Effectiveness of cryotherapy, sucrose solution and a combination therapy for pain control during local anesthesia in children: a split mouth study

Background: Pain management in dentistry is inevitable without the use of local anesthesia. However, the agonizing experience of dental injections incorporates a fear of dentist in children. Therefore, the painless administration of local anesthetic agents is crucial in providing optimum dental care.

Aim: To compare the effectiveness of four different techniques in minimizing the pain during administration of local anesthesia in 7-11 years old children.

Study design: In this split mouth study design, 132 healthy and cooperative children of age 7-11 years, who needed bilateral extraction of primary molars were children were randomly allocated to four different groups: Group I (cryotherapy), Group II (30% sucrose solution), Group III (combination of cryotherapy + sucrose) and Group IV (topical anesthetic agent). The pain perception during administration of local anesthesia (IANB) was recorded before, during and after anesthesia using VAS (visual analogue scale), oxygen saturation (SpO₂) and pulse rate (PR), SEM (sound, eye, body movement) and FLACC (face, legs, activity, cry, consolability) scale.

Results: The mean difference of scores of VAS scale showed a statistically significant difference (p < 0.05) in all the groups. The FLACC and SEM scores, pulse rate (PR) and SpO₂ of Group I (popsicle) showed a statistically significant difference (p < 0.05) when compared to Group III (ice-cubes) and Group IV (topical anesthetic).

Conclusion: Pain management using a combination of cryotherapy & sweet substance in pediatric patients can be a safe and effective alternative to the conventional topical anesthetic agents in minimizing pain as the sweet taste acts a reward and offers the advantage of providing a positive dental experience for the patient.