Cochrane · intervention · CD011024
Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment
Monteiro, J, Tanday, A, Ashley, PF, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
73
current version
GRADE rated
11
No studies
55
Included studies
26
as reported
No studies 55 · 75.3%Ungraded 7 · 9.6%Very low 10 · 13.7%Low 1 · 1.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents up to 18 years old having dental treatment under local anaesthetic without general anaesthesia. Children and adolescents (up to 18 years) with any form of special healthcare needs were not excluded | 2435 children aged 2 to 16 years across 26 parallel RCTs (studies carried out 2002-2019 in UK, USA, Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea) |
| Intervention | Equipment factors: Audiovisual technology (Visual; Auditory; Combined visual and auditory); Topical anaesthetic (Topical anaesthetic agents; Cooling of injection site); Local anaesthetic (Gauge of needle; Temperature of cartridge); Electronic devices (Infiltration devices; Intraosseous devices; Intraligamental devices); Others (Needleless devices; Vibration device; Transcutaneous nerve stimulation). Dentist factors (non-pharmacological interventions): Imagery suggestion; Counter-stimulation; Systematic desensitisation; Hypnosis; Others (Language - non-threatening words; Viewing/hiding needle; Time taken to deliver local anaesthetic; Site of injection/order of treatment) | Audiovisual distraction (n=3); Pre-cooling of injection site (n=1); The wand (n=9); Camouflage syringe (n=1); Counter-stimulation or distraction (n=5); Electrical counter-stimulation device DentalVibe (n=1); Counter-stimulation and distraction (n=1); Hypnosis (n=3); Video modelling (n=2) |
| Comparison | Delivery of LA using a conventional syringe (usual care), or any other dental equipment or dentist-led intervention | Conventional treatment/traditional LA/conventional syringe (usual care); Sleeper One; Oral hygiene video; Acclimatisation in clinic (tell-show-do) |
| Outcomes | Primary outcomes: Acceptance of LA (yes/no). Secondary outcomes: Completion of dental treatment (yes/no); Successful LA/painless treatment (yes/no); Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA; Pain on injection (yes/no); Pre and postoperative anxiety measures; Patient satisfaction (questionnaires); Parent satisfaction (questionnaires); Adverse events | Self- or observational assessment of intraoperative distress/pain/acceptance during provision of LA (n=26; graded very low to low); Pain on injection; Pre and postoperative anxiety measures; Physiological measures (pulse rate) |
| Study designs | Parallel randomised controlled trials. Quasi-randomised and cross-over trials were excluded | Randomised controlled trials, parallel design (n=26) |
| Timing | Interventions delivered in advance of LA; immediately before LA; during LA | In advance of LA (video modelling); immediately before LA; during LA |
Search date: 2019-05. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; Web of Science; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Current version onlyAudiovisual distraction vs Conventional treatment
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Successful LA/painless treatment During LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Pre- and post-operative anxiety measures (Modified Child Dental Anxiety Scale: faces, MCDAS(f), after LA) During LA · Audiovisual glasses vs conventional | MD -12.60 [-15.33, -9.87] | 1 study | Ungraded |
Acceptance of LA During LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment During LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain-related behaviour during LA (negative vs positive behaviour; Frankl Behaviour Rating Scale) During LA | RR 0.13 [0.03, 0.50] 533 vs 69 | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects During LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires During LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Pain on injection (Wong-Baker Faces Pain Rating Scale, after inferior alveolar block) During LA · VR box vs conventional | MD 0.04 [-0.41, 0.48] | 1 study | Ungraded |
Pre-cooling of the injection site vs Conventional treatment
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of dental treatment Immediately before LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain (SEM scale - Sound, Eyes, and Motor scale) Immediately before LA | pain (SEM scale); risk with conventional treatment -, risk with pre-cooling -; 160 (1 RCT); VERY LOW. Evidence is uncertain regarding the effect of pre-cooling of the injection site on pain (data presented in a form… | 1 study · 160 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects Immediately before LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires Immediately before LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Acceptance of LA Immediately before LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment Immediately before LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
The wand (computer-controlled LA delivery system) vs Traditional local anaesthetic
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient satisfaction: measured by questionnaires During LA (injection is the intervention) | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Pain perception during the intervention (pooled) During LA (injection is the intervention) | RR 1.15 [0.83, 1.59] | 2 studies · 68 participants | Ungraded |
Acceptance of LA During LA (injection is the intervention) | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain-related behaviour (any disruptive behaviour/sudden reaction/movement) During LA (injection is the intervention) | pain-related behaviour (any disruptive behaviour/sudden reaction/movement); 4 studies reported a benefit in using the wand while the remaining studies results suggested no difference between the 2 methods of delivering… | 6 studies · 704 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects During LA (injection is the intervention) | Adverse effects: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment During LA (injection is the intervention) | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment During LA (injection is the intervention) | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
The wand (computer-controlled LA delivery system) vs Sleeper One (electronic LA delivery system)
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects During LA (injection is the intervention) | Adverse effects: included studies did not report on this outcome | NR | No studies |
Acceptance of LA During LA (injection is the intervention) | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment During LA (injection is the intervention) | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain-related behaviour (any disruptive behaviour; modified Wong-Baker Faces Scale) During LA (injection is the intervention) | MD 0.06 [0.01, 0.11] | 1 study · 112 participants | Very low Downgraded: risk of bias, imprecision |
Successful LA/painless treatment During LA (injection is the intervention) | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires During LA (injection is the intervention) | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Pain on injection (self-reported; FACES Pain Scale Revised) During LA (injection is the intervention) | MD 0.68 [-1.31, 2.67] | 1 study · 112 participants | Ungraded |
Camouflage syringe vs Conventional syringe
