Anda di halaman 1dari 5

Original Article

Effectiveness of new vibration delivery system on pain


associated with injection of local anesthesia in children
Mangalampally Shilpapriya, Mungara Jayanthi, Venumbaka Nilaya Reddy, Rajendran Sakthivel,
Girija Selvaraju, Poornima Vijayakumar
Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai, Tamil Nadu, India

ABSTRACT Address for correspondence:


Dr. Mungara Jayanthi,
Aim: Pain is highly subjective and it is neurologically
Department of Pedodontics and Preventive Dentistry, Ragas
proven that stimulation of larger diameter Dental College and Hospital, Uthandi, Chennai - 600 119,
fibers  —  e.g., using appropriate coldness, warmth, Tamil Nadu, India.
rubbing, pressure or vibration - can close the neural E-mail: jayanthi_1963@yahoo.com
“gate” so that the central perception of itch and pain
is reduced. This fact is based upon “gate control”
theory of Melzack and Wall. The present study was Access this article online
carried out to investigate the effects of vibration Quick response code Website:
stimuli on pain experienced during local anesthetic www.jisppd.com
injections. Materials and Methods: Thirty patients DOI:
aged 6-12 years old of both the genders with 10.4103/0970-4388.160343
Frankel’s behavior rating scale as positive and
PMID:
definitely positive requiring bilateral local anesthesia
******
injections for dental treatment were included in
the split-mouth cross over design. Universal pain
assessment tool was used to assess the pain with application of topical analgesics,[2,3] distraction
and without vibration during the administration techniques,[4-6] application of counter irritation,[7]
of local anesthesia and the results obtained were varying the rates of infiltration, buffering and warming
tabulated and statistically analyzed. Results: Local the local anesthesia,[8] reduced speed of injection,[9] use
anesthetic administration with vibration resulted of fine needles with improved syringes, precooling the
in significantly less pain (P  =  0.001) compared to injection site[10] and use of vibration have been reported
the injections without the use of vibe. Conclusion: in many studies, but no conclusive painless injection
The results suggest that vibration can be used as method has been established.
an effective method to decrease pain during dental
local anesthetic administration. Topical application of local anesthesia is the most
common means used to control the pain of local
KEYWORDS: Dental vibe, gate control theory, local anesthesia injections. Topical anesthetics may be
anesthesia, pain associated with toxic sequel because of the amounts
of drug absorbed through the mucosa and the
relative toxicity of some of the topical agents.[11]
Further, the taste associated with the gels and sprays
Introduction can make the child uncomfortable. The dissolution of
the agent with the saliva was also observed which can
Pain is a complex and multidimensional construct that further reduce the effectiveness of the agent at the site.
involves sensory, emotional, and cognitive processes. Because of these problems, a predictable means of pain
control for injections is desirable.
One of the most important aspects of child behavior
guidance is the control of pain.[1] Effective pain Vibratory stimulation is one of the several
control in children during regional dental injections nonpharmacological techniques used to reduce pain.
is important to achieve comfort, cooperation, and Previously, vibration was applied using a hand-held
compliance with dental care. The pain induced by massager/a vibrating cotton swab. As the vibration
injection of local anesthetic agents can be reduced in of the hand-held massager cannot be monitored
a number of complementary methods which include throughout, there may be variations in frequency and

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 | 173
Shilpapriya, et al.: Dental vibe in pediatric dentistry

