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Original Research

Open Access

The effect of a needle-free injection system on dental injection pain in children: a randomised cross-over clinical trial

  • Figen Eren1,*,
  • Mehmet Sertac Peker1
  • Gulnaz Nural Bekiroglu2
  • Emrah Gokay Ozgur2
  • Betul Kargul1,3

1Department of Pediatric Dentistry, School of Dentistry, Marmara University, 34854 Istanbul, Turkey

2Department of Biostatistics, School of Medicine, Marmara University, 34854 Istanbul, Turkey

3Queen Mary University of London, N7 8DB London, UK

DOI: 10.22514/jocpd.2025.083 Vol.49,Issue 4,July 2025 pp.128-139

Submitted: 13 August 2024 Accepted: 25 October 2024

Published: 03 July 2025

*Corresponding Author(s): Figen Eren E-mail: figen.eren@marmara.edu.tr

Abstract

Background: This study aimed to compare pain perception and behavioral responses in pediatric patients during dental injections using needle-free (NF) or traditional injection methods (TMs) over two consecutive dental visits. Methods: This randomized, clinical crossover study involved 28 children aged 6 to 12 years who exhibited positive or absolute positive behavior according to the Frankl Behavior Scale and required dental anesthesia for bilateral operative procedures on their primary maxillary molars. The children were randomly assigned to receive both the NF and TM injections, for a total of 56 injections. Patients who underwent filling or pulpotomy treatment on a primary maxillary molar received anesthesia with both techniques at a one-week interval. At each visit and after the administration of anesthesia, the patients’ pain levels were assessed using the Wong-Baker Faces Pain Rating Scale (Wong-Baker) and the Face, Legs, Activity, Cry, Consolability scale. The data were recorded, and statistical analyses were performed using paired t-tests or Wilcoxon nonparametric tests and Chi-square tests. Statistical significance was defined as a p ≤ 0.05. Results: There was no significant difference between the NF system and the TM according to the Wong-Baker scores. However, there were significant differences in the amount of anesthetic solution and duration of the analgesic effect between the first and second visits for both injection methods, respectively (p = 0.003 for NF-TM and p < 0.0001 for the TM-NF groups). Conclusions: In this study, the NF system and the TM exhibited similar results when evaluated using different pain scales. However, the NF injection system may be a promising approach when working with uncooperative children. Clinical Trial Registration: ClinicalTrials.gov PRS ID: NCT06541925.


Keywords

Children; Comfort-in system; Needle injection; Needle-free injection; Pain


Cite and Share

Figen Eren,Mehmet Sertac Peker,Gulnaz Nural Bekiroglu,Emrah Gokay Ozgur,Betul Kargul. The effect of a needle-free injection system on dental injection pain in children: a randomised cross-over clinical trial. Journal of Clinical Pediatric Dentistry. 2025. 49(4);128-139.

References

[1] McDonald RE, Avery DR, Dean JA. Local anesthesia and pain control for the child and adolescent. In McDonald RE, Avery DR, Dean JA (eds.) Dentistry for the child and adolescent (pp. 272). 8th edn. CV Mosby Inc.: St. Louis, MO. 2004.

[2] Bahl R. Local anesthesia in dentistry. Anesthesia Progress. 2004; 51: 138–142.

[3] Lee SH, Lee NY. An alternative local anaesthesia technique to reduce pain in paediatric patients during needle insertion. European Journal of Paediatric Dentistry. 2013; 14: 109–112.

[4] Thoppe-Dhamodhara YK, Asokan S, John BJ, Pollachi-Ramakrishnan G, Ramachandran P, Vilvanathan P. Cartridge syringe vs computer controlled local anesthetic delivery system: pain related behaviour over two sequential visits—a randomized controlled trial. Journal of Clinical and Experimental Dentistry. 2015; 7: 513–518.

[5] Meechan JG. Effective topical anesthetic agents and techniques. Dental Clinics of North America. 2002; 46: 759–766.

[6] Amrollahi N, Rastghalam N, Faghihian R. Effect of pre-cooling on pain associated with dental injections in children: a systematic review. The Journal of Evidence-Based Dental Practice. 2021; 21: 101588.

[7] Kravitz J. The palatal press and roll anesthesia technique. Practical Procedures & Aesthetic Dentistry. 2006; 18: 242, 244–245.

[8] Uçar G, Şermet Elbay Ü, Elbay M. Effects of low level laser therapy on injection pain and anesthesia efficacy during local anesthesia in children: a randomized clinical trial. International Journal of Paediatric Dentistry. 2022; 32: 576–584.

[9] Valiulla MUE, Halli R, Khandelwal S, Mittal A, Singh A, Bhindora K. Efficacy of sodium bicarbonate-buffered local anesthetic oslution in cases requiring bilateral maxillary premolar orthodontic extraction: a comparative split-mouth study. Cureus. 2023; 15: e37934.

