Figure - uploaded by Faezeh Ghaderi
Content may be subject to copyright.
Visual analogue scale (VAS) for assessment of children's pain perception

Visual analogue scale (VAS) for assessment of children's pain perception

Source publication
Article
Full-text available
Injection of local anesthesia is one of the most important reasons for development of avoidance behavior in children. Efforts have been performed to decrease pain perception of injection. The present research evaluated the effect of cooling the injection site on pain perception before infiltration of local anesthetics. A prospective single-blind cr...

Context in source publication

Context 1
... a visual analogue scale (VAS) [ Figure 1], the subjects were instructed how to point to the position on the line between faces to indicate how much pain they might feel. In this system the total scores range from 0 to 100 based on measuring the distance in millimeters from the left end bar to mark made by the child on the 10 cm line anchored by happy to sad faces, with a higher score indicating more severe pain. ...

Similar publications

Article
Full-text available
Topical anesthesia is widely advocated in pediatric dentistry practice to reduce pain and anxiety produced by administration of local anesthesia. Cryoanesthesia to lessen the injection pain has also been reported to be promising. However, sparse literature reports exist regarding clinical efficacy of these agents. Aim: The purpose of this study was...

Citations

... The efficacy of cold refrigerated lignocaine (4-6 °C) has been found to be effective with a faster onset and longer duration of inferior alveolar nerve block in mandibular molars diagnosed with SIP in an earlier study [20]. In addition, literature evidence also suggests that topical cooling of injection site with ice sticks prior to infiltration anesthesia significantly reduced the pain on injection [21,22]. ...
... A counter-irritant effect also occurs due to the activation of thermal receptors [35]. Mohiuddin et al. [22] and Ghaderi et al. [21] had demonstrated similar results on topical application of ice in pediatric patients prior to extractions. In addition to enhanced pain control, topical ice combined with precooled LE overcomes the slow onset and altered taste sensation as encountered with conventional topical gels. ...
Article
Full-text available
Objective This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP).Materials and methodsSixty patients diagnosed with SIP (preoperative pain score ≥ 85 mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15 s and refrigerated (4–6 °C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36 mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann–Whitney U test was performed to analyze the data (p < 0.01).ResultsExperimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0 mm vs 54.5 mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4 min which was also significantly lower than control group (4.5 min) (p < 0.01).Conclusions Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP.Clinical relevancePrecooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.
... 15 Studies have reported that it lowers edema, nerve conduction velocities, cellular metabolism, and local blood flow. 2, 16 The application of ice provides a physiological as well as psychological benefit to the patients as it may distract them from focusing on their discomfort. 17 Sprains, wounds, fractures, bruises, insect stings, and other physical injuries have all been managed with this procedure. ...
Article
Background: Profound local anesthetic delivery promotes successful treatment for children in terms of easing their fear, anxiety, and discomfort during dental procedures. Local anesthetic injections are the utmost anticipated or anxious stimuli in the dental operatory. Precooling the oral mucosa by application of cryotherapy before local anesthetic injections can alter the pain perception in children. Aim and objectives: To compare the efficacy of cryotherapy application and 20% benzocaine gel at reducing pain perception during buccal infiltration in pediatric patients. Materials and methods: In this split-mouth study, 30 pediatric patients between 7 years and 10 years of age who needed maxillary buccal infiltration of local anesthetics bilaterally for dental treatment were selected. They received cryotherapy (ice pack) on one quadrant (test group) for 2 minutes and 20% benzocaine topical gel on the contralateral quadrant (control group). A pediatric dentist blinded to the study assessed sound, eye, motor (SEM) scale based on patients' reaction during injection (objective method), and patients were instructed to use a visual analog scale (VAS) to rate their distress during injection (subjective method). Statistical analyses were performed using Wilcoxon and Mann-Whitney U tests. Results: The cryotherapy group had significantly reduced pain scores on the VAS scale (40.66 ± 14.60) when compared with the topical anesthetic gel group (61.33 ± 9.73). The cryotherapy group had reduced pain scores on the SEM scale as well (1.2 ± 0.1) when compared with the topical anesthetic gel group (1.6 ± 0.1), which was not statistically significant. Conclusion: When compared with topical anesthetic gel, precooling the injection site with cryotherapy is beneficial in reducing pain before local anesthesia injection in pediatric patients. Clinical significance: Cryotherapy application eliminates the fear of pain ascribed to injection of local anesthesia and assists in providing pertinent dental care. How to cite this article: Lakshmanan L, Ravindran V. Efficacy of Cryotherapy Application on the Pain Perception during Intraoral Injection: A Randomized Controlled Trial 2021;14(5):616-620.