pressure applied from subject to subject over time. dental vibe or the topical anesthesia. The children
Recently, the Dental vibe® (Dental Vibe Inc.) was requiring at least two clinical sessions of operative
introduced into dentistry by Dr. Steven Goldberg, procedures preceded by a local anesthetic injection,
which delivers vibration in a sustained frequency as a one on either side of the same jaw were included
counter stimulation on to the site of injection thereby in the study. Fifteen children received Precaine Gel
alleviating pain. (Pascal International™) (containing 8% lignocaine
and 0.8% dibucaine) topical anesthetic gel prior to
It is a cordless, rechargeable, hand-held device that administration of local anesthesia injection, whereas
delivers soothing, pulsed, percussive micro-oscillations the remaining 15 received Dental vibe® (Dental Vibe
to the site where an injection is being administered and Inc.) during the first appointment and vice versa
gently stimulates sensory nerves [Figure 1]. It sends during the subsequent second appointment. Children
intermittent micro-sonic oscillations to the brain’s with a history of eventful dental experiences with
neurological pain sensors, closing the pain gate, local anesthesia injection and children with special
blocking the pain of injections and is also more useful health care needs were excluded.
for pediatric patients and those who have a phobia
of intraoral injection or pain as there is an audible Subjects were informed, and parental consent for the
distraction (70-75db) provided. Additionally, the same was obtained. Using basic behavior management
comfort tip provides gentle massaging of the injection techniques and euphemisms in the first appointment
site, through Vibra-Pulse Technology and prevents a the site of injection was isolated using cotton swab
swelling of the bolus of the anesthetic solution as it is and the topical Precaine anesthetic gel was applied
injected. This causes dissipation of the solution faster, with applicator tip for 30 s and then 2 ml of local
and causes a profound anesthetic effect and further anesthetic solution was deposited with the help of a
on application of increased pressure the device shuts 27 gauge needle (unilock, dispovan). In the second
down automatically. appointment on the opposite side of the same arch,
using tell show do technique the Dental vibe® (Dental
With this background, the present study was done Vibe Inc.) was introduced and applied to the injection
to evaluate and compare the efficacy of Dental vibe® site 1 min prior to the local anesthesia administration.
(Dental Vibe Inc.) and topical local anesthetic in The local anesthesia is administered by keeping the
split-mouth randomized clinical trial. needle as close as possible to one of the prongs and
the application of vibration continued for 10 s after the
removal of the needle as this helps in the dissipation of
Materials and Methods the local anesthetic solution.

The study was conducted by the Department of Universal pain assessment tool [Figure 2] was used
Pedodontics and Preventive Dentistry of Ragas to assess the pain for both the appointments during
Dental College and Hospital, Chennai. Thirty the administration of local anesthesia.[12,13] The patient
patients aged 6-12 years old of both the genders was asked to describe his/her pain verbally and it
with Frankel’s behavior rating scale as positive was marked according to his/her own subjective
and definitely positive requiring bilateral Local perception of pain on the universal pain rating scale
anesthesia injections for dental treatment were and the results obtained were statistically analyzed
included in the study. A  random crossover design and tabulated.
was used so that each child served as his/her
own control with 15 children in each group. The
local anesthesia was delivered using either the
Results
Table 1 shows the comparison between the pain
intensity with and without the use of dental vibe.
Mann–Whitney test shows that reported mean pain
scores were significantly lower in children who had

Figure 1: Dental vibe Figure 2: Universal pain assessment tool

174 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |
Shilpapriya, et al.: Dental vibe in pediatric dentistry

