|Year : 2015 | Volume
| Issue : 3 | Page : 173-176
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
|Date of Web Publication||9-Jul-2015|
Dr. Mungara Jayanthi
Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai - 600 119, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: Pain is highly subjective and it is neurologically proven that stimulation of larger diameter fibers - e.g., using appropriate coldness, warmth, rubbing, pressure or vibration - can close the neural "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 carried out to investigate the effects of vibration stimuli on pain experienced during local anesthetic injections. Materials and Methods: Thirty patients aged 6-12 years old of both the genders with Frankel's behavior rating scale as positive and 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 and without vibration during the administration of local anesthesia and the results obtained were tabulated and statistically analyzed. Results: Local anesthetic administration with vibration resulted in significantly less pain (P = 0.001) compared to the injections without the use of vibe. Conclusion: The results suggest that vibration can be used as an effective method to decrease pain during dental local anesthetic administration.
Keywords: Dental vibe, gate control theory, local anesthesia, pain
|How to cite this article:|
Shilpapriya M, Jayanthi M, Reddy VN, Sakthivel R, Selvaraju G, Vijayakumar P. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children. J Indian Soc Pedod Prev Dent 2015;33:173-6
|How to cite this URL:|
Shilpapriya M, Jayanthi M, Reddy VN, Sakthivel R, Selvaraju G, Vijayakumar P. Effectiveness of new vibration delivery system on pain associated with injection of local anesthesia in children. J Indian Soc Pedod Prev Dent [serial online] 2015 [cited 2021 Mar 3];33:173-6. Available from: https://www.jisppd.com/text.asp?2015/33/3/173/160343
| Introduction|| |
Pain is a complex and multidimensional construct that involves sensory, emotional, and cognitive processes. One of the most important aspects of child behavior guidance is the control of pain.  Effective pain control in children during regional dental injections is important to achieve comfort, cooperation, and compliance with dental care. The pain induced by injection of local anesthetic agents can be reduced in a number of complementary methods which include application of topical analgesics, , distraction techniques, ,, application of counter irritation,  varying the rates of infiltration, buffering and warming the local anesthesia,  reduced speed of injection,  use of fine needles with improved syringes, precooling the injection site  and use of vibration have been reported in many studies, but no conclusive painless injection method has been established.
Topical application of local anesthesia is the most common means used to control the pain of local anesthesia injections. Topical anesthetics may be associated with toxic sequel because of the amounts of drug absorbed through the mucosa and the relative toxicity of some of the topical agents.  Further, the taste associated with the gels and sprays can make the child uncomfortable. The dissolution of the agent with the saliva was also observed which can further reduce the effectiveness of the agent at the site. Because of these problems, a predictable means of pain control for injections is desirable.
Vibratory stimulation is one of the several nonpharmacological techniques used to reduce pain. Previously, vibration was applied using a hand-held massager/a vibrating cotton swab. As the vibration of the hand-held massager cannot be monitored throughout, there may be variations in frequency and pressure applied from subject to subject over time. Recently, the Dental vibe ® (Dental Vibe Inc.) was introduced into dentistry by Dr. Steven Goldberg, which delivers vibration in a sustained frequency as a counter stimulation on to the site of injection thereby alleviating pain.
It is a cordless, rechargeable, hand-held device that delivers soothing, pulsed, percussive micro-oscillations to the site where an injection is being administered and gently stimulates sensory nerves [Figure 1]. It sends intermittent micro-sonic oscillations to the brain's neurological pain sensors, closing the pain gate, blocking the pain of injections and is also more useful for pediatric patients and those who have a phobia of intraoral injection or pain as there is an audible distraction (70-75db) provided. Additionally, the comfort tip provides gentle massaging of the injection site, through Vibra-Pulse Technology and prevents a swelling of the bolus of the anesthetic solution as it is injected. This causes dissipation of the solution faster, and causes a profound anesthetic effect and further on application of increased pressure the device shuts down automatically.
With this background, the present study was done to evaluate and compare the efficacy of Dental vibe ® (Dental Vibe Inc.) and topical local anesthetic in split-mouth randomized clinical trial.
| Materials and Methods|| |
The study was conducted by the Department of Pedodontics and Preventive Dentistry of Ragas Dental College and Hospital, Chennai. Thirty patients aged 6-12 years old of both the genders with Frankel's behavior rating scale as positive and definitely positive requiring bilateral Local anesthesia injections for dental treatment were included in the study. A random crossover design 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 dental vibe or the topical anesthesia. The children requiring at least two clinical sessions of operative procedures preceded by a local anesthetic injection, one on either side of the same jaw were included in the study. Fifteen children received Precaine Gel (Pascal International™ ) (containing 8% lignocaine and 0.8% dibucaine) topical anesthetic gel prior to administration of local anesthesia injection, whereas the remaining 15 received Dental vibe ® (Dental Vibe Inc.) during the first appointment and vice versa during the subsequent second appointment. Children with a history of eventful dental experiences with local anesthesia injection and children with special health care needs were excluded.