... An alternative method to allay injection pain is pre-cooling the injection site. The application of cold stimuli on the injection site before LA administration remains an easy and physiologically effective procedure without any surplus costs [11]. Harbert stated that cooling the palatal region before injection significantly relieves pain perception [12]. ...
... The Buzzy Ⓡ device's ice wings play an influential role in soothing the pain perceived by the children during LA administration. Ghaderi et al. placed an ice stick to the injection site for 1 min prior to local anesthesia; they found that this application considerably decreased pain related to LA administration [11]. cooling were used on local anesthetic sites during dental treatment in children [37,29]. ...
Article
Full-text available
Background: This study aimed to evaluate the efficacy of external vibrating devices and counterstimulation on a child's dental anxiety, apprehension, and pain perception during local anesthetic administration. Methods: This was a prospective, randomized, parallel-arm, single-blinded interventional, clinical trial. One hundred children aged 4-11 years, requiring pulp therapy or extraction under local anesthesia (LA), were recruited and allocated equally into two groups (1:1) based on the interventions used: Group BD (n = 50) received vibration using a Buzzy® device {MMJ Labs, Atlanta, GE, USA} as a behavior guidance technique; Group CS (n = 50) received counterstimulation for the same technique. Anxiety levels [Venham's Clinical Anxiety Rating Scale (VCARS), Venham Picture Test (VPT), Pulse oximeter {Gibson, Fingertip Pulse Oximeter}, Beijing, China)] were assessed before, during, and after LA administration, while pain perception [Wong-Baker Faces Pain Rating Scale (WBFPS), Visual Analogue Scale (VAS)] was evaluated immediately after injection. Statistical analysis was performed using the Student's t-test to assess the mean difference between the two groups and the repeated measures ANOVA for testing the mean difference in the pulse rates. Statistical significance was set at P < 0.05. Results: Significant differences in mean pulse rate values were observed in both groups. In contrast, the children in the BD group had higher diminution (P < 0.05), whereas the mean VCARS and VPT scores were conspicuous (P < 0.05). Based on the mean WBFPS and VAS scores, delayed pain perception after LA injection was more prominent in the BD group than in the CS group. Conclusion: External vibration using a Buzzy® device is comparatively better than counterstimulation in alleviating needle-associated anxiety in children requiring extraction and pulpectomy.
... The dentist can overcome the issue of injection pain by altering the pH and temperature of local anaesthetic solution and by reducing the speed of injecting the solution into the tissues [8]. Preparation of tissues before injection is another technique i.e., surface anaesthesia, which includes refrigeration [1], transcutaneous electronic nerve stimulation (TENS), [2]and desensitization of the oral site using topical anaesthetics. ...
Article
Full-text available
Pain control is an integral part of modern dentistry. Needle injection of local anaesthetic itself proves to be painful for the child. Topical anaesthetic agents are widely used in the field of Paediatric dentistry to reduce pain and apprehension during administration of local anaesthesia. The aim of this study is to evaluate and compare the efficacy of two topical anaesthetic agents—Lignocaine 5% gel and EMLA 5% cream (Eutectic mixture of local anaesthetics—Lignocaine 2.5% and prilocaine 2.5%) in reducing pain during administration of local anesthetic injection in children. Children of the age group between 6 and 9 years of age were selected. The two selected topical anaesthetics were applied on the maxillary buccal vestibule following which the local anaesthetic was administered. The pain responses of the children were evaluated using the Wong Baker Faces Pain Rating Scale at the 5th min and 10th min. The results were then statistically analysed using Independent t-test and ƿ value <0.05 was considered statistically significant. EMLA 5% cream was more effective in pain reduction than Lignocaine 5% gel at the 5th and 10th min. EMLA 5% cream is comparatively better than Lignocaine 5% gel with regards to pain reduction during the administration of local anaesthetic injection in children.
