Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures. J Dent Anesth Pain Med 2019;19(2):101–109. DOI: 10.17245/jdapm.2019.19.2.101.
  29. Aulestia-Viera PV, Braga MM, Borsatti MA. The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta-analysis. Int Endod J 2018;51(8):862–876. DOI: 10.1111/iej.12899.
  30. Daublander M, Liebaug F, Niedeggen G, et al. Effectiveness and safety of phentolamine mesylate in routine dental care. J Am Dent Assoc 2017;148(3):149–156. DOI: 10.1016/j.adaj.2016.11.017.
  31. Ogle O, Mahjoubi G. Advances in local anesthesia in dentistry. Dent Clin N Am 2011;55(3):481–499. DOI: 10.1016/j.cden.2011.02.007.
  32. Tavares M, Goodson JM, Pavlovich DS. Reversal of soft-tissue local anaesthesia with phentolamine mesylate in pediatric patients. J Am Dent Assoc 2008;139(8):1095–1104. DOI: 10.14219/jada.archive.2008.0312.
  33. Hersh EV, Lindemeyer R, Berg JH, et al. Phase four, randomized, double-blinded, controlled trial of phentolamine mesylate in two-to five-year-old dental patients. Pediatr Dent 2017;39(1):39–45.
  34. Grover HS, Gupta A, Saksena N, et al. Phentolamine mesylate: It's role as a reversal agent for unwarranted prolonged local analgesia. J Indian Soc Pedod Prev Dent 2015;33(4):265–268. DOI: 10.4103/0970-4388.165646.
  35. Vinnakota DN, Kamatham R. Safety profile of phentolamine mesylate as reversal agent of pulpal and soft tissue dental anesthesia: a systematic review and meta-analysis. Quintessence Int 2019;50(7):568–575. DOI: 10.3290/j.qi.a42574.
  36. Al-Khafaji HH, Abass MK, Al-Ameedee AH. Unaddressed local anesthesia reversal action of phentolamine mesylate after plain mepivacaine. Eurasia J Biosci 2020;14:3883–3888.
  37. Gune NS, Katre AN. Comparison of 0.5% centbucridine and 2% lignocaine as local anesthetic agents for dental procedures in children: a randomised controlled trial. Indian J Pediatr 2020;87(4):268–274. DOI: 10.1007/s12098-019-03161-6.
  38. Ram D, Peretz B. Administering local anaesthesia to paediatric dental patients - current status and prospects for the future. Int J Paediatr Dent 2002;12(2):80–89. DOI: 10.1046/j.1365-263x.2002.00343.x.
  39. Peedikayil F, Vijayan A. An update on local anesthesia for pediatric dental patients. Anesth Essays Res 2013;7(1):4–9. DOI: 10.4103/0259-1162.113977.
  40. Arapostathis KN, Dabarakis NN, Coolidge T, et al. 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(1):3–12. DOI: 10.2344/0003-3006-57.1.3.
  41. Giannetti L, Forabosco E, Spinas E, et al. Single tooth anaesthesia: a new approach to the paediatric patient. A clinical experimental study. Eur J Paediatr Dent 2018;19(1):40–43. DOI: 10.23804/ejpd.2018.19.01.07.
  42. Garret-Bernardin A, Cantile T, D'Antò V, et al. Pain experience and behavior management in pediatric dentistry: a comparison between traditional local anesthesia and the wand computerized delivery system. Pain Res Manag 2017;2017:7941238. DOI: 10.1155/2017/7941238.
  43. Al-Obaida MI, Haider M, Hashim R, et al. Comparison of perceived pain and patients’ satisfaction with traditional local anesthesia and single tooth anesthesia: a randomized clinical trial. World J Clin Cases 2019;7(19):2986–2994. DOI: 10.12998/wjcc.v7.i19.2986.
  44. Sixou JL, Marie-Cousin A. Intraosseous anaesthesia in children with 4% articaine and epinephrine 1:400,000 using computer-assisted systems. Eur Arch Paediatr Dent 2015;16(6):477–481. DOI: 10.1007/s40368-015-0197-5.
  45. Sovatdy S, Vorakulpipat C, Kiattavorncharoen S, et al. Inferior alveolar nerve block by intraosseous injection with Quicksleeper® at the retromolar area in mandibular third molar surgery. J Dent Anesth Pain Med 2018;18(6):339–347. DOI: 10.17245/jdapm.2018.18. 6.339.
  46. Smaïl-Faugeron V, Muller-Bolla M, Sixou JL, et al. Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerized Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomized controlled trial. BMJ Open 2015;5(7):e007724. DOI: 10.1136/bmjopen-2015-007724.
  47. Smaïl-Faugeron V, Muller-Bolla M, Sixou JL, et al. Evaluation of intraosseous computerized injection system (QuickSleeper™) vs conventional infiltration anaesthesia in paediatric oral health care: a multicentre, single-blind, combined split-mouth and parallel-arm randomized controlled trial. Int J Paediatr Dent 2019;29(5):573–584. DOI: 10.1111/ipd.12494.