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of dental treatment During LA (injection is the intervention) | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain-related behaviour (crying) During LA (injection is the intervention) | RR 0.02 [0.00, 0.37] 420 vs 8 | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Patient satisfaction: measured by questionnaires During LA (injection is the intervention) | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Acceptance of LA During LA (injection is the intervention) | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Adverse effects During LA (injection is the intervention) | Adverse effects: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment During LA (injection is the intervention) | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Counter-stimulation or distraction vs Conventional treatment
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient satisfaction: measured by questionnaires Immediately before or during LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Adverse effects Immediately before or during LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment Immediately before or during LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment Immediately before or during LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Acceptance of LA Immediately before or during LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Pain on injection (Wong-Baker Faces / TPPPS / FPS-R, after LA) Immediately before or during LA · Kamath 2013 (WITAUL) | MD -3.18 [-4.26, -2.10] | 1 study | Ungraded |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain (SEM scale; any pain vs no pain) Immediately before or during LA | RR 0.12 [0.04, 0.34] 407 vs 49 | 1 study · 134 participants | Very low Downgraded: risk of bias, imprecision |
Electrical counter-stimulation device (DentalVibe) vs Conventional treatment (no stimulation)
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Acceptance of LA During LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment During LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment During LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain (Wong-Baker Faces Pain Scale, 0 to 10) During LA | MD -1.34 [-2.35, -0.33] | 1 study · 100 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects During LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires During LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Counter-stimulation and distraction (combined) vs Conventional treatment
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA (SEM scale, distress) During LA | No numeric data reported. Study authors reported lower distress values (SEM scale) for all categories in the combined counter-stimulation and distraction group; this difference was significant when compared to the… | 1 study · 78 participants | Very low Downgraded: risk of bias, imprecision |
Adverse effects During LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment During LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Acceptance of LA During LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment During LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires During LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Hypnosis vs Conventional treatment
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Physical/verbal resistance and self-reported pain during LA (other studies) Immediately before or during LA · Oberoi 2016 (resistance) | RR 0.47 [0.34, 0.65] | 1 study · 200 participants | Ungraded |
Patient satisfaction: measured by questionnaires Immediately before or during LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Adverse effects Immediately before or during LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Acceptance of LA Immediately before or during LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain (modified objective pain score, mOPS; VAS 0 to 10) Immediately before or during LA | MD -1.79 [-3.01, -0.57] | 1 study · 29 participants | Very low Downgraded: risk of bias, imprecision |
Successful LA/painless treatment Immediately before or during LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment Immediately before or during LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Video modelling acclimatisation for LA vs Oral hygiene video
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Completion of dental treatment In advance of LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Acceptance of LA In advance of LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: anxiety/pain experience (VAS, higher scores indicate worsened anxiety) In advance of LA | MD -37.16 [-50.94, -23.38] | 1 study · 66 participants | Low Downgraded: imprecision |
Adverse effects In advance of LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment In advance of LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Patient satisfaction: measured by questionnaires In advance of LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Video modelling acclimatisation vs Acclimatisation in clinic (tell-show-do)
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Adverse effects In advance of LA | Adverse effects: included studies did not report on this outcome | NR | No studies |
Acceptance of LA In advance of LA | Acceptance of LA: included studies did not report on this outcome | NR | No studies |
Successful LA/painless treatment In advance of LA | Successful LA/painless treatment: included studies did not report on this outcome | NR | No studies |
Pre- and post-operative anxiety measures (Venham's scale) In advance of LA | MD 0.13 [-0.37, 0.63] | 1 study · 46 participants | Ungraded |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of LA: pain-related behaviour/co-operation (Frankl scale) In advance of LA | MD 0.01 [-0.33, 0.35] | 1 study · 46 participants | Very low Downgraded: risk of bias, imprecision |
Patient satisfaction: measured by questionnaires In advance of LA | Patient satisfaction: included studies did not report on this outcome | NR | No studies |
Completion of dental treatment In advance of LA | Completion of dental treatment: included studies did not report on this outcome | NR | No studies |
Any equipment or dentist-led intervention to increase acceptance of local anaesthetic (audiovisual technology; topical anaesthetic/cooling of injection site; LA delivery devices - needle gauge/cartridge temperature; electronic infiltration/intraosseous/intraligamental devices; needleless/vibration devices; transcutaneous nerve stimulation; imagery suggestion; counter-stimulation; systematic desensitisation; hypnosis) vs Delivery of local anaesthetic without the test intervention (conventional/usual care)
Population: Children and adolescents having dental treatment under local anaesthetic without general anaesthesia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Parent satisfaction: measured by questionnaires | Protocol only: planned outcome, no studies included yet | NR | No studies |
Completion of dental treatment (yes/no) | Protocol only: planned outcome, no studies included yet | NR | No studies |
Acceptance of local anaesthetic (yes/no) | Protocol only: planned outcome, no studies included yet | NR | No studies |
Pain on injection (yes/no) | Protocol only: planned outcome, no studies included yet | NR | No studies |
Successful local anaesthetic/painless treatment (yes/no) | Protocol only: planned outcome, no studies included yet | NR | No studies |
Adverse events | Protocol only: planned outcome, no studies included yet | NR | No studies |
Self- or observational assessment of intraoperative distress/pain/acceptance of treatment during provision of local anaesthesia | Protocol only: planned outcome, no studies included yet | NR | No studies |
Pre- and post-operative anxiety measures | Protocol only: planned outcome, no studies included yet | NR | No studies |
Patient satisfaction: measured by questionnaires | Protocol only: planned outcome, no studies included yet | NR | No studies |