... Moreover, it stimulates myelinated A-delta fibers, activating inhibitory pain pathways, which raise the pain threshold, especially to noxious stimuli such as local anesthetic agents (4). Various studies have evaluated the efficacy of pre-cooling techniques on pain relief in pediatric dentistry (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Some studies found that the cooling technique significantly decreases injection pain than traditional techniques (1,2,(5)(6)(7)9), while others found no significant difference between the two conditions (3,8). ...
... Various studies have evaluated the efficacy of pre-cooling techniques on pain relief in pediatric dentistry (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). Some studies found that the cooling technique significantly decreases injection pain than traditional techniques (1,2,(5)(6)(7)9), while others found no significant difference between the two conditions (3,8). A brief review in 2016 surveyed the efficacy of different non-pharmacological techniques, including pre-cooling, in relieving the discomfort due to the injection of local anesthetic agents during dental procedures. ...
... Moreover, in Alanazi et al (6) study, the face, legs, activity, cry, and consolability (FLACC) pain scale was also utilized. For subjective pain assessment in four studies (3,5,7,8), the visual analog scale (VAS) was used, while the Wong-Baker pain scale was used in three studies (2,5,6). By applying topical anesthesia only in the control groups, three studies (Vafaee et al (3), Lathwal et al (9), and Hameed et al (8)) evaluated the effectiveness of topical gel versus pre-cooling on pain of dental injections. ...
Article
Objectives : Several methods, including cooling of the injection site, have been proposed for pain control during the dental local anesthetic injection. This systematic review aimed to evaluate the scientific evidence on the precooling of the injection site to reduce pediatric dental injection pain. Data Sources : The search terms were selected according to the Medical Subject Headings (MeSH) and non-MeSH. The main keywords included dental injection, cooling, pain, and children. Potentially eligible studies involved the subjective or objective pain evaluation in children receiving any dental injection. Risk of bias assessment was carried out using the Cochrane risk of bias tool. An electronic search was carried out for published studies in the English language up to March 2020 on Scopus, Cochrane, and PubMed databases. Of 761 articles retrieved initially, 14 were eligible to be included in the systematic review, of which six articles were excluded. Regarding the type of intervention, six articles used cooling agents in the intervention group, and two studies used the Buzzy device (a combination of cold and vibratory stimuli). All studies included in the systematic review except one considered that the use of intra- or extra-oral cooling could reduce pain during anesthesia injections in children significantly. Conclusion : Overall, the evidence presented in this review was limited and had low quality. It may be concluded that application of cold agents before dental anesthesia can be more helpful than the traditional dental injection in reducing pain in children. Besides, the use of the Buzzy device showed promising results, as shown by two studies.
... For the recording of parameters at different time intervals, the patients were instructed to refrain from any oral hygiene procedure eight hours before the evaluation. Pain assessment by VAS 13 and HI 14 were recorded at 1-week postoperative period. ...
Article
Background. The present randomized clinical trial aimed to determine the additive clinical and microbiological benefits of diode laser (DL) with modified Widman flap (MWF) to manage chronic periodontitis. Methods. Seventy-two sites in 36 healthy non-smoking patients diagnosed with chronic periodontitis were randomly assigned to the test group (MWF + active DL) or control group (MWF + sham DL). Clinical (probing pocket depth [PPD], clinical attachment level [CAL]) and microbiological (colony-forming units [CFUs]) measurements were recorded at baseline and 6- and 6-month postoperative intervals. Results. Compared to baseline, 6-month results showed significant changes in clinical and microbiological parameters in both groups. However, the intergroup comparison revealed significantly lower PPD (1.90±0.48 mm vs. 2.35±0.41 mm), CAL (4.43±0.57 mm vs. 4.93±0.58 mm), and CFUs for Porphyromonas gingivalis (6.32±0.18 vs. 8.88 ±1.88), Prevotella intermedia (7.62±1.86 vs. 8.12±1.78), and Aggregatibacter actinomycetemcomitans (6.43±1.44 vs. 7.24±1.22) in the test group after six months. Conclusion. Within the limitations, the present study confirmed the useful role of DL with MWF to manage chronic periodontitis.
