This document discusses future pain management strategies in pediatric dentistry. It outlines various pain assessment tools used for different age groups, including the Neonatal Infant Pain Scale for infants and the Wong-Baker Faces Pain Rating Scale for children over 3 years old. Local anesthesia techniques and devices to reduce pain are also examined, such as precooling injection sites, topical anesthetics, computer-controlled delivery systems, and vibrating devices. The conclusion states that achieving successful local anesthesia in children remains a challenge, but adjuvant techniques and devices can effectively decrease pain experienced during dental treatments.

1. FUTURE OF PAIN MANAGEMENT IN PEDIATRIC
DENTISTRY

2. CONTENTS
PAIN
PAIN ASSESSMENTTOOLS
LOCALANESTHESIA
METHODS OF REDCUING PAIN DURING
USAGE OF ANESTHETICAGENTS
DEVICES USED FOR REDUCING PAIN
DISCUSSION
CONCLUSION
REFERENCES

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t nsational experience
initiated by noxious stimulus & transmitted over a
specialized neural network to CNS where it is interpreted as
such feeling
 DEFINITION
PAIN

4.  INFANTS
 NEONATAL INFANT PAIN SCALE(NIPS)
 CRIES
 CHILDREN >3 YEARS
 WONG-BAKERS FACE PAIN RATING SCALE
 FLACC SCALE
 PRE SCHOOL
 CHILD FACIAL CODING SYSTEM
 SCHOOLAGE
 VISUAL ANALOUG SCALE
Measurement and Assessment of Pain In Children – A Review Amit Jain*/ Ramakrishna Yeluri