Subjects were informed, and parental consent for the same was obtained. Using basic behavior management techniques and euphemisms in the first appointment the site of injection was isolated using cotton swab and the topical Precaine anesthetic gel was applied with applicator tip for 30 s and then 2 ml of local anesthetic solution was deposited with the help of a 27 gauge needle (unilock, dispovan). In the second appointment on the opposite side of the same arch, using tell show do technique the Dental vibe ® (Dental Vibe Inc.) was introduced and applied to the injection site 1 min prior to the local anesthesia administration. The local anesthesia is administered by keeping the 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 the local anesthetic solution.3
Universal pain assessment tool [Figure 2] was used to assess the pain for both the appointments during the administration of local anesthesia. , The patient was asked to describe his/her pain verbally and it was marked according to his/her own subjective perception of pain on the universal pain rating scale and the results obtained were statistically analyzed and tabulated.
| 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 Dental vibe ® (Dental Vibe Inc.) application during the local anesthesia delivery compared to the other group (P = 0.001).
|Table 1: Comparison between the pain score with and without the use of dental vibe|
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| Discussion|| |
The present study was undertaken to evaluate and compare the efficacy of dental vibe with that of topical local anesthetic (Precaine) in reduction of pain perception during the administration of local anesthesia injection. A split-mouth crossover design was planned to standardize the patient pain threshold and the carry over effect. Further patients with Frankel's behavior rating scale as positive and definitely positive were only included in the study to rule out the emotional factors such as anxiety, previous eventful dental experiences and depression from influencing the study outcome as emotional factors such as anxiety, worry, tension and depression opens the pain gate thus increasing the pain perception.
In our study, topical anesthesia was chosen for comparison with the dental vibe as it is a standard routine procedure followed prior to local anesthesia administration.  Studies of the effectiveness of this technique have had conflicting results, Minasian and Yagiela suggested that topical anesthesia might be more effective if the charged ions of an anesthetic agent were driven through the tissue by iontophoresis before insertion of a needle.  Other studies have suggested that topical anesthetics may be associated with toxic sequelae because of the amounts of drug absorbed through the mucosa and the relative toxicity of some of the topical agents, Because of these problems, a predictable means of pain control for injections is desirable. Use of vibration was stated to be an effective alternative. The vibration might also be more effective if it was continued during the injection or if a more effective vibration transfer device than the foam swab were employed. 
The effects of vibration on pain have been reported in both clinical and experimental settings. Interference stimulation such as vibration can relieve pain on the basis of the gate control theory.  Based on gate control theory mechanisms of pain relief induced by vibration can be reduced by simultaneous activation of nerve fibers that conduct nonnoxious stimuli. , When vibration is applied as a counter stimulation to an anesthetic injection, it will reach the brain before the pain sensation does. The brain can perceive only one sensation at a time. Therefore, the sensation that arrives at the brain first is the one that will be felt. Hence as counter stimulation vibration reduces pain perception. ,
The utilization of this theory may be important 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 mouth. In the orofacial region vibration, stimuli are easily applied and have been used to raise the pain threshold to relieve pain of dental origin whether pulpal, periodontal, or postsurgical.  Furthermore, it has been suggested that pain reduction is greatest in the orofacial region if the source of vibration is applied not only within the area directly affected by pain, but when the firmness of vibration application stimulates the underlying bone on the same side as the pain. ,,,
Based on this theory, several methods were developed but they have been restricted to a vibrating needle or vibrating swab  or VibraJect ® . VibraJect ® enables a less painful palatal injection because it delivers small amounts of anesthetic solution over a period.  They also point out that dental vibe has improvements in several structural features including vibration mode bringing enhanced effectiveness to the method of using vibration in dental anesthesia injection. Keeping these facts in mind, the present study was undertaken and the results showed a significantly lesser pain score (P < 0.001) in children who had dental vibe application compared to topical anesthetic application (mean pain score 1.27 ± 0.78 vs. 2.73 ± 0.87). Similar findings were observed by Blair using of VibraJect ® .  In contrast; Yoshikawa et al. found no significant pain reduction when VibraJect ® was applied with a conventional dental syringe.  Saijo et al. found no statistically significant difference in pain perception when he compared between VibraJect ® and a conventional syringe in combination with anaject. 