... Recent studies have demonstrated the efficacy of ice as an alternative to lidocaine 5% gel 23 and as a nonpharmacological intervention for pain management for dental procedures. [34][35][36][37][38] Walco et al reported a 13-year-old leukemia patient who had difficulty swallowing pills was helped by using progressively larger pieces of ice, which helped to keep gagging and choking to a minimum, 39 consistent with the concept of alternative adjunct therapies to improve the patient's comfort. 40 The cold temperature might decrease neural transmission of stimuli in the thin unmyelinated neurons 41,42 and local vasoconstriction may slow down lidocaine metabolism and absorption with a greater local anesthetic effect. ...
Article
Full-text available
Purpose: Esophagogastroduodenoscopy (EGD) under topical pharyngeal anesthesia has the advantage of avoiding the unwanted cardiopulmonary adverse events experienced following intravenous sedation. Lidocaine spray is a common anesthetic option and is safe for unsedated EGD. Although several studies have compared different topical anesthetic agents, their formulations, and delivery techniques, questions still remain concerning the optimal mode of administration. We have designed a lidocaine formulation in the form of an ice popsicle and compared its effectiveness and tolerability with lidocaine spray in patients undergoing unsedated EGD. Methods: This was a single-center prospective randomized controlled trial. Unsedated EGD patients were randomly allocated the lidocaine spray [Group (Gp) A] or lidocaine ice popsicle (Gp B) formulation. Results: In total, 204 unsedated EGD patients were evaluated. Compared to the spray, the lidocaine ice popsicle group showed better scores for effects in terms of endoscopist satisfaction (Gp A, 7.28±1.44; Gp B, 7.8±0.89; p=0.0022), gag reflex (Gp A, 1.3±0.66; Gp B, 1.02±0.61; p=0.0016), patient satisfaction (Gp A, 7.74±0.82; Gp B, 8.08±0.82; p=0.0039), discomfort (Gp A, 6.54±1.34; Gp B, 5.95±1.21; p=0.0012), and pain (Gp A, 5.38±1.85; Gp B, 4.51±2.01; p=0.0015). Conclusion: Both the lidocaine spray and ice popsicle formulations are safe, effective options for diagnostic EGD with the ice popsicle exhibiting better performance. We propose the lidocaine ice popsicle formulation for topical pharyngeal anesthesia in patients undergoing unsedated diagnostic EGD and suggest it may be a suitable option during the COVID-19 pandemic. Clinical trial register: Thai Clinical Trials Registry (TCTR) number TCTR20190502001.
... Pain is considered the fifth vital sign 1 and is an unpleasant emotional and sensory experience associated with likely tissue damage. 2 There are many factors, 3,4 out of which major factors are pricking pain and fear caused by the vision of the needle which is known as blenophobia. 5 Anticipation of pain due to needle prick is most commonly observed in dental procedures. Multiple methods, such as use of topical anaesthetic agent, like benzocaine, buffering the local anaesthetics, distraction methods, warming the local anaesthetic agents and adjusting the pace of the infiltration by lowering the speed of injection, are employed to alleviate such pain. ...
... Multiple methods, such as use of topical anaesthetic agent, like benzocaine, buffering the local anaesthetics, distraction methods, warming the local anaesthetic agents and adjusting the pace of the infiltration by lowering the speed of injection, are employed to alleviate such pain. 5 One of the major techniques to relieve pricking pain is to cool the site of injection. 6 There are several ways to do this, such as use of refrigerant spray, like 1,1,1,3,3pentaflouropropane or 1,1,1,,2-tetrafluoroethane, customised form of ice etc. ...
