Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

Hindawi Pain Research and Management Volume 2017, Article ID 7941238, 6 pages https://doi.org/10.1155/2017/7941238 Research Article Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System Annelyse Garret-Bernardin,1 Tiziana Cantile,1 Vincenzo D’Antò,1 Alexandros Galanakis,1 Gabriel Fauxpoint,2 Gianmaria Fabrizio Ferrazzano,3 Sara De Rosa,1 Giulia Vallogini,1 Umberto Romeo,4 and Angela Galeotti1 1 Unit of Dentistry, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy Clinique Saint Nicolas, 55 allée Charles de Fitte, 31300 Toulouse, France 3 Department of Neuroscience, Reproductive and Oral Sciences, Section of Pediatric Dentistry, University of Naples, Federico II, Via Pansini 5, 80131 Naples, Italy 4 Department of Oral and Maxillofacial Sciences, “Sapienza” University of Rome, Via Caserta 6, 00196 Rome, Italy 2 Correspondence should be addressed to Angela Galeotti; Received 3 November 2016; Revised 27 December 2016; Accepted 23 January 2017; Published 15 February 2017 Academic Editor: Alessandro Villa Copyright © 2017 Annelyse Garret-Bernardin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe. 1. Introduction In dentistry, the injection of a local anesthetic represents the greatest source of fear and anxiety, especially in children and adolescents, because it is mainly associated with pain and discomfort [1, 2]. Furthermore, severe anxiety and fear may increase pain perception [3, 4]. Although the aim of local anesthesia is to eliminate pain during dental procedures, the fear connected to the needle puncture is frequently considered a reason for not visiting the dentist [4–6]. Grace et al., summarizing the results from other studies, reported that, in different countries (Belfast, Northern Ireland; Helsinki, Finland; Jyväskylä, Finland; Dubai, UAE; Norway; Dunedin, New Zealand; Singapore), among adolescents and young adults, dental phobics represent from 5 to 15% and 11 to 26% have high dental fear and anxiety [7–11]. Colares et al., in a cross-sectional study on 970 children between 5 and 12 years old, found a prevalence of dental fear and anxiety of 14.4% [12]. The strongest fears are associated with injections [13]. 2 Fear and anxiety-related behavior can be a significant impediment to dental care and can negatively influence the patient’s global health [5, 14]. In particular, a recent study, investigating the prevalence of clinical consequences of untreated dental caries and its relation to dental fear, showed that children with high dental fear had 2.05 times the risk of untreated caries as compared to children with low fear [15]. Untreated decayed teeth were found in 28% of five-year-olds and in 39% of eight-yearolds in England, Wales, and Northern Ireland [16, 17]. In a Brazilian study on 8- to 10-year-old schoolchildren, untreated dental caries and their clinical consequences exerted a negative impact on the quality of life [18]. Therefore, there is an urgent need to develop techniques that decrease pain during injection, preventing patients from avoiding dental treatment [19]. The devices used to make needle punctures less painful (slow injection, warmed-up local anesthetic, thin needle, and pretreatment with topical anesthetic gel) are not sufficient for certain patients, especially for noncollaborating fearful and anxious children [3]. To address this need, a computerized local anesthetic system, the Wand STA system (Milestone Scientific, Livingston, NJ), has been developed to reduce pain during injections [4, 20, 21]. The Wand STA system is made up of a computer controlled unit and a hand-piece component, allowing delivering the anesthetic solution at a constant pressure and at a slow rate, potentially below the threshold of pain [1, 22, 23]. Using a slow flow, the drops of solution can anesthetize tissues immediately ahead of the needle, resulting in an imperceptible injection [23, 24]. Furthermore, the lightweight, pen-like hand-piece allows a more controlled insertion of the needle, improving patient comfort and decreasing pain perception and, consequently, fear of injection [22]. Using this device, all local anesthesia techniques can be executed (maxillary and mandibular infiltration, mandibular block, intraligamentary, anterior middle superior alveolar injection, and even palatal approach injection that is considered the most painful) [1]. Several investigations have been conducted to evaluate the effectiveness of the Wand STA system compared to conventional local anesthesia in children. In a recent randomized controlled study on one hundred children aged 8–12 years, Mittal et al. found that pain perception was significantly higher during traditional palatal infiltration injection as compared to computerized palatal infiltration, while there was no difference in pain perception during buccal infiltration with both techniques [25]. In a clinical trial on pediatric patients, conducted by using a crossover design, San Martin-Lopez et al. showed that computerized injection device reduced pain perception compared to the traditional syringe during dental anesthetic management [26]. On the contrary, Kandiah and Tahmassebi in a prospective, randomized, parallel, controlled study on children demonstrated that pain experience was not different using the Wand or the conventional technique [27]. The reasons for these divergences (...truncated)