  48. Sixou J, Marie-Cousin A, Huet A, et al. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper™). Int J Paediatr Dent 2009;19(5):360–366. DOI: 10.1111/j.1365-263X.2009.00983.x.
  49. Carugo N, Paglia L, Re D. Pain perception using a computer-controlled anaesthetic delivery system in paediatric dentistry: a review. Eur J Paediatr Dent 2020;21(3):180–182. DOI: 10.23804/ejpd.2020.21.03.03.
  50. Shahidi Bonjar AH. Syringe micro vibrator (SMV) a new device being introduced in dentistry to alleviate pain and anxiety of intraoral injections, and a comparative study with a similar device. Ann Surg Innov Res 2011;5(1):1–5. DOI: 10.1186/1750-1164-5-1.
  51. Ungor C, Tosun E, Dayisoylu EH, et al. The effects of vibration on pain and anxiety during local anaesthesia administration. JSM Dent 2014;2:1022.
  52. Saxena P, Gupta SK, Newaskar V, et al. Advances in dental local anesthesia techniques and devices: an update. Natl J Maxillofac Surg 2013;4(1):19–24. DOI: 10.4103/0975-5950.117873.
  53. Chaudhry K, Shishodia M, Singh C, et al. Comparative evaluation of pain perception by vibrating needle (VibrajectTM) and conventional syringe anesthesia during various dental procedures in pediatric patients: a short study. Int Dent Med J Adv Res 2015;1(1):1–5. DOI: 10.15713/ins.idmjar.5.
  54. Nanitsos E, Vartuli R, Forte A, et al. The effect of vibration on pain during local anaesthesia injections. Aust Dent J 2009;54(2):94–100. DOI: 10.1111/j.1834-7819.2009.01100.x.
  55. Yoshikawa F, Ushito D, Ohe D, et al. Vibrating dental local anesthesia attachment to reduce injection pain. J Jpn Dent Soc Anesthesiol 2003;31:194–195.
  56. Saijo M, Ito E, Ichinohe T, et al. Lack of pain reduction by a vibrating local anesthetic attachment: a pilot study. Anesth Prog 2005;52(2):62–64. DOI: 10.2344/0003-3006(2005)52[62:LOPRBA]2.0.CO;2.
  57. Shilpapriya M, Jayanthi M, Reddy VN, et al. Effectiveness of new vibration delivery system on pain associated with injection of local anaesthesia in children. J Indian Soc Pedod Prev Dent 2015;33(3):173–176. DOI: 10.4103/0970-4388.160343.
  58. Tung J, Carillo C, Udin R, et al. Clinical performance of the DentalVibe® injection system on pain perception during local anesthesia in children. ASDC J Dent Child 2018;85(2):51–57.
  59. Şermet Elbay Ü, Elbay M, Yıldırım S, et al. Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomized clinical trial. Int J Paediatr Dent 2016;26(5):336–345. DOI: 10.1111/ipd.12204.
  60. Bangerter C, Mines P, Sweet M. The use of intraosseous anesthesia among endodontists: results of a questionnaire. J Endod 2009;35(1):15–18. DOI: 10.1016/j.joen.2008.10.003.
  61. Idris M, Sakkir N, Naik KG, et al. Intraosseous injection as an adjunct to conventional local anesthetic techniques: a clinical study. J Conserv Dent 2014;17(5):432–435. DOI: 10.4103/0972-0707.139828.
  62. Clark TM, Yagiela JA. Advanced techniques and armamentarium for dental local anesthesia. Dent Clin N Am 2010;54(4):757–768. DOI: 10.1016/j.cden.2010.06.017.
  63. Dixit UB, Joshi AV. Efficacy of intraosseous local anesthesia for restorative procedures in molar incisor hypomineralization-affected teeth in children. Contemp Clin Dent 2018;9(Suppl 2):272–277. DOI: 10.4103/ccd.ccd_252_18.
  64. Remmers T, Glickman G, Spears R, et al. The efficacy of IntraFlow intraosseous injection as a primary anesthesia technique. J Endod 2008;34(3):280–283. DOI: 10.1016/j.joen.2007.12.005.
  65. Meechan JG. Intra-oral topical anaesthetics: a review. J Dent 2000;28(1):3–14. DOI: 10.1016/s0300-5712(99)00041-x.
  66. Thongkukiatkun W, Vongsavan K, Kraivaphan P, et al. Effects of the iontophoresis of lignocaine with epinephrine into exposed dentine on the sensitivity of the dentine in man. Arch Oral Biol 2015;60(8):1098–1103. DOI: 10.1016/j.archoralbio.2015. 04.006.
  67. Cubayachi C, Couto ROD, de Gaitani CM, et al. Needle-free buccal anesthesia using iontophoresis and amino amide salts combined in a mucoadhesive formulation. Colloids Surf B Biointerfa 2015;136:1193–1201. DOI: 10.1016/j.colsurfb.2015.11.005.