... 7 Nearly all dental studies involving pre-cooling agents have been done in paediatric patients. 5 A study found that cooling the palatal area prior to injection alleviates pain. 8 Another study regarding the comparison between different pre-cooling agents and topical anaesthesia found that ice cone was more effective than refrigerant spray and topical anaesthesia in children aged 5-8 years. ...
Article
Objective: To determine the effect of pre-cooling agent on the intensity of pricking pain at the intraoral injection site in adult patients. Methods: The in-vivo interventional study was conducted at the Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from September 2018 to August 2019, and comprised adult patients of either gender. The pricking pain perception during needle administration was assessed using split-mouth technique. Topical anaesthesia benzocaine gel was applied on the left side, which was treated as controls, for 1 min, while on the right side, which was treated as the experimental side, refrigerated cartridge was placed for 2 min. Infiltration anaesthesia was then administered on both sides. Pain perception ratings were measured through visual analogue scale. After profound anaesthesia was achieved, restorative treatment was performed under rubber dam isolation. Data was analysed using SPSS 24. Results: Of the 152 subjects, 77(50.65%) were females and 75(49.34%) were males. The overall mean age was 35.97±8.669 years (range: 21-50 years). The effect of refrigerated cartridge was significant on the intensity of pricking pain at the intraoral injection site in patients aged 41-50 years, and in female patients aged 21-30 years (p<0.05), whereas its effect was non-significant in males aged 21-30 years and patients aged 31-40 years (p>0.05). Conclusions: Pre-cooling agent was found to be effective in decreasing pricking pain felt by patients.
... However, the usage of vibration devices to distract patients during dental anesthesia administration has revealed a mixed response in dentistry. Few studies reported that results have not been promising [9][10][11], whereas others have reported it as a successful technique in alleviation of pain during administration of dental anesthesia [12][13][14][15]. Another technique commonly used in medicine to relieve the pain of injection is cooling of the injection site and it has been successfully tested in dentistry also [14]. ...
... Few studies reported that results have not been promising [9][10][11], whereas others have reported it as a successful technique in alleviation of pain during administration of dental anesthesia [12][13][14][15]. Another technique commonly used in medicine to relieve the pain of injection is cooling of the injection site and it has been successfully tested in dentistry also [14]. ...
... Current research in dentistry is focused on the usage of cold temperatures in addition to a vibration device [14,15]. e rationale for using this technique is that, as a psychological component, pain is reliant on the perception and attention of the patient [17,18]. ...
Article
Full-text available
Background. The ‘‘gate control’’ theory suggests pain can be reduced by simultaneous activation of larger diameter nerve fibers using appropriate coldness, warmth, rubbing, pressure, or vibration. This study investigated the efficacy of a device combining cold and vibration, for needle-related procedural pain in children. Methodology. A total of 51 children aged 5–12 years participated in this randomized controlled clinical trial. Half of the children were in the control group and received maxillary buccal infiltration, by injecting 1.8 ml of 2% lidocaine with 1 : 100,000 adrenaline using topical anesthesia 20% benzocaine gel for 15 seconds, while the other half were in the test group and received the same anesthesia using a commercially available external cold and a vibrating device. A face version of Visual Analogue Scale (VAS) was used as a subjective measure to assess the child’s pain experience. The parents were requested to evaluate the child’s ability to tolerate pain using a behavioral/observational pain scale. Sound, Eyes, and Motor (SEM) scale and Faces, Legs, Activity, Cry, and Consolability (FLACC) scale were used to record the child’s pain as perceived by the external evaluator. T-test or Mann–Whitney U-test was used for scale variables, paired sample T-test or Wilcoxon rank t-test was used for before and after data, and chi-square was used for categorical variable, based on the results of normality test. Results. The results showed a statistically significant reduction in pain after the injection for the test group compared with control using VAS scale (mean = 6.68 (1.09) and 8.42 (0.50); ) and FLACC scale (mean = 5.92 (1.05) and 8.16 (0.54); ), but not when using SEM scale (mean 3.22 (0.42) and 4.24 (2.74);). Conclusions. Combined external cold and vibrating devices can be an effective alternative in reducing experienced pain and fear in children undergoing infiltration dental anesthesia. This study was registered with clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001). 