The management of pain stimuli, or better, the prevention of intraoperative pain, is a fundamental requirement in pediatric patients. Pain is one of the fundamental causes of dental anxiety: paradoxically, however, it is injection anesthesia that represents one of the strongest triggers in this sense.

The guidelines of the American Academy of Pediatric Dentistry, for this reason, support the use and testing of alternative methods that are not pharmacological or that, however, are able to mediate the injection technique to reduce the associated discomfort.

Topical cryotherapy, or the application of cold, is an effective method in different areas of the body surface to reduce painful stimulations.

This solution, transferred to the stomatognathic site, could be a simple option, perhaps well accepted even by young patients, who have experience in relation to the use by parents following minor accidents at home or in sports.

With this in mind, Bilsin conducted a study, which was recently published in the Journal of PeriAnesthesia Nursing, The study aimed at testing the effectiveness of cooling—and also vibratory stimulation—in reducing the painful symptom associated with anesthesiological injection procedure.

The study surveyed a total of 60 patients aged between 7 and 12 years, all aimed at the extraction of a deciduous molar.

The sample was facial in two numerically equivalent groups: a control group and a case group. The latter patients underwent the application of a cooling and vibration device two minutes before mandibular anesthesia, conducted with a 21 mm needle (30 gauge) and 2 mL of 2% lidocaine.

The pain data was evaluated by the Frankl Behavior Scale, which provides that the assessment of the child’s response to treatment is classified as definitely negative, negative, positive or definitely positive, and the Wong-Baker Faces Pain Rating Scale, for which pain (increasing from 0 to 10) is determined on the basis of facial expression (from smiling to crying).

The average pain scores recorded according to the Wong-Baker Scale are 3.33 ± 1.91 and 0.86 ± 1.13, respectively for the control group and for the case group: the difference between the two was statistically significant.

By the authors’ own admission, the main limit of the protocol, which has proved effective in practice, is the failure to pass the conventional injection procedure, which has triggered several crying crises among the subjects of the study. It therefore seems right to give space also to studies that consider alternative techniques to completely eliminate this fundamental trigger of dental anxiety in the pediatric patient.

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