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Original Article

Effectiveness of new vibration delivery system on pain


associated with injection of local anesthesia in children
Mangalampally Shilpapriya, Mungara Jayanthi, Venumbaka Nilaya Reddy, Rajendran Sakthivel,
Girija Selvaraju, Poornima Vijayakumar
Department of Pedodontics and Preventive Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai, Tamil Nadu, India

ABSTRACT
Aim: Pain is highly subjective and it is neurologically
proven that stimulation of larger diameter
fibers e.g., using appropriate coldness, warmth,
rubbing, pressure or vibration - can close the neural
gate so that the central perception of itch and pain
is reduced. This fact is based upon gate control
theory of Melzack and Wall. The present study was
carried out to investigate the effects of vibration
stimuli on pain experienced during local anesthetic
injections. Materials and Methods: Thirty patients
aged 6-12 years old of both the genders with
Frankels behavior rating scale as positive and
definitely positive requiring bilateral local anesthesia
injections for dental treatment were included in
the split-mouth cross over design. Universal pain
assessment tool was used to assess the pain with
and without vibration during the administration
of local anesthesia and the results obtained were
tabulated and statistically analyzed. Results: Local
anesthetic administration with vibration resulted
in significantly less pain (P = 0.001) compared to
the injections without the use of vibe. Conclusion:
The results suggest that vibration can be used as
an effective method to decrease pain during dental
local anesthetic administration.

KEYWORDS: Dental vibe, gate control theory, local


anesthesia, pain

Introduction
Pain is a complex and multidimensional construct that
involves sensory, emotional, and cognitive processes.
One of the most important aspects of child behavior
guidance is the control of pain.[1] Effective pain
control in children during regional dental injections
is important to achieve comfort, cooperation, and
compliance with dental care. The pain induced by
injection of local anesthetic agents can be reduced in
a number of complementary methods which include

Address for correspondence:

Dr. Mungara Jayanthi,


Department of Pedodontics and Preventive Dentistry, Ragas
Dental College and Hospital, Uthandi, Chennai - 600 119,
TamilNadu, India.
E-mail: jayanthi_1963@yahoo.com
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Website:
www.jisppd.com
DOI:
10.4103/0970-4388.160343
PMID:
******

application of topical analgesics,[2,3] distraction


techniques,[4-6] application of counter irritation,[7]
varying the rates of infiltration, buffering and warming
the local anesthesia,[8] reduced speed of injection,[9] use
of fine needles with improved syringes, precooling the
injection site[10] and use of vibration have been reported
in many studies, but no conclusive painless injection
method has been established.
Topical application of local anesthesia is the most
common means used to control the pain of local
anesthesia injections. Topical anesthetics may be
associated with toxic sequel because of the amounts
of drug absorbed through the mucosa and the
relative toxicity of some of the topical agents.[11]
Further,thetaste associated with the gels and sprays
can make the child uncomfortable. The dissolution of
the agent with the saliva was also observed which can
further reduce the effectiveness of the agent at the site.
Because of these problems, a predictable means of pain
control for injections is desirable.
Vibratory stimulation is one of the several
nonpharmacological techniques used to reduce pain.
Previously, vibration was applied using a hand-held
massager/a vibrating cotton swab. As the vibration
of the hand-held massager cannot be monitored
throughout, there may be variations in frequency and

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |

173

Shilpapriya, et al.: Dental vibe in pediatric dentistry

pressure applied from subject to subject over time.


