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Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review

Evidence-Based Dentistry volume 26, page 65 (2025)Cite this article

Subjects

Abstract

Objectives

The aim of this study was to review the most effective topical anesthetic methods for reducing pain/discomfort prior to dental local anesthetic needle puncture for dental procedures in children and adolescents.

Methods

A scoping review was conducted. Individual search strategies were developed for each of the bibliographic databases (Cochrane, Embase, LILACS, LIVIVO, Pubmed, Scopus, PsyINFO, Web of Science), and in the gray literature (Google Scholar, Open Gray), comprehensively, without restrictions on language, publication data, or level of socioeconomic development of the country in which the study was conducted. The search was conducted on April 21, 2021 and the updates on May 24, 2024. Randomized controlled studies conducted in patients up to 18 years of age were included. Variables collected: characteristics of the included studies, topical anesthetics evaluated, time and the mode of application.

Results

Initially, 8579 studies were retrieved. Then 3127 were identified as eligible, of which (n = 3127), 52 studies were included in the narrative synthesis. The most commonly observed anesthetic methods with the most favorable outcomes were lidocaine, benzocaine, ice cooling, and EMLA. Spray, gel or patch were used, with application times ranging from 1 to 10 min. Mucosal cooling an ice stick was analyzed by eight studies. Only one showed a smaller reduction in pain perception scores than others.

Conclusions

Cooling is a technique with numerous clinical advantages from the clinical point of view, for reduction of pain/discomfort prior to needle puncture of dental local anesthesia in children and adolescents. It is an accessible, inexpensive and pleasant method that does not resemble needles or unpleasant tastes, nor involves systemic toxicity and complications that may be associated with others anesthetics agents. Future randomized controlled studies in accordance with the Consort Statement are needed to further investigate the topic.

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Fig. 1: Flow Diagram of Literature Search and Selection.
Fig. 2: Number of studies published by countries.
Fig. 3
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Data availability

The authors declare that they agree with the availability of data, upon request of the journal, confirming transparence in the presentation of the data.

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Authors and Affiliations

  1. Department of Clinical Dentistry, Federal University of Espírito Santo, Vitória, Brazil

    Luciana Faria Sanglard, Luana da Silva Paiva & Daniela Nascimento Silva

  2. Centro Universitário UNINOVAFAPI, Teresina, Brazil

    Isabel Cristina Quaresma Rego

  3. Post-Graduation Student Program, Department of Dentistry, Federal University of Espírito Santo, Vitória, Brazil

    Amanda Vieira Barollo & Mariana Pires Feletti

  4. Division of Pharmacology, Anesthesiology and Therapeutics, São Leopoldo Mandic College, Campinas, Brazil

    Juliana Cama Ramacciato

  5. São Leopoldo Mandic College, Campinas, Brazil

    Luciana Butini Oliveira

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Contributions

Luciana Faria Sanglard1 contributed with the conception, design, acquired data and/or played an important role in interpreting the results, analysis and interpretation, drafted the initial manuscript, critically reviewed the manuscript, approved of the final version to be published. Is responsible for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved; and for communicating with the journal during the submission process. Luana da Silva Paiva2 contributed with the conception, acquired data and drafted the initial manuscript, played an important role in interpreting the results, approval of the final version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Isabel Cristina Quaresma Rego3 contributed with drafted the initial manuscript, approval of the final version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Amanda Vieira Barollo4 contributed with on data collection, with approval of the final version to be published and responsible for all aspects of the work; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Mariana Pires Feletti5 contributed with the conception, on data collection and analysis and drafted the initial manuscript, approval of the final version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Daniela Nascimento Silva6 contributed with the conception, on data collection and drafted the initial manuscript, played an important role in interpreting the results, approval of the final version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Juliana Cama Ramacciato7 contributed with the conception, on data collection, drafted the initial manuscript and critical review of the manuscript, played an important role in interpreting the results, approval of the final version to be published; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Luciana Butini Oliveira8 contributed to the conception, design, data collection, played an important role in analysis and interpretation, drafted the initial manuscript and critical review of the manuscript, approval of the final version to be published and responsible for all aspects of the work; agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Sanglard, L.F., da Silva Paiva, L., Rego, I.C.Q. et al. Topical anesthetics methods used to reduce needle pain/discomfort prior to local anesthesia in children and adolescents: a scoping review. Evid Based Dent 26, 65 (2025). https://doi.org/10.1038/s41432-025-01106-x

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  • Issue date:

  • DOI: https://doi.org/10.1038/s41432-025-01106-x

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