Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

IN BRIEF • The Wand technique seems to be of RESEARCH Pain perception during inferior alveolar injection administered with the Wand or conventional syringe benefit during inferior alveolar injection of patients with low dental anxiety. • Most of the patients preferred inferior alveolar injection with the Wand than with conventional syringe for future dental injections. • The Wand technique not only lowers the pain of injection, but also eliminates the visual stimulus of dental syringes for patients with low dental anxiety. C. Yesilyurt,1 G. Bulut2 and T. Taşdemir3 VERIFIABLE CPD PAPER Objective This study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection. Methods and materials The subjects were 40 patients between the ages of 18 and 30 years requiring local anaesthesia for dental restoration in the mandible. Before anaesthetic administration, the patients’ anxiety levels were determined. Contralateral IAN injections were administrated at two separate appointments with random use of either the Wand or a conventional syringe. Following the injection, the patients used both the pain rating score (PRS) and a visual analogue scale (VAS) to assess the intensity of pain. Results When pain was measured after the injection, the Wand was found to be less painful than the syringe for the pain of both needle insertion and injection (p <0.05). Conclusion The Wand technique resulted in significantly lower pain scores during the IAN block injections. Most of the patients preferred the IAN injection with the Wand for future dental injections. INTRODUCTION Local anaesthesia is used most widely for delivering dental care1 and although anaesthesia is necessary for a painless dental procedure, patients sometimes fi nd the needle puncturing the mucosa or the delivery of local anaesthetic solutions to be painful or uncomfortable.2 Fear and anxiety associated with local anaesthesia injection can be a major impediment to dental care because it frequently causes patients to delay or even avoid treatment.3 To minimise the pain on injection, the use of topical anaesthesia, low-pressure injection,4 narrow sharp needles,5 a slow injection rate6 and solutions that are warmed7 and buffered8 have been suggested. Nevertheless, 1* Assistant Professor, 2Research Assistant, Department of Operative Dentistry, Faculty of Dentistry, Karadeniz Technical University, 61080 Trabzon, Turkey; 3Assistant Professor, Department of Endodontics, Faculty of Dentistry, Karadeniz Technical University, 61080 Trabzon, Turkey *Correspondence to: Dr Cemal Yesilyurt Email: Online article number E10 Refereed Paper - accepted 29 May 2008 DOI: 10.1038/sj.bdj.2008.757 © British Dental Journal 2008; E10 a totally painless injection is impossible to achieve under all circumstances. A computerised injection device (the Wand) was developed as an alternative to the conventional syringe to alleviate pain and anxiety during intraoral injections. According to the manufacturer, the device is a computer-controlled system that maintains constant pressure and volume ratios, delivering local anaesthetic solutions at a constant rate regardless of tissue resistance. It is claimed that when advanced slowly, the drops of solution anaesthetise the tissue ahead of the needle, thereby resulting in a virtually painless needle insertion. In addition, the rate and aspiration cycle are both activated using a foot control.9 It is claimed that new computerised injection devices reduce pain and discomfort during intraoral injections. An earlier study found that dentists were very satisfied with the effectiveness and performance of a prototype computer-controlled dental local anaesthetic system and patients were satisfied with both the level of comfort with anaesthetic delivery and the effectiveness of the anaesthesia itself.10 Some studies showed a reduction in the pain of injection when using the Wand compared to conventional injection.11,12 However, another study showed no advantages of using a computerised injection unit and that conventional methods of anaesthetic delivery, when well performed, were superior.13 The differences between these results may be related to several factors, such as the patients’ anxiety levels, injection technique, and tactile skill in syringe injections.11 Low-pressure, slow-delivery apparatus, such as the Wand, should be evaluated as a possible means of alleviating the perceived pain on injection. Therefore, this study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection. METHODS AND MATERIALS Forty adult patients scheduled for routine dental restorative treatment participated in this study. The participants were in good general health and were not taking any medication (eg alcohol or any analgesic medication) that would alter pain perception. Pregnant females BRITISH DENTAL JOURNAL 1 © 2008 Macmillan Publishers Limited. All rights reserved. RESEARCH were not eligible for the study. Nineteen women and 21 men, ranging in age from 18 to 30 years, were enrolled. All patients were selected based on their need for restorative dentistry in the right and left mandible requiring local anaesthesia. The Karadeniz Technical University (Trabzon, Turkey) Human Subjects Review committee approved the study, and written informed consent was obtained from each subject. After completing the medical history and consent form, the dental anxiety of the participants was measured using Corah’s Dental Anxiety Scale (DAS).14 Pre-operatively, all of the subjects were asked to complete the questionnaire to rate their anxiety levels. A score of 4 corresponded to the least anxiety and 20 indicated the most. The basic DAS scale of each group was used with the aim of determining the patients with minimal anxiety. DAS scores of all the patients participating in the study were 12 or lower. The patients whose DAS scores were over 12 excluded from the study. The anaesthetic agent was 1.7 ml of 4% articaine (68 mg) with 1:100,000 epinephrine (17 µg) (Ultracaine D-S forte; Aventis Pharma San. ve Tic, Istanbul, Turkey). Before any injections were given, 10% lidocaine (Xylocaine; AstraZeneca, Lund, Sweden) topical anaesthetic spray on a cotton applicator was applied to the injection area under both techniques. The 40 subjects randomly received contralateral inferior alveolar nerve (IAN) block injections at two separate appointments spaced at most five days apart. The subjects received IAN block injections of articaine with epinephrine using the Wand Plus® local anaesthesia system with a 27 gauge/0.4 mm diameter needle (The Wand, Tudor Health Care Ltd., Nottingham, UK) at one appointment and the same amount of articaine with epinephrine, using a conventional syringe with a 27 gauge/0.4 mm diameter n (...truncated)