Effectiveness of various modes of computerized delivery of local anesthesia in primary maxillary molars

Abstract

Purpose: The purpose of this study was to compare the effectiveness of infiltration and intrasulcular injection, delivered by a computerized delivery system (CDS), to primary maxillary molars.

Methods: The study population consisted of 178 children (2-14 years old) who received local infiltration (buccal and palatal) or intrasulcular injection to primary maxillary molars with the use of a CDS. Behavior was managed using: (1) behavioral management techniques; (2) N2O inhalation; or (3) sedation. Measured dependent variables included the: (1) child's subjective perception of well-being before and immediately after anesthesia (scale = 0-100); (2) child's pain behavior during anesthesia, as measured by Children's Hospital of Eastern Ontario pain scale (CHEOPS; range = 4-13); and (3) effectiveness of anesthesia during dental treatment.

Results: Low stress levels were shown for most children before and immediately after anesthesia (range = 12-23). The CHEOPS rating for pain-distractive behavior associated with palatal and buccal infiltration and intrasulcular anesthesia by CDS was similar (6.0 +/- 1.9, 5.8 +/- 1.7, and 5.9 +/- 1.6, respectively). Children treated under sedation, compared to behavioral management techniques, showed higher CHEOPS scores (P = .004). The effectiveness of anesthesia using a CDS (infiltration and intrasulcular) had a downward trend, but was not significantly different for restoration (91%), pulpotomy and preformed crowns (79%), or extraction (74%; mean = 86%). There was no significant difference between infiltration and intrasulcular effectiveness or for age, gender, or tooth location (primary maxillary first vs second molars).

Conclusions: CDS caused low levels of stress and pain reaction after palatal infiltration equal to that for buccal infiltration. All procedures achieved anesthesia effectiveness (86%), with no differences between primary maxillary first and second molars.