Table 1: Comparison between the pain score one sensation at a time. Therefore, the sensation that
with and without the use of dental vibe arrives at the brain first is the one that will be felt.
Hence as counter stimulation vibration reduces pain
Groups Mean Mean pain score P
age (mean ± SD) perception.[4,10]
Group I – (without vibe) (n=30) 7.5 2.73±0.87 0.001***
Group II – (with vibe) (n=30) 7.5 1.27±0.78 The utilization of this theory may be important
SD = Standard deviation; *** Statistically significant
especially in the very sensitive oral region where more
than a third of the cells in the somatosensory cortex
of the brain are devoted to sensory inputs from the
Dental vibe® (Dental Vibe Inc.) application during the mouth. In the orofacial region vibration, stimuli are
local anesthesia delivery compared to the other group easily applied and have been used to raise the pain
(P = 0.001). threshold to relieve pain of dental origin whether
pulpal, periodontal, or postsurgical.[17] Furthermore,
Discussion it has been suggested that pain reduction is greatest
in the orofacial region if the source of vibration is
The present study was undertaken to evaluate and applied not only within the area directly affected by
compare the efficacy of dental vibe with that of pain, but when the firmness of vibration application
topical local anesthetic (Precaine) in reduction of pain stimulates the underlying bone on the same side as
perception during the administration of local anesthesia the pain.[2,18-20]
injection. A split-mouth crossover design was planned
to standardize the patient pain threshold and the carry Based on this theory, several methods were developed
over effect. Further patients with Frankel’s behavior but they have been restricted to a vibrating needle or
rating scale as positive and definitely positive were only vibrating swab[21] or VibraJect®. VibraJect® enables a
included in the study to rule out the emotional factors less painful palatal injection because it delivers small
such as anxiety, previous eventful dental experiences amounts of anesthetic solution over a period.[7] They
and depression from influencing the study outcome also point out that dental vibe has improvements in
as emotional factors such as anxiety, worry, tension several structural features including vibration mode
and depression opens the pain gate thus increasing the bringing enhanced effectiveness to the method of
pain perception. using vibration in dental anesthesia injection. Keeping
these facts in mind, the present study was undertaken
In our study, topical anesthesia was chosen for and the results showed a significantly lesser pain score
comparison with the dental vibe as it is a standard (P < 0.001) in children who had dental vibe application
routine procedure followed prior to local anesthesia compared to topical anesthetic application (mean pain
administration.[11] Studies of the effectiveness of this score 1.27 ± 0.78 vs. 2.73 ± 0.87). Similar findings were
technique have had conflicting results, Minasian and observed by Blair using of VibraJect®.[20] In contrast;
Yagiela suggested that topical anesthesia might be Yoshikawa et al. found no significant pain reduction
more effective if the charged ions of an anesthetic agent when VibraJect® was applied with a conventional
were driven through the tissue by iontophoresis before dental syringe.[22] Saijo et al. found no statistically
insertion of a needle.[14] Other studies have suggested significant difference in pain perception when he
that topical anesthetics may be associated with toxic compared between VibraJect® and a conventional
sequelae because of the amounts of drug absorbed syringe in combination with anaject.[7]
through the mucosa and the relative toxicity of some
of the topical agents, Because of these problems, a However, no similar comparative studies were found
predictable means of pain control for injections is in relation to dental vibe. Hence, future studies can
desirable. Use of vibration was stated to be an effective be aimed to compare the effectiveness of Dental
alternative. The vibration might also be more effective vibe® (Dental Vibe Inc.) with similar kind of other
if it was continued during the injection or if a more devices available to reduce pain perception during the
effective vibration transfer device than the foam swab administration of local anesthesia.
were employed.[15]
Conclusion
The effects of vibration on pain have been reported in
both clinical and experimental settings. Interference Dental vibe® (Dental Vibe Inc.) is a useful accessory
stimulation such as vibration can relieve pain on device prior to the use of dental injection syringe and
the basis of the gate control theory.[13] Based on gate conventional intramuscular injections to alleviate
control theory mechanisms of pain relief induced by pain and stress of injection. From the aspect of the
vibration can be reduced by simultaneous activation patient pain management, this device contributes both
of nerve fibers that conduct nonnoxious stimuli.[15,16] physiologically (based on Gate Control Theory of pain)
When vibration is applied as a counter stimulation to and psychologically (based on the audible distraction
an anesthetic injection, it will reach the brain before of the device) and has shown to be a useful tool in
the pain sensation does. The brain can perceive only patient management.

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 | 175
Shilpapriya, et al.: Dental vibe in pediatric dentistry

References 12. Wong D, Whaley L. Clinical Handbook of Pediatric Nursing.


