Electronic Device Allays Needle Injection Discomfort - research into electronic dental anesthesia in pediatric dentistry - Brief Article

Using electronic anesthesia can reduce discomfort and disruptive behaviors in young, sedated dental patients. Researchers at Ohio State University, Columbus, used electronic dental anesthesia (EDA) to numb the gums of 15 children aged two to four during the injection of a local anesthetic. EDA was administered after the youngsters had received sedatives to calm them. During the injection, EDA significantly reduced moving and crying and also minimized usual heart rate and blood pressure changes associated with injections, compared to a control group of 15 children whom did not receive EDA.

"An injection can evoke a very strong physiologic and emotional response, even in a sedated child," notes Stephen Wilson, professor of pediatric dentistry. "EDA was somewhat effective in helping children cope with an injection."

EDA is a battery-operated device that sends electrical impulses through a finger pad that the dentist holds against the tissue surrounding the tooth. EDA--which produces a pulsating, tingling sensation--numbs the tissue or distracts the patient so the discomfort of the injection is partially masked.

While EDA is popular among some dentists for adults, Wilson indicates, it hasn't received widespread use in pediatric care. EDA has traditionally been used in periodontal research, and periodontal problems are more common in adults than children. Also, the EDA finger probe that is placed against the soft tissue is rather large for a child's mouth. "Children have little lips and mouths, which sometimes makes it difficult to place the electrodes on the gums," he points out.

Moreover, there had never been a study looking at EDA while a patient is under sedation. "Whenever kids are sedated, the one stimulus that really gets them excited is the injection. It's the injection in the upper front part of the mouth that seems to be the most painful."

The children in this study had what dentists call "baby bottle syndrome"--cavities, usually on the front teeth, that result from direct exposure to the sweetened liquids a child drinks frequently. Wilson and his colleagues divided 30 children into two groups. The researchers turned the EDA device on to treat half of the children, while in the other group, the EDA device was turned off. Each child was given an oral sedative 60 minutes before dental treatment began. "Very young children are typically sedated because they don't have good coping skills when it comes to dental treatments like having a cavity filled," Wilson explains.

Each patient also received the anesthetic nitrous oxide (laughing gas). The EDA finger pad was placed on the gums five minutes later. A dental assistant increased the current every 20 seconds for a minimum of two minutes before Xylocaine, a local anesthetic, was injected into the gum. The EDA finger pad was removed once the Xylocaine was administered.

The researchers videotaped each child during the procedure to assess four behaviors: quiet, crying, moving, and struggling with crying. They found that the children receiving the activated EDA cried and moved less frequently than those who didn't.

The heart rates and blood pressures of the children not receiving EDA treatment increased with the injection of Xylocaine by an average of eight and 10%, respectively.

The heart rates and blood pressures of the children receiving the EDA decreased by two and three percent, respectively.

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