What do systematic reviews say?

Counter-stimulation or distraction vs Conventional treatment

Counter-stimulation or distraction led to lower pain on injection (Wong-Baker Faces / TPPPS / FPS-R, after LA) compared with conventional treatment; GRADE not reported.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  Immediately before or during LA · Kamath 2013 (WITAUL)
  MD -3.18 [-4.26, -2.10]
  1 study
  GRADE not reported

Audiovisual distraction vs Conventional treatment

Audiovisual distraction showed no clear difference in pain on injection (Wong-Baker Faces Pain Rating Scale, after… compared with conventional treatment; GRADE not reported.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  During LA · VR box vs conventional
  MD 0.04 [-0.41, 0.48]
  1 study
  GRADE not reported

The wand (computer-controlled LA delivery system) vs Sleeper One (electronic LA delivery system)

The wand (computer-controlled LA delivery system) showed no clear difference in pain on injection (self-reported; FACES Pain Scale Revised) compared with sleeper One (electronic LA delivery system); GRADE not reported.

• Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment 2020 · Cochrane All outcomes

  During LA (injection is the intervention)
  MD 0.68 [-1.31, 2.67]
  1 study · 112 participants
  GRADE not reported

4% prilocaine plain vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% mepivacaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment; 147 participants, 147 interventions (2 studies); unclear whether data relate to just solution deposition. Not pooled/graded.
  2 studies · 147 participants
  GRADE not reported

4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study); 86 participants, 172 interventions (1 study). Not pooled/graded.
  1 study · 86 participants
  GRADE not reported
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study; exact time of follow-up not reported); 86 participants, 172 interventions (1 study). Not pooled/graded.
  1 study · 86 participants
  GRADE not reported

3% prilocaine, 0.03 IU felypressin vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study; unclear whether data relate to just solution deposition; SDs not reported); 18 participants, 36 interventions (1 study). Not pooled/graded.
  1 study · 18 participants
  GRADE not reported
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study; unclear whether data relate to just solution deposition; SDs not reported); 18 participants, 36 interventions (1 study). Not pooled/graded.
  1 study · 18 participants
  GRADE not reported

4% articaine, 1:200,000 epinephrine vs 4% articaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found
• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment (orphan study; unclear whether data relate to just solution deposition); 48 participants, 48 interventions (1 study). Not pooled/graded.
  1 study · 48 participants
  GRADE not reported

4% articaine, 1:200,000 epinephrine vs 0.5% bupivacaine, 1:200,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% prilocaine plain vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: See comment; 0 participants (0 studies); 1 case of prolonged anaesthesia recorded; no clinical studies met the outcome definition (unable to confirm whether prolonged anaesthesia = paraesthesia).
  0 studies
  No studies found

3% prilocaine, 0.03 IU felypressin vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

2% mepivacaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% mepivacaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine showed no clear difference in adverse effects: pain on injection (solution deposition),… compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  0-1 minute following needle insertion
  MD 4.74 [-1.98, 11.46]
  3 studies · 157 participants
  Moderate

0.5% bupivacaine, 1:200,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

The review found no eligible studies for this question.

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes
  SoF: Not measured.
  0 studies
  No studies found

4% articaine, 1:100,000 epinephrine vs 2% lidocaine, 1:100,000 epinephrine

4% articaine, 1:100,000 epinephrine probably leads to higher adverse effects: pain following injection, Heft-Parker VAS 0-170 mm compared with 2% lidocaine, 1:100,000 epinephrine (moderate certainty).

• Injectable local anaesthetic agents for dental anaesthesia 2018 · Cochrane All outcomes

  Measured at the time anaesthesia wore off
  MD 6.41 [1.01, 11.8]
  3 studies · 156 participants
  Moderate