Assessing Behavior and Anxiety among 3–9-year-old Children during Local Anesthesia Administration Using Conventional and Camouflaged Syringes: A Randomized Split-mouth Design
Reshma E Rajan, Sowndarya Gunasekaran, Veena Arali, Vijayakumar Mohan, Arya A Vargheese, Yash S Latkar
Citation Information :
Rajan RE, Gunasekaran S, Arali V, Mohan V, Vargheese AA, Latkar YS. Assessing Behavior and Anxiety among 3–9-year-old Children during Local Anesthesia Administration Using Conventional and Camouflaged Syringes: A Randomized Split-mouth Design. J South Asian Assoc Pediatr Dent 2024; 7 (1):21-26.
Aim and background: Childhood dental fear often stems from painful stimuli and heightened pain perception. Needles, perceived as threatening instrument, triggers anxiety, exacerbating pain memory. Camouflaged syringes, shaped like toy alligators, conceal the instrument alleviating children's anxiety. This study aims to evaluate whether camouflaged syringes compared to conventional syringes have a favorable impact on the behavior and anxiety levels of the children according to variations in pulse rates, Face, Legs, Activity, Cry, Consolability (FLACC) behavior pain scale and facial image scale (FIS).
Materials and methods: The study included 60 children divided into two age-groups (3–6 years and 6–9 years). It was also registered in Clinical Trials Registry, India (CTRI) as a prospective study with CTRI number CTRI/2023/08/056189. Conventional syringes were used in the first appointment, and camouflaged syringes in the second, employing a split-mouth design. Prior to block administration, a topical anesthetic gel was applied. Pulse rates were noted before and during the block administrations using a pulse oximeter. Behavior was evaluated by the FLACC scale before and during the administration of local anesthesia (LA). After the injection, children were expressed their anxiety during the block administration using FIS. Paired sample t-tests were used for (p ≤ 0.05) assessing significant differences in bivariate samples.
Results: In 3–6-year-olds, camouflaged syringes significantly improved FLACC pain scale and reduced anxiety according to FIS during LA, positively impacting children's behavior.
Conclusion: Camouflaged syringes have a positive impact on children's behavior, especially in the 3–6-year-old age-group where cognitive abilities are limited. They enhance distraction, effectively reducing anxiety levels.
Shim YS, Kim AH, Jeon EY, et al. Dental fear & anxiety and dental pain in children and adolescents; a systemic review. J Dent Anesth Pain Med 2015;15(2):53–61. DOI: 10.17245/jdapm.2015.15.2.53
Arslan S, Tarım Ertaş E, Ülker M. The relationship between dental fear and sociodemographic variables. J Clin Pract Res 2011;33(4):295–300.
Jaakkola S, Rautava P, Alanen P, et al. Dental fear: one single clinical question for measurement. Open Dent J 2009;3:161–166. DOI: 10.2174/1874210600903010161
Roshan NM, Virupaxi SG, Bharath KP, et al. A comparative study of filmed modeling and tell-show-do technique on anxiety in children undergoing dental treatment. J Oral Health Comm Dent 2018;12(1):20–24. DOI: 10.5005/jp-journals-10062-0020
Kalra N, Sabherwal P, Tyagi R, et al. Relationship between subjective and objective measures of anticipatory anxiety prior to extraction procedures in 8- to 12-year-old children. J Dent Anesth Pain Med 2021;21(2):119–128. DOI: 10.17245/jdapm.2021.21.2.119
Kohli N, Hugar SM, Patil VH, et al. Evaluating anxiety levels and pain perception while administering local anesthesia using conventional, insulin, and deception syringes in 6-12-year-olds. J Dent Anesth Pain Med 2022;22(3):197–204. DOI: 10.17245/jdapm.2022.22.3.197
Melwani AM, Srinivasan I, Setty JV, et al. A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6-11-year-old children during local anesthesia administration-a novel approach. J Dent Anesth Pain Med 2018;18(1):35–40. DOI: 10.17245/jdapm.2018.18.1.35
Frankl N. Should the parent remain with the dental operatory? J Dent Child 1962;29:150–163.
Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs 1997;23(3):293–297. PMID: 9220806.
