The effectiveness of cryotherapy and cooled topical anesthesia compared with conventional topical anesthesia in alleviating intraoral injection pain: A systematic review and meta-analysis.

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Pooya Saeedi, Alireza Sarraf Shirazi, Mahsa Ghorbani

Author Information

Pooya Saeedi: Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Alireza Sarraf Shirazi: Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Mahsa Ghorbani: Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. ORCID

PMID: 39370577 DOI: 10.1111/ipd.13275

BACKGROUND: Injection pain remains a significant concern in dental procedures, often leading to patient anxiety and reluctance to seek necessary care.
AIM: This study aimed to assess the effectiveness of cryotherapy in reducing injection pain compared with topical anesthesia during intraoral local anesthesia.
DESIGN: MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL databases were searched up to November 2023. Inclusion criteria involved randomized clinical trials aligned with the PICO question. Study selection, data extraction, and risk of bias assessment using the ROB-2 tool were performed. The results were synthesized through a random-effects inverse variance meta-analysis. The primary outcomes assessed were the Visual Analogue Scale (VAS) and Sound Eye Motor (SEM). Subgroup analysis was conducted for children and adults.
RESULTS: In the meta-analysis, 31 RCTs involving 2470 subjects were included. Twenty-seven studies demonstrated cryotherapy's significant superiority over topical anesthesia in reducing injection pain via VAS in adults (p = .01), children (p = .01), and combined age groups (p < .001). Additionally, cryotherapy significantly outperformed topical anesthesia in reducing pain via SEM in children (p = .04) and combined age groups (p = .03) across 13 studies, with no significant difference in adults (p = .51). Furthermore, cooled topical anesthesia also outperformed room temperature topical anesthesia (p < .001). The certainty of the results, however, is of very low quality.
CONCLUSIONS: Our results indicate that cryotherapy significantly reduces injection pain compared with topical anesthesia, especially in children and combined age groups, but is less effective in adults. Additionally, cooled topical anesthesia is more effective than room temperature topical anesthesia. Thus, cryotherapy is a and potentially superior alternative to topical anesthesia, particularly for children.

behavior control child cryotherapy dental anesthesia ice pain

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Humans

Cryotherapy

Anesthesia, Local

Anesthetics, Local

Injections

Anesthesia, Dental

Pain, Procedural

Pain Measurement

Pain Management

Randomized Controlled Trials as Topic

Child

Anesthetics, Local

Journal Article Systematic Review Meta-Analysis Comparative Study

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