Recently, the Dental vibe (Dental Vibe Inc.) was
introduced into dentistry by Dr. Steven Goldberg,
which delivers vibration in a sustained frequency as a
counter stimulation on to the site of injection thereby
alleviating pain.
It is a cordless, rechargeable, hand-held device that
delivers soothing, pulsed, percussive micro-oscillations
to the site where an injection is being administered and
gently stimulates sensory nerves [Figure 1]. It sends
intermittent micro-sonic oscillations to the brains
neurological pain sensors, closing the pain gate,
blocking the pain of injections and is also more useful
for pediatric patients and those who have a phobia
of intraoral injection or pain as there is an audible
distraction (70-75db) provided. Additionally, the
comfort tip provides gentle massaging of the injection
site, through Vibra-Pulse Technology and prevents a
swelling of the bolus of the anesthetic solution as it is
injected. This causes dissipation of the solution faster,
and causes a profound anesthetic effect and further
on application of increased pressure the device shuts
down automatically.
With this background, the present study was done
to evaluate and compare the efficacy of Dental vibe
(Dental Vibe Inc.) and topical local anesthetic in
split-mouth randomized clinical trial.

Materials and Methods


The study was conducted by the Department of
Pedodontics and Preventive Dentistry of Ragas
Dental College and Hospital, Chennai. Thirty
patients aged 6-12 years old of both the genders
with Frankels behavior rating scale as positive
and definitely positive requiring bilateral Local
anesthesia injections for dental treatment were
included in the study. A random crossover design
was used so that each child served as his/her
own control with 15 children in each group. The
local anesthesia was delivered using either the

dental vibe or the topical anesthesia. The children


requiring at least two clinical sessions of operative
procedures preceded by a local anesthetic injection,
one on either side of the same jaw were included
in the study. Fifteen children received Precaine Gel
(Pascal International) (containing 8% lignocaine
and 0.8% dibucaine) topical anesthetic gel prior to
administration of local anesthesia injection, whereas
the remaining 15 received Dental vibe (Dental Vibe
Inc.) during the first appointment and vice versa
during the subsequent second appointment. Children
with a history of eventful dental experiences with
local anesthesia injection and children with special
health care needs were excluded.
Subjects were informed, and parental consent for the
same was obtained. Using basic behavior management
techniques and euphemisms in the first appointment
the site of injection was isolated using cotton swab
and the topical Precaine anesthetic gel was applied
with applicator tip for 30 s and then 2 ml of local
anesthetic solution was deposited with the help of a
27 gauge needle (unilock, dispovan). In the second
appointment on the opposite side of the same arch,
using tell show do technique the Dental vibe (Dental
Vibe Inc.) was introduced and applied to the injection
site 1 min prior to the local anesthesia administration.
The local anesthesia is administered by keeping the
needle as close as possible to one of the prongs and
the application of vibration continued for 10 s after the
removal of the needle as this helps in the dissipation of
the local anesthetic solution.
Universal pain assessment tool [Figure 2] was used
to assess the pain for both the appointments during
the administration of local anesthesia.[12,13] The patient
was asked to describe his/her pain verbally and it
was marked according to his/her own subjective
perception of pain on the universal pain rating scale
and the results obtained were statistically analyzed
and tabulated.

Results
Table 1 shows the comparison between the pain
intensity with and without the use of dental vibe.
MannWhitney test shows that reported mean pain
scores were significantly lower in children who had

Figure 1: Dental vibe

174

Figure 2: Universal pain assessment tool

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |

Shilpapriya, et al.: Dental vibe in pediatric dentistry

Table 1: Comparison between the pain score


with and without the use of dental vibe
Groups
Group I (without vibe) (n=30)
Group II (with vibe) (n=30)

Mean Mean pain score


P
age
(mean SD)
7.5
2.730.87
0.001***
7.5
1.270.78

SD = Standard deviation; *** Statistically significant

Dental vibe (Dental Vibe Inc.) application during the


local anesthesia delivery compared to the other group
(P = 0.001).