[10] Taddio A, Ho T, Vyas C, Thivakaran S, Jamal A, Ilersich AF, et al. A randomized controlled trial of clinician-led tactile stimulation to reduce pain during vaccination in infants. Clinical Pediatrics. 2014; 53: 639–644.

[11] Felemban OM, Alshamrani RM, Aljeddawi DH, Bagher SM. Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial. BMC Oral Health. 2021; 21: 321.

[12] Mittal M, Kumar A, Srivastava D, Sharma P, Sharma S. Pain perception: computerized versus traditional local anesthesia in pediatric patients. Journal of Clinical Pediatric Dentistry. 2015; 39: 470–474.

[13] Albouni MA, Kouchaji C, Al-Akkad M, Voborna I, Mounajjed R. Evaluation of the injection pain with the use of vibraject during local anesthesia injection for children: a randomized clinical trial. The Journal of Contemporary Dental Practice. 2022; 23: 749–754.

[14] Felemban, AR Oghli, II Alsaati, LK Alattas, AM Olwi, SM Bagher. The effect of DentalVibe on pain and discomfort during local anesthesia in children: a randomized clinical trial. Quintessence International. 2021; 52: 434–443.

[15] Pushpasanthy M, Ephraim R, Ayilliath A, Dhanya KB. Effectiveness of Aculief acupressure device on pain perception during local anesthesia in children: a double‑blinded study. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2023; 41: 309–315.

[16] Prabhakar AR, Marwah N, Raju OS. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients. Journal of the Indian Society of Pedodontics and Preventive Dentistry. 2007; 25: 177–182.

[17] Melwani AM, Srinivasan I, Setty JV, D R MK, Pamnani SS, Lalitya D. A clinical comparative study between conventional and camouflaged syringes to evaluate behavior and anxiety in 6–11-year-old children during local anesthesia administration-a novel approach. Journal of Dental Anesthasia and Pain Medicine. 2018; 18: 35–40.

[18] Porritt J, Marshman Z, Rodd HD. Understanding children’s dental anxiety and psychological approaches to its reduction. International Journal of Paediatric Dentistry. 2012; 22: 397–405.

[19] MK global. No needle for soft injection. Your best solution, Comfort-in™ needle free & easy-quick injection system. 2017. Available at: http://www.comfort-in.com/html/download/Catalogue2017.pdf (Accessed: 22 January 2017).

[20] Altan H, Belevcikli M, Coşgun A, Demir O. Comparative evaluation of pain perception with a new needle-free system and dental needle method in children: a randomized clinical trial. BMC Anesthesiology. 2021; 21: 301.

[21] Yilmaz N, Baygin O, Tüzüner T, Menteşe A, Demir S. Determination of the effect of two different methods of dental anesthesia on pain level in pediatric patients: a cross-over, randomized trial. Nigerian Journal of Clinical Practice. 2022; 25: 1853–1863.

[22] Belevcikli M, Altan H, Demir O. Effect of the new needle-free injection system on pain perception and dental anxiety during anesthesia: randomized controlled split-mouth study. Journal of Dental Anesthesia and Pain Medicine. 2023; 23: 1–8.

[23] Kaya E, Yıldırım S. Effect of a needle-free system versus traditional anesthesia on pain perception during palatal injections in children. International Journal of Paediatric Dentistry. 2023; 33: 132–140.

[24] Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Journal of Pharmacology & Pharmacotherapeutics. 2010; 1: 100–107.

[25] Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatric Nursing. 1988; 14: 9–17.

[26] Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nursing. 1997; 23: 293–297.

[27] Klingberg G, Broberg A. Temperament and child dental fear. Pediatric Dentistry. 1998; 20: 237–243.

[28] O’Rourke D. The measurement of pain in infants, children, and adolescents: from policy to practice. Physical Therapy. 2004; 84: 560–570.

[29] Yıldırım S, Tokuç M, Aydın MN. The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial. Clinical Oral Investigation. 2020; 24: 4355–4361.

[30] Garra G, Singer AJ, Taira BR, Chohan J, Cardoz H, Chisena E, et al. Validation of the Wong-Baker FACES Pain Rating Scale in pediatric emergency department patients. Academic Emergency Medicine. 2010; 17: 50–54.

[31] Shields BJ, Cohen DM, Harbeck-Weber C, Powers JD, Smith GA. Pediatric pain measurement using a visual analogue scale: a comparison of two teaching methods. Clinical Pediatrics. 2003; 42: 227–234.

[32] Crellin DJ, Harrison D, Santamaria N, Huque H, Babl FE. The Psychometric properties of the FLACC scale used to assess procedural pain. The Journal of Pain. 2018; 19: 862–872.

[33] Nogueira APA, Ferreira MC, Maia CCR, Gonçalves BLL, Filho EM, Costa CP, et al. Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial. Clinical Oral Investigation. 2024; 28: 205.

[34] Council on Clinical Affairs, American Academy of Pediatric Dentistry. Guideline on use of local anesthesia for pediatric dental patients. Pediatric Dentistry. 2015; 37: 71–77.


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