Pain behaviour and distress in children during two sequential dental visits: Comparing a computerised anaesthesia delivery system and a traditional syringe

Abstract

Objective: To compare the pain and distress response of children receiving a local anesthesia injection using a computerised device (Wand®) or a traditional syringe over two consecutive treatment sessions and to study whether the response to the two injection techniques was different for high or low dentally anxious children. Design: Randomised controlled trial. Setting: Secondary dental care practice specialised in treating children. Subjects and Methods: Children were selected and randomly allocated to the Wand® or traditional injection condition. Parents completed the Dental Subscale of the Children's Fear Survey Schedule (CFSS-ds). Based on video recordings of the injections, for each 15 seconds, the occurrence of five pain related behaviours was registered and a score was given on the Venham distress scale. Children rated their pain after each injection. Intervention: Over two consecutive treatment sessions one group received two local anaesthesia injections with the traditional syringe and the other group received two injections with the Wand®. Outcome measures: The mean number of pain related behaviours, the mean distress scores and the self-reported pain scores were compared. Based on the CFSS-ds subjects were split into highly and low dentally anxious children. Results: One hundred and forty-seven subjects participated in the study: aged 4-11 years, 71 girls. Based on the behaviour displayed during the local anaesthesia injection and the self-reported pain after the injection, no difference could be found between an injection with the traditional syringe or the Wand® over the first or second treatment session. However, on the first treatment session, highly anxious children reported more pain (p = 0.001), displayed more pain related behaviour (p = 0.002) and more distress (p <0.001) than low anxious children in reaction to the local anaesthesia injection. Conclusion: No clear difference in the response of referred children could be found between an injection with the Wand® or the traditional syringe. Level of dental anxiety was found to be an important factor in the response of children to a local anaesthesia injection. © 2008 Macmillan Publishers Limited. All rights reserved.