Comparative Evaluation of Two Different Topical Anesthetic Agents against Pain Associated with Intraoral Injections in Pediatric Dental Patients

ABSTRACT

Aim:

This study aimed to examine the effectiveness of two topical anesthetics in minimizing the discomfort related to intraoral injections.

Material and Method:

For the study, 40 healthy kids between the ages of 6 and 10 were chosen. To the injection site, two topical anesthetic products were applied: lignocaine hydrochloride gel and benzocaine 20% gel. The effectiveness of the topical agents was evaluated using a four-point scale, which was previously used by Topçuoglu and colleagues to evaluate pain.

Result:

A significant difference between the lignocaine group (2.1 ± 0.5) and the benzocaine group (1.2 ± 0.6) was found on a four-point scale (P < 0.05).

Conclusion:

Benzocaine demonstrates a higher degree of efficacy in comparison with lignocaine. However, additional research is necessary to ascertain the result of this study.

INTRODUCTION

The primary objective of the pediatric dentist is to secure the child’s cooperation within the dental setting, as it is crucial for the proper completion of various pediatric operations. Administering anesthesia to young kids is typically the most challenging aspect of dental procedures. Painful local anesthetic (LA) injections are the true source of a child’s anxiety during a pediatric dental procedure.[1]

Due to its pharmacological and psychological effects, topical anesthesia plays a crucial role in the administration of local anesthesia. Topical anesthetics alter pain perception and response by inhibiting sensory nerve terminal fiber signals. Their effects only control unpleasant stimuli on or under the mucosa. A wide range of medicines is currently available for topical analgesia such as gels, sprays, ointments, and adhesive patches. Although lignocaine is often considered the usual choice, benzocaine, known for its greater surface anesthetic characteristics, was also employed in this study.[2] The aim of the present research was to examine the effectiveness of two topical anesthetics in minimizing the discomfort related to intraoral injections.

MATERIAL AND METHOD

For the study, 40 children aged 6 to 10 years who required LA were considered.

Inclusion criteria

• Healthy youngsters aged 6 to 10 years.

• Children who have had no prior dental experience.

• Children for whom parental permission was obtained.

• Children who required only Inferior alveolar nerve block (IANB) on any side for tooth extractions, pulpal therapies, or operational operations in the mandibular arch.

Exclusion criteria

• Medically compromised patient.

• Extremely anxious and fearful subjects.

• Infection at injection site.

• Patient allergic to LA solution.

Children were randomly divided into two groups with 20 children in each group requiring the need for local anesthesia before the procedure.

Group I: Children received lignocaine gel (xylocaine 2% jelly, Zydus Cadila).

Group II: Children received benzocaine gel (Precaine B gel, Pascal International).

The application of the anesthetic agent involved administering 0.5 ml into a desiccated oral mucous membrane. This was performed by exerting mild pressure and employing a circular rubbing motion for a few seconds. A cotton applicator tip or small cotton pallet was used for this purpose. Approximately one to two minutes following the application of a topical agent in a restricted area, any excess agent was removed using a gauze piece to prevent the occurrence of gag reflexes. Subsequently, a 2% lignocaine anesthetic solution (Lox*2%, Neon Laboratories Ltd.) was administered using a disposable syringe. The LA drug was administered at a rate of 1 milliliter per minute. The evaluation of the efficacy of the topical medications was conducted using a four-point scale, which had been previously employed by Topçuoglu et al.[3] to assess the level of pain experienced after injections [Figure 1].

Figure 1.

Four-point scale

Statistical analysis

Statistical Package for the Social Sciences (SPSS) version 22 evaluated data with a P-value of 0.05 defined as significant. To evaluate significance, the independent-samples t-test compares two group means.

RESULT

The study covers 40 children, 20 boys and 20 girls (50%) each. There were no statistically significant differences between research groups in baseline factors including age and participant distribution [Table 1]. Table 2 shows the significant difference between the lignocaine group (2.1 ± 0.5) and the benzocaine group (1.2 ± 0.6) on a four-point scale.

Table 1.

Demographic data of the study population

Parameters	Group I	Group II	P
Girls	11	9	>0.05
Boys	9	11	>0.05
Mean age	7.50±0.45	7.00±0.50	>0.05

Table 2.

Intergroup evaluation of mean pain score

Groups	Mean pain score	P
Group I	2.1±0.5	< 0.05*
Group II	1.2±0.6

DISCUSSION

The most unpleasant component of pediatric dentistry is pain, which can significantly impair a child’s cooperation in the dental office. The patient can have the most comfort and happiness by minimizing the pain related to LA administration.[4]

The main LAs currently used in ordinary clinical practice can be split into two categories: those with an amide connection, such as lignocaine and dibucaine, and those with an ester linkage, such as benzocaine. Lignocaine and benzocaine continue to be the most often utilized topical anesthetics by dental professionals, despite the availability of numerous novel formulations of topical anesthetic for intraoral purposes.[5]

The primary aim of the present investigation was to assess the efficacy of 2% lignocaine and 20% benzocaine as topical anesthetics in a cohort of 40 children aged 6 to 10 years. Before the administration of the nerve block, a topical anesthetic was employed. The treatment was standardized by including solely the mandibular arch and consequently administering the inferior alveolar nerve block. This study found a substantial difference in the mean pain scores between groups A and B.

In the present investigation, a four-point scale was utilized to assess the pain score. The scale in question is characterized by its simplicity and ease of comprehension and demonstrated positive association. Pain assessment in both pediatric and adult populations has been examined in multiple research investigations.[3]

In the conducted investigation, it was observed that the use of a 20% benzocaine solution yielded more favorable outcomes compared with the utilization of a 2% lignocaine solution in terms of pain reduction during the delivery of an LA agent. The findings of our investigation align with the results obtained from a study conducted by Nair M and Gurunathan[6] and Patel D et al.[2]

Both lignocaine and benzocaine were found to be more effective than a placebo in alleviating pain associated with needle insertion into the palate, as documented in a study by Rosa et al.[7] Kreider et al.[8] found that, compared to topical benzocaine administration, the use of a lignocaine patch significantly reduced verbal reports of injection pain.

DiMarco and Wetmore[9] tested a fast-acting refrigerant topical with 20% benzocaine in a split-mouth study. They observed that both agents had similar advantages, although the refrigerant worked faster. In the study conducted by Vongsavan and Vongsavan,[10] it was observed that the application of a 20% benzocaine gel resulted in a more significant reduction in pain experienced during palatal injections compared with the administration of a placebo.

Limitation

Regarding the limitations of the study, a notable concern pertains to the very limited sample size. Self-reported measurement scales of pain intensity and anxiety are also the limiting factors associated with the potential bias.

CONCLUSION

The present investigation provides evidence supporting the efficacy of topical anesthetics in mitigating the discomfort associated with needle penetration in the mucosal tissue. Benzocaine demonstrates a higher level of efficacy in comparison with lignocaine. However, additional research is necessary to ascertain the result of the present study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.