A Comparative Study between Conventional and Cartoon Syringes to Evaluate Pain Perception and Anxiety in Children during Dental Local Anesthesia Administration
Keywords:
Anxiety, Pain, Cartoon syringe, Pediatric dentistry, Local anesthesiaAbstract
Background: Local anesthetic injection is one of the most anxiety-provoking procedures in pediatric dentistry, potentially affecting treatment cooperation and success. Objective: To compare conventional and cartoon syringes in terms of pain perception and anxiety in children during dental local anesthesia administration. Method: A split-mouth True-experimental study was conducted on 30 children aged 5-12 years at Sikhoraphum Hospital, Surin Province. Participants were randomly divided into two groups of 15 each. Group 1 received treatment using conventional syringes in week 1 and cartoon syringes in week 2, while Group 2 received the opposite sequence. Anxiety was assessed using Venham Picture Test (VPT), Venham Clinical Anxiety Scale (VCAS) and heart rate monitoring. Pain was evaluated using Wong-Baker Faces Pain Rating Scale (WBFPS) and Children's Hospital of Eastern Ontario Pain Scale (The CHEOPS Scale). Data were analyzed using Wilcoxon sign-ranked test and Mann-Whitney U test. Result: Cartoon syringes significantly reduced anxiety when measured by VPT, particularly in Group 1 (p = .004), with significant between-group differences in week 2 (p = .033). Pain perception was also significantly lower with cartoon syringes in week 2 (p = .024). Conclusion: Cartoon syringes were more effective in reducing both anxiety and pain compared to conventional syringes. This approach should be considered as an alternative method for anxiety and pain management in pediatric dental procedures requiring local anesthesia.
References
P BJ. Dental subscale of children's fear survey schedule and dental caries prevalence. Eur J Dent 2013;7(2):181-5.
Bellingrath S, Kudielka BM. Effort-reward-imbalance and overcommitment are associated with hypothalamus-pituitary-adrenal (HPA) axis responses to acute psychosocial stress in healthy working schoolteachers. Psychoneuroendocrinology 2008;33(10):1335-43.
Blitz M, Britton KC. Management of the uncooperative child. Oral Maxillofac Surg Clin North Am 2010;22(4):461-9.
Welbury R, Duggal MS, Hosey MT. Paediatric dentistry. Oxford: Oxford University Press; 2018.
Nakai Y, Hirakawa T, Milgrom P, Coolidge T, Heima M, Mori Y, et al. The children's fear survey schedule-dental subscale in Japan. Community Dent Oral Epidemiol 2005;33(3):196-204.
Ghaderi F, Banakar S, Rostami S. Effect of pre-cooling injection site on pain perception in pediatric dentistry:"A randomized clinical trial". Dent Res J 2013;10(6):790-4.
Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. J Indian Soc Pedod Prev Dent 2007;25(4):177-82.
Fakhruddin KS, Gorduysus MO. Effectiveness of audiovisual distraction eyewear and computerized delivery of anesthesia during pulp therapy of primary molars in phobic child patients. Eur J Dent 2015;9(04):470-5.
Pomper U, Hofle M, Hauck M, Kathmann N, Engel AK, Senkowski D. Crossmodal bias of visual input on pain perception and pain-induced beta activity. Neuroimage 2013;66:469-78.
Faul F, Erdfelder E, Lang AG, Buchner A. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175-91.
Suraseranivongse S. Validation of pain measurements in Thai children aged 1-5 years within 24 hours following operation. [Master of Science Thesis] Bangkok: Chulalongkorn University; 1999.
Monika K, Poonacha KS, Anshula D, Bhavna D, Rameshwari R, Neha P. Comparative evaluation of dental anxiety and fear in children by using Camouflaged syringe and conventional syringe. J Dental Sci 2019;4(1):000214.
Melwani AM, Srinivasan I, Setty JV, D R MK, Pamnani SS, Lalitya D. 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.
Darrow CW. Physiological and clinical tests of autonomic function and autonomic balance. Physiological Reviews 1943;23(1):1-36.
Shetty RM, Khandelwal M, Rath S. RMS Pictorial Scale (RMS-PS): an innovative scale for the assessment of child's dental anxiety. J Indian Soc Pedod Prev Dent 2015;33(1):48-52.
Oosterink FM, de Jongh A, Aartman IH. What are people afraid of during dental treatment? Anxiety-provoking capacity of 67 stimuli characteristic of the dental setting. Eur J Oral Sci 2008;116(1):44-51.
Rantavuori K, Zerman N, Ferro R, Lahti S. Relationship between children's first dental visit and their dental anxiety in the Veneto Region of Italy. Acta Odontol Scand 2002;60(5):297-300.
Vallakatla V, Vallakatla S, Dutta S, Sengupta P, Penukonda R. Conventional and camouflage syringe during Maxillary dental procedures: Relevance to anxiety and pain levels in children. Biomed Pharmacol J 2020;13(1):253-8.
Ujaoney S, Mamtani M, Thakre T, Tote J, Hazarey V, Hazarey P, et al. Efficacy trial of Camouflage Syringe to reduce dental fear and anxiety. Eur J Paediatr Dent 2013;14(4):273-8.
Nikolova-Varlinkova K, Kabaktchieva R. Reaction of 5 and 6 year old children to local anesthesia during dental treatment. Journal of IMAB: Annual Proceeding (Scientific Papers)-2008-Book 2008;2:47-51.
Aartman IH, van Everdingen T, Hoogstraten J, Schuurs AH. Self-report measurements of dental anxiety and fear in children: a critical assessment. ASDC J Dent Child 1998;65(4):252-8,29-30.
Raadal M, Milgrom P, Weinstein P, Mancl L, Cauce AM. The prevalence of dental anxiety in children from low-income families and its relationship to personality traits. J Dent Res 1995;74(8):1439-43.
Cuthbert MI, Melamed BG. A screening device: children at risk for dental fears and management problems. J Dent Child 1982;49(6):432-6.
Herbertt RM, Innes JM. Familiarization and preparatory information in the reduction of anxiety in child dental patients. ASDC J Dent Child 1979;46(4):319-23.
Pani SC, AlAnazi GS, AlBaragash A, AlMosaihel M. Objective assessment of the influence of the parental presence on the fear and behavior of anxious children during their first restorative dental visit. J Int Soc Prev Community Dent 2016;6(Suppl 2):S148-52.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Department of Medical Services, Ministry of Public Health
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของกรมการแพทย์ กระทรวงสาธารณสุข
ข้อความและข้อคิดเห็นต่างๆ เป็นของผู้เขียนบทความ ไม่ใช่ความเห็นของกองบรรณาธิการหรือของวารสารกรมการแพทย์