Discussion
The present study was undertaken to evaluate and
compare the efficacy of dental vibe with that of
topical local anesthetic (Precaine) in reduction of pain
perception during the administration of local anesthesia
injection. A split-mouth crossover design was planned
to standardize the patient pain threshold and the carry
over effect. Further patients with Frankels behavior
rating scale as positive and definitely positive were only
included in the study to rule out the emotional factors
such as anxiety, previous eventful dental experiences
and depression from influencing the study outcome
as emotional factors such as anxiety, worry, tension
and depression opens the pain gate thus increasing the
pain perception.
In our study, topical anesthesia was chosen for
comparison with the dental vibe as it is a standard
routine procedure followed prior to local anesthesia
administration.[11] Studies of the effectiveness of this
technique have had conflicting results, Minasian and
Yagiela suggested that topical anesthesia might be
more effective if the charged ions of an anesthetic agent
were driven through the tissue by iontophoresis before
insertion of a needle.[14] Other studies have suggested
that topical anesthetics may be associated with toxic
sequelae because of the amounts of drug absorbed
through the mucosa and the relative toxicity of some
of the topical agents, Because of these problems, a
predictable means of pain control for injections is
desirable. Use of vibration was stated to be an effective
alternative. The vibration might also be more effective
if it was continued during the injection or if a more
effective vibration transfer device than the foam swab
were employed.[15]
The effects of vibration on pain have been reported in
both clinical and experimental settings. Interference
stimulation such as vibration can relieve pain on
the basis of the gate control theory.[13] Based on gate
control theory mechanisms of pain relief induced by
vibration can be reduced by simultaneous activation
of nerve fibers that conduct nonnoxious stimuli.[15,16]
When vibration is applied as a counter stimulation to
an anesthetic injection, it will reach the brain before
the pain sensation does. The brain can perceive only

one sensation at a time. Therefore, the sensation that


arrives at the brain first is the one that will be felt.
Hence as counter stimulation vibration reduces pain
perception.[4,10]
The utilization of this theory may be important
especially in the very sensitive oral region where more
than a third of the cells in the somatosensory cortex
of the brain are devoted to sensory inputs from the
mouth. In the orofacial region vibration, stimuli are
easily applied and have been used to raise the pain
threshold to relieve pain of dental origin whether
pulpal, periodontal, or postsurgical.[17] Furthermore,
it has been suggested that pain reduction is greatest
in the orofacial region if the source of vibration is
applied not only within the area directly affected by
pain, but when the firmness of vibration application
stimulates the underlying bone on the same side as
the pain.[2,18-20]
Based on this theory, several methods were developed
but they have been restricted to a vibrating needle or
vibrating swab[21] or VibraJect. VibraJect enables a
less painful palatal injection because it delivers small
amounts of anesthetic solution over a period.[7] They
also point out that dental vibe has improvements in
several structural features including vibration mode
bringing enhanced effectiveness to the method of
using vibration in dental anesthesia injection. Keeping
these facts in mind, the present study was undertaken
and the results showed a significantly lesser pain score
(P < 0.001) in children who had dental vibe application
compared to topical anesthetic application (mean pain
score 1.27 0.78 vs. 2.73 0.87). Similar findings were
observed by Blair using of VibraJect.[20] In contrast;
Yoshikawa et al. found no significant pain reduction
when VibraJect was applied with a conventional
dental syringe.[22] Saijo et al. found no statistically
significant difference in pain perception when he
compared between VibraJect and a conventional
syringe in combination with anaject.[7]
However, no similar comparative studies were found
in relation to dental vibe. Hence, future studies can
be aimed to compare the effectiveness of Dental
vibe (Dental Vibe Inc.) with similar kind of other
devices available to reduce pain perception during the
administration of local anesthesia.

Conclusion
Dental vibe (Dental Vibe Inc.) is a useful accessory
device prior to the use of dental injection syringe and
conventional intramuscular injections to alleviate
pain and stress of injection. From the aspect of the
patient pain management, this device contributes both
physiologically (based on Gate Control Theory of pain)
and psychologically (based on the audible distraction
of the device) and has shown to be a useful tool in
patient management.

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Shilpapriya, et al.: Dental vibe in pediatric dentistry

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How to cite this article: Shilpapriya M, Jayanthi M, Reddy VN,
Sakthivel R, Selvaraju G, Vijayakumar P. Effectiveness of new
vibration delivery system on pain associated with injection
of local anesthesia in children. J Indian Soc Pedod Prev Dent
2015;33:173-6.
Source of Support: Nil, Conflicts of Interest: None declared.

Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |

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