Article Data

  • Views 1822
  • Dowloads 481

Original Research

Open Access

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

  • Nikita Dhingra1,*,
  • Shivani Mathur1
  • Manvi Malik1

1Department of Pediatric and preventive Dentistry ITS-CDSR, Muradnagar, Ghaziabad, India

DOI: 10.22514/jocpd.2022.018 Vol.46,Issue 6,November 2022 pp.1-5

Published: 01 November 2022

*Corresponding Author(s): Nikita Dhingra E-mail:


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.


Pain; Cryotherapy; Sucrose; Anesthesia

Cite and Share

Nikita Dhingra,Shivani Mathur,Manvi Malik. Effectiveness of cryotherapy, sucrose solution and a combination therapy for pain control during local anesthesia in children: a split mouth study. Journal of Clinical Pediatric Dentistry. 2022. 46(6);1-5.


1. Kumari K, Kaur G, Arora SS, Pandher PK, Singh R, Bhat RA. To compare the effect of ice and the lignocaine gel in reducing pain of needle prick before palatal nerve block. Oral Surgery. 2021; 14: 23–28.

2. Kumar A, Narang GS, Singh G, Kaur J. Comparison of the effectiveness of oral sucrose solution and topical anaesthetics during immunization in infants between age 6 weeks-6 months. International Journal of Contemporary Pediatrics. 2019; 6: 1008–1013.

3. Taddio A, Chambers C, Halperin S, Ipp M, Lockett D, Rieder MJ, et al. Inadequate pain management during childhood immunization: the nerve of it. Clinical Therapeutics. 2009; 31: S152–67.

4. Song J, Kim H, Park E, Ahn JH, Yoon E, Lampotang S, Gravenstein N, Choi S. Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial. Emergency Medicine Journal. 2018; 35: 103–107.

5. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews. 2016; 7: CD001069.

6. Gümüş H, Aydinbelge M. Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial. Clinical Oral Investigations. 2020; 24: 2315–2319.

7. Leff DR, Nortley M, Dang V, and Bhutiani RP. The effect of local cooling on pain perception during infiltration of local anesthetic agents, a prospective randomized controlled trial. Anesthesia. 2007; 62: 677–682.

8. Ghaderi F, Banakar S, Rostami S. Effect of pre-cooling injection site on pain perception in pediatric dentistry: “A randomized clinical trial”. Dental Research Journal. 2013; 10: 790–794.

9. Sabu J, Anantharaj A, Ramakrishna S, Jagdeesh R, Praveen P, Shankarappa P. A comparative evaluation of pain perception following topical application of benzocaine gel, clove-papaya based anesthetic gel and precooling of the injection site before intraoral injections in children. Journal of Indian Society of Pedodontics and Preventive Dentistry. 2020; 38: 184.

10. Shehab LA, Basheer B, Baroudi K. Effectiveness of lidocaine Denti patch® system versus lidocaine gel as topical anesthetic agent in children. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2015; 33: 285–290.

11. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965; 150: 971–979.

12. Kakigi R, Shibasaki H. Mechanisms of pain relief by vibration and movement. Journal of Neurology, Neurosurgery & Psychiatry. 1992; 55: 282–286.

13. Nahra H, Plaghki L. Innocuous skin cooling modulates perception and neurophysiological correlates of brief CO_2 laser stimuli in humans. European Journal of Pain. 2005; 9: 521–521.

14. H. Merskey, D. Albe-Fessard, and J. Bonica, Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain. 1979; 6: 249.

15. McNair C, Campbell Yeo M, Johnston C, Taddio A. Nonpharmaco-logical management of pain during common needle puncture procedures in infants. Clinics in Perinatology. 2013; 40: 493–508.

16. Rn PMK, Rn KMV, Rn AKP. Children’s postoperative pain at home: family interview study. International Journal of Nursing Practice. 2002; 8: 32–41.

17. Ram D, Peretz B. Assessment of the pain reaction of children receiving periodontal ligament local anesthesia using a computerized device (Wand). The Journal of Clinical Pediatric Dentistry. 2003; 27; 247–250.

18. Yilmaz G, Caylan N, Oguz M, Karacan CD. Oral sucrose administration to reduce pain response during immunization in 16–19-month infants: a randomized, placebo-controlled trial. European Journal of Pediatrics. 2014; 173: 1527–1532.

19. Ghaderi F, Ahmadbeigi M, Vossoughi M, Sardarian A. The efficacy of administrating a sweet-tasting solution for reducing the pain related to dental injections in children: a randomized controlled trial. International Journal of Paediatric Dentistry. 2021; 31: 184–190.

20. Kakeda T, Ogino Y, Moriya F, Saito S. Sweet taste-induced analgesia: an fMRI study. NeuroReport. 2010; 21: 427–431.

21. Aminabadi NA, Farahani RMZ. The effect of pre-cooling the injection site on pediatric pain perception during the administration of local anesthesia. The Journal of Contemporary Dental Practice. 2009; 10: 43–50.

22. Mahshidfar B, Shevi SC, Abbasi M, Kasnavieh MH, Rezai M, Zavereh M, et al. Ice reduces needle-stick pain associated with local anesthetic injection. Anesthesiology and Pain Medicine. 2016; 6: e38293.

23. Hindocha N, Manhem F, Bäckryd E, Bågesund M. Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa—a randomized cross-over study. BMC Anesthesiology. 2019; 19: 227.

24. Havale R, Rao DG, S P S, M Tuppadmath K, Tharay N, Mathew I, et al. Comparative evaluation of pain perception following topical application of clove oil, betel leaf extract, lignocaine gel, and ice prior to intraoral injection in children aged 6–10 years: a randomized control study. Journal of Dental Anesthesia and Pain Medicine. 2021; 21: 329–336.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time