1. Introduction Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage [1]. One of the most fear-inducing and expected to be painful procedures in pediatric dentistry is the injection of local anesthetic [2]. Effective pain control is the cornerstone for successful behavior guidance in pediatric dental office [3]. Therefore, pain management during dental treatment is of utmost importance as it could significantly alter the physiological signs like hypoxemia, tachycardia [4], psychological symptoms like needle phobia [5, 6], and other emotional consequences. Long-term consequences of needle phobia include the evasion from healthcare settings and noncompliance with needle-related procedures and other health conditions [6]. Up till now, several pharmacological mediations like topical anesthetics, physical methods like cold and acupuncture or devices, and psychological interventions like distraction techniques have been assessed for pain control during needle-related procedures in pediatric patients [7]. Recently, vibrating devices have been used successfully to distract pediatric patients and masking the pain of intramuscular injections and venipuncture [8]. However, the usage of vibration devices to distract patients during dental anesthesia administration has revealed a mixed response in dentistry. Few studies reported that results have not been promising [9–11], whereas others have reported it as a successful technique in alleviation of pain during administration of dental anesthesia [12–15]. Another technique commonly used in medicine to relieve the pain of injection is cooling of the injection site and it has been successfully tested in dentistry also [14]. Recently, a simple and easy-to-use device was developed to prevent pain from needle-related procedures in children. It is a bee-shaped device and consists of a main vibrating body and two removable ice wings [16]. The main vibrating body is power driven by two alkaline (AAA) batteries, which can be started by a switch on the top of the device. The ice wings contain 18 g of ice and are inserted at the back of the body with elastic bands. The device is placed in close proximity to the site of local anesthetic injection and then kept activated throughout the injection period [16]. Current research in dentistry is focused on the usage of cold temperatures in addition to a vibration device [14, 15]. The rationale for using this technique is that, as a psychological component, pain is reliant on the perception and attention of the patient [17, 18]. The aims of this study were to (1) determine whether or not individuals anticipate and report actual pain before and during a buccal infiltration injection and (2) quantify the effect of this device during a possibly painful experience such as buccal infiltration injection. The null hypotheses were as follows: (1) no pain will be experienced during standard buccal infiltration injection and no difference will be observed between anticipated and actual pain; and (2) application of the device at the site of injection would have no significant consequence on the observation of pain. 2. Materials and Methods 2.1. Ethical Approval This study was registered with the clinical trial registry of the United States National Institutes of Health (NIH) at ClinicalTrials.gov (NCT03953001). Ethical approval for the conduct of this study was obtained (IRB-2016-02-100) from the Institutional Review Board of the College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam. Parents were informed and consent was obtained in writing from them before inclusion of patient in the study. 2.2. Study Design Two parallel arm, randomized controlled clinical trial design was used. 2.3. Sample Size Determination The following assumptions were used to calculate sample size:(1)Expected proportion of reporting pain in the control group = 50%(2)Expected proportion of reporting pain in vibration system group = 20%(3)Alpha error = 5%(4)Study power = 80% The sample size was calculated using the G-power sample size calculator (University of Kiel, Kiel, Germany). The minimum sample size needed to detect difference between control and vibration system is 45 children. The planned sample size was increased to 50 to make up for losses due to various reasons. 2.4. Inclusion Criteria for Participants (1)Children 5–12 years of age.(2)Positive or definitely positive behavior on Frankl scale.(3)Children receiving treatment on the dental chair. Those in need of treatment under general anesthesia were excluded from the study.(4)Free from allergies to topical anesthetic used in the study.(5)Parental consent for child participation in the study.(6)Child is free from any neurological or psychological disorders. 2.5. Recruitment Fifty children were recruited from those visiting the clinics of College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam. Eligibility criteria were applied, and patients included in the study were listed and assigned an identifying number (Figure 1).
... Ghaderi et al 11 in their studies clarified that precooling of the injection site with ice popsicles reduced the injection pain significantly. Hogan et al, 12 in their systematic review, declared that warming of the local anesthetic could decrease the pain induced during the injection. ...