2nd ed. St. Louis, Mo: Mosby; 1986.
13. Dalton JA, McNaull F. A call for standardizing the clinical
1. McDonald RE, Avery DR, Dean JA, editors. Local anesthesia
rating of pain intensity using a 0 to 10 rating scale. Cancer
and pain control for the child and adolescent. In: Dentistry for
Nurs 1998;21:46-9.
the Child and Adolescent. 8th ed. St. Louis, Mo: CV Mosby
14. Minasian A, Yagiela J. Iontophuretic Application of Lidocaine
Inc.; 2004. p. 272.
with Cpinephrine for Anesthesia of the Hard Palate. Presented at
2. Lundeberg T, Abrahamsson P, Bondesson L, Haker E. Effect
the 5th International Dental Congress on Modern Pain Control,
of vibratory stimulation on experimental and clinical pain.
American Dental Society of Anesthesiology and International
Scand J Rehabil Med 1988;20:149-59.
Federation of Dental Anesthesiology Societies; 1991. p. 9-12.
3. O’Brien L, Taddio A, Lyszkiewicz DA, Koren G. A critical 15. Hutchins HS Jr, Young FA, Lackland DT, Fishburne CP. The
review of the topical local anesthetic amethocaine (Ametop) effectiveness of topical anesthesia and vibration in alleviating
for pediatric pain. Paediatr Drugs 2005;7:41-54. the pain of oral injections. Anesth Prog 1997;44:87-9.
4. Aminabadi NA, Farahani RM, Balayi Gajan E. The efficacy 16. Kakigi R, Watanabe S. Pain relief by various kinds of
of distraction and counterstimulation in the reduction of pain interference stimulation applied to the peripheral skin in
reaction to intraoral injection by pediatric patients. J Contemp humans: Pain-related brain potentials following CO2 laser
Dent Pract 2008;9:33-40. stimulation. J Peripher Nerv Syst 1996;1:189-98.
5. Touyz LZ, Lamontagne P, Smith BE. Pain and anxiety reduction 17. Melzack R, Wall PD. Pain mechanisms: A new theory. Science
using a manual stimulation distraction device when administering 1965;150:971-9.
local analgesia oro-dental injections: A multi-center clinical 18. Blair J. Vibraject from ITL dental. Dent Econ 2002;92:90.
investigation. J Clin Dent 2004;15:88-92. 19. Lundeberg T, Nordemar R, Ottoson D. Pain alleviation by
6. Ong EL, Lim NL, Koay CK. Towards a pain-free venepuncture. vibratory stimulation. Pain 1984;20:25-44.
Anaesthesia 2000;55:260-2. 20. Lundeberg T, Ottoson D, Hakansson S, Meyerson BA.
7. Saijo M, Ito E, Ichinohe T, Kaneko Y. Lack of pain reduction Vibratory stimulation for the control of intractable chronic
by a vibrating local anesthetic attachment: A pilot study. orofacial pain. Adv Pain Res Ther 1983;5:555-61.
Anesth Prog 2005;52:62-4. 21. Nanitsos E, Vartuli R, Forte A, Dennison PJ, Peck CC. The
8. Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine effect of vibration on pain during local anaesthesia injections.
administration through buffering and warming. Am J Emerg Aust Dent J 2009;54:94-100.
Med 1998;16:353-6. 22. Yoshikawa F, Ushito D, Ohe D, Shirasishi Y, Fukayama H,
9. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Umino M. Vibrating dental local anesthesia attachment to reduce
Rate of administration and buffering. Ann Emerg Med injection pain. J Jpn Dent Soc Anesthesiol 2003;31:194-5.
1998;31:36-40.
10. Aminabadi NA, Farahani RM. The effect of pre-cooling How to cite this article: Shilpapriya M, Jayanthi M, Reddy VN,
the injection site on pediatric pain perception during the Sakthivel R, Selvaraju G, Vijayakumar P. Effectiveness of new
administration of local anesthesia. J Contemp Dent Pract vibration delivery system on pain associated with injection
2009;10:43-50. of local anesthesia in children. J Indian Soc Pedod Prev Dent
11. Quarnstrom F, Libed EN. Electronic anesthesia versus topical 2015;33:173-6.
anesthesia for the control of injection pain. Quintessence Int
Source of Support: Nil, Conflicts of Interest: None declared.
1994;25:713-6.

176 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |
Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.