Beegum N, Vishwanathan S. A clinical comparative study to evaluate anxiety in children with the use of conventional and camouflaged syringe. Int J Med Sci Clin Res Stud 2022;2(7):603–610. DOI: 10.47191/ijmscrs/v2-i7-02
Versloot J, Veerkamp JS, Hoogstraten J. Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children. Eur J Oral Sci 2005;113(6):488–493. DOI: 10.1111/j.1600-0722.2005.00252.x
Panchal J, Panda A, Trivedi K, et al. Comparative evaluation of the effectiveness of two innovative methods in the management of anxiety in a dental office: a randomized controlled trial. J Dent Anesth Pain Med 2022;22(4):295–304. DOI: 10.17245/jdapm.2022.22.4.295
Elicherla SR, Bandi S, Nuvvula S, et al. Comparative evaluation of the effectiveness of a mobile app (Little Lovely Dentist) and the tell-show-do technique in the management of dental anxiety and fear: a randomized controlled trial. J Dent Anesth Pain Med 2019;19(6):369–378. DOI: 10.17245/jdapm.2019.19.6.369
de Menezes Abreu DM, Leal SC, Mulder J, et al. Patterns of dental anxiety in children after sequential dental visits. Eur Arch Paediatr Dent 2011;12(6):298–302. DOI: 10.1007/BF03262827
Nigam AG, Marwah N, Goenka P, et al. Correlation of general anxiety and dental anxiety in children aged 3 to 5 years: a clinical survey. J Int Oral Health 2013;5(6):18–24.
Yadav AN, Garg SH, Shrivastava AN, et al. Child drawing: a projective tool for dental anxiety assessment. Int J Health Res 2020;4(1):19–25. DOI: 10.26440/IHRJ/0401.04331
Rosenberg HM, Katcher AH. Heart rate and physical activity of children during dental treatment. J Dent Res 1976;55(4):648–651. DOI: 10.1177/00220345760550041801
Padminee K, Hemalatha R. Comparing conventional syringe with camouflage syringe by evaluating behavior and anxiety in 6–10 year old children while administering local anaesthesia - a cross over trial with split mouth study design. Int J Dent Sci Innov Res 2019;2(3):381–389.
Crellin DJ, Harrison D, Hutchinson A, et al. Procedural Pain Scale Evaluation (PROPoSE) study: protocol for an evaluation of the psychometric properties of behavioural pain scales for the assessment of procedural pain in infants and children aged 6–42 months. BMJ Open 2017;7(9):e016225. DOI: 10.1136/bmjopen-2017-016225
Babl FE, Crellin D, Cheng J, et al. The use of the faces, legs, activity, cry and consolability scale to assess procedural pain and distress in young children. Pediatr Emerg Care 2012;28(12):1281–1296. DOI: 10.1097/PEC.0b013e3182767d66
Ismail NA, Mohamed N, Yusof NA, et al. The effectiveness of hydroshooter (needle cover syringe) in reducing dental anxiety during local anaesthesia. Int J Innov Res 2018;7(1):373–379. DOI: 10.24940/ijird/2018/v7/i1/121079-287535-1-SM
Bagher SM, Felemban OM, Alsabbagh GA, et al. The effect of using a camouflaged dental syringe on children's anxiety and behavioral pain. Cureus 2023;15(12):e50023. DOI: 10.7759/cureus.50023
Ujaoney S, Mamtani M, Thakre T, et al. Efficacy trial of camouflage syringe to reduce dental fear and anxiety. Eur J Paediatr Dent 2013;14(4):273–278. PMID: 24313577.
Buchanan H, Niven N. Validation of a facial image scale to assess child dental anxiety. Int J Paediatr Dent 2002;12(1):47–52. PMID: 11853248.
Fathima F, Jeevanandan G. Validation of a facial image scale to assess child dental anxiety. Drug Invent Today 2018;10(1):2825–2828. ISSN: 0975-7619.
Muinelo-Lorenzo J, Sanfeliú JO, Alegre SV, et al. Haemodynamic response and psychometric test measuring dental anxiety in a Spanish population in Galicia. Oral Health Prev Dent 2014;12(1):3–12. DOI: 10.3290/j.ohpd.a30605
Khokhar V, Gupta B, Kaur J. Evaluation of anxiety level of children aged 6-9 years during sequential dental visits using objective and subjective measures. EC Dent Sci 2017;15(4):93–103.
Hegde KM, R N, Srinivasan I, et al. Effect of vibration during local anesthesia administration on pain, anxiety, and behavior of pediatric patients aged 6–11 years: a crossover split-mouth study. J Dent Anesth Pain Med 2019;19(3):143–149. DOI: 10.17245/jdapm.2019.19.3.143
Malamed Stanley F. Handbook of Local Anesthesia, 6th edition. Brazil: Elsevier; 2013.
Nikolova-Varlinkova K, Kabaktchieva R. Reaction of 5 and 6 year old children to local anesthesia during dental treatment. J of IMAB 2008;2:47–51.
Maragakis GM, Musselman RJ, Ho CC. Reaction of 5 and 6 year olds to dental injection after viewing the needle: pilot study. J Clin Pediatr Dent 2006;31(1):28–31. DOI: 10.17796/jcpd.31.1.g6q6q8j067755071