  68. Walsh LJ. Laser analgesia with pulsed infrared lasers: theory and practice. J Oral Laser Appl 2008;8:7–16.
  69. Genovese MD, Olivi G. Laser in paediatric dentistry: patient acceptance of hard and soft tissue therapy. Eur J Paediatr Dent 2008;9(1):13–17.
  70. Chan A, Armati P, Moorthy AP, et al. YAG laser induces pulpal analgesia: a randomized clinical trial. J Dent Res 2012;91(7_suppl):79–84. DOI: 10.1177/0022034512447947.
  71. Efthymiou A, Marques MM, Franzen R, et al. Acceptance and efficiency of anesthesia by photobiomodulation therapy during conventional cavity preparation in permanent teeth: a pilot randomized crossover clinical study. Laser Dent Sci 2017;1(2-4):65–71. DOI: 10.1007/s41547-017-0007-y.
  72. Poli R, Parker S, Anagnostaki E, et al. Laser analgesia associated with restorative dental care: a systematic review of the rationale, techniques, and energy dose considerations. Dent J 2020;8(4):128. DOI: 10.3390/dj8040128.
  73. Agarwal N, Dhawan J, Kumar D, et al. Effectiveness of two topical anaesthetic agents used along with audio-visual aids in paediatric dental patients. J Clin Diagn Res 2017;11:80–83. DOI: 10.7860/JCDR/2017/23180.9217.
  74. Nuvvula S, Alahari S, Kamatham R, et al. Effect of audiovisual distraction with 3D video glasses on dental anxiety of children experiencing administration of local analgesia: a randomized clinical trial. Eur Arch Paediatr Dent 2014;16(1):43–50. DOI: 10.1007/s40368-014-0145-9.
  75. Atzori B, Lauro Grotto R, Giugni A, et al. Virtual reality analgesia for pediatric dental patients. Front Psychol 2018;9:226. DOI: 10.3389/fpsyg.2018.02265.
  76. Nunna M, Dasaraju RK, Kamatham R, et al. Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children. J Dent Anesth Pain Med 2019;19(5):277–288. DOI: 10.17245/jdapm.2019.19.5.277.
  77. Kakigi R, Shibasaki H. Mechanisms of pain relief by vibration and movement. J Neurol Neurosurg Psychia 1992;55(4):282–286. DOI: 10.1136/jnnp.55.4.282.
  78. Chilakamuri S, Nirmala SVSG, Nuvvula S. The effect of precooling versus topical anesthesia on pain perception during palatal injections in children aged 7–9 years: a randomized split-mouth crossover clinical trial. J Dent Anesth Pain Med 2020;20(6):377–386. DOI: 10.17245/jdapm.2020.20.6.377.
  79. Suohu T, Sharma S, Marwah N, et al. A comparative evaluation of pain perception and comfort of a patient using conventional syringe and buzzy system. Int J Clin Pediatr Dent 2020;13(1):27–30. DOI: 10.5005/jp-journals-10005-1731.
  80. Bilsin E, Gungormus Z, Gungormus M. The efficacy of external cooling vibration on decreasing the pain of local anesthesia injections during dental treatment in children: a randomized controlled study. J Perianesth Nurs 2020;35(1):44–47. DOI: 10.1016/j.jopan.2019.06.007.
  81. Lathwal G, Pandit IK, Gugnani N, et al. Efficacy of different precooling agents and topical anesthetics on the pain perception during intraoral injection: a comparative clinical study. Int J Clin Pediatr Dent 2015;8(2):119–122. DOI: 10.5005/jp-journals-10005-1296.
  82. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med 2015;127(1):57–65. DOI: 10.1080/00325481.2015.992719.
  83. Halar EM, DeLisa JA, Brozovich FV. Nerve conduction velocity. Relationship of skin, subcutaneous and intramuscular temperatures. Arch Phys Med Rehabil 1980;61(5):199–203.
  84. Hindocha N, Manhem F, Backryd E, et al. Ice ver-sus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized crossover study. BMC Anesthesiol 2019;19(1):227–238. DOI: 10.1186/s12871-019-0902-8.
  85. Hameed NN, Sargod SS, Bhat SS, et al. Effectiveness of precooling the injection site using tetrafluorethane on pain perception in children. J Indian Soc Pedod Prev Dent 2018;36(3):296–300. DOI: 10.4103/JISPPD.JISPPD_222_17.
  86. Bose S, Garg N, Pathivada L, et al. Cooling the soft tissue and its effect on perception of pain during infiltration and block anesthesia in children undergoing dental procedures: a comparative study. J Dent Res Dent Clin Dent Prospects 2019;13(3):159–165. DOI: 10.15171/joddd.2019.025.
  87. Bansal D, Mahajan M, Mathur S. A comparative evaluation of ice and topical anesthetic gel in the reduction of pain before the injection: a clinical trial. SRM J Res Dent Sci 2020;11(1):6–10. DOI: 10.4103/srmjrds.srmjrds_66_19.
  88. Tirupathi SP, Rajasekhar S. Effect of precooling on pain during local anesthesia administration in children: a systematic review. J Dent Anesth Pain Med 2020;20(3):119–127. DOI: 10.17245/jdapm.2020.20.3.119.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.