However, no similar comparative studies were found in relation to dental vibe. Hence, future studies can be aimed to compare the effectiveness of Dental vibe ® (Dental Vibe Inc.) with similar kind of other devices available to reduce pain perception during the administration of local anesthesia.
| Conclusion|| |
Dental vibe ® (Dental Vibe Inc.) is a useful accessory device prior to the use of dental injection syringe and conventional intramuscular injections to alleviate pain and stress of injection. From the aspect of the patient pain management, this device contributes both physiologically (based on Gate Control Theory of pain) and psychologically (based on the audible distraction of the device) and has shown to be a useful tool in patient management.
| References|| |
McDonald RE, Avery DR, Dean JA, editors. Local anesthesia and pain control for the child and adolescent. In: Dentistry for the Child and Adolescent. 8 th
ed. St. Louis, Mo: CV Mosby Inc.; 2004. p. 272.
Lundeberg T, Abrahamsson P, Bondesson L, Haker E. Effect of vibratory stimulation on experimental and clinical pain. Scand J Rehabil Med 1988;20:149-59.
O′Brien L, Taddio A, Lyszkiewicz DA, Koren G. A critical review of the topical local anesthetic amethocaine (Ametop) for pediatric pain. Paediatr Drugs 2005;7:41-54.
Aminabadi NA, Farahani RM, Balayi Gajan E. The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients. J Contemp Dent Pract 2008;9:33-40.
Touyz LZ, Lamontagne P, Smith BE. Pain and anxiety reduction using a manual stimulation distraction device when administering local analgesia oro-dental injections: A multi-center clinical investigation. J Clin Dent 2004;15:88-92.
Ong EL, Lim NL, Koay CK. Towards a pain-free venepuncture. Anaesthesia 2000;55:260-2.
Saijo M, Ito E, Ichinohe T, Kaneko Y. Lack of pain reduction by a vibrating local anesthetic attachment: A pilot study. Anesth Prog 2005;52:62-4.
Colaric KB, Overton DT, Moore K. Pain reduction in lidocaine administration through buffering and warming. Am J Emerg Med 1998;16:353-6.
Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med 1998;31:36-40.
Aminabadi NA, Farahani RM. The effect of pre-cooling the injection site on pediatric pain perception during the administration of local anesthesia. J Contemp Dent Pract 2009;10:43-50.
Quarnstrom F, Libed EN. Electronic anesthesia versus topical anesthesia for the control of injection pain. Quintessence Int 1994;25:713-6.
Wong D, Whaley L. Clinical Handbook of Pediatric Nursing. 2 nd
ed. St. Louis, Mo: Mosby; 1986.
Dalton JA, McNaull F. A call for standardizing the clinical rating of pain intensity using a 0 to 10 rating scale. Cancer Nurs 1998;21:46-9.
Minasian A, Yagiela J. Iontophuretic Application of Lidocaine with Cpinephrine for Anesthesia of the Hard Palate. Presented at the 5 th
International Dental Congress on Modern Pain Control, American Dental Society of Anesthesiology and International Federation of Dental Anesthesiology Societies; 1991. p. 9-12.
Hutchins HS Jr, Young FA, Lackland DT, Fishburne CP. The effectiveness of topical anesthesia and vibration in alleviating the pain of oral injections. Anesth Prog 1997;44:87-9.
Kakigi R, Watanabe S. Pain relief by various kinds of interference stimulation applied to the peripheral skin in humans: Pain-related brain potentials following CO2 laser stimulation. J Peripher Nerv Syst 1996;1:189-98.
Melzack R, Wall PD. Pain mechanisms: A new theory. Science 1965;150:971-9.
Blair J. Vibraject from ITL dental. Dent Econ 2002;92:90.
Lundeberg T, Nordemar R, Ottoson D. Pain alleviation by vibratory stimulation. Pain 1984;20:25-44.
Lundeberg T, Ottoson D, Hakansson S, Meyerson BA. Vibratory stimulation for the control of intractable chronic orofacial pain. Adv Pain Res Ther 1983;5:555-61.
Nanitsos E, Vartuli R, Forte A, Dennison PJ, Peck CC. The effect of vibration on pain during local anaesthesia injections. Aust Dent J 2009;54:94-100.
Yoshikawa F, Ushito D, Ohe D, Shirasishi Y, Fukayama H, Umino M. Vibrating dental local anesthesia attachment to reduce injection pain. J Jpn Dent Soc Anesthesiol 2003;31:194-5.
[Figure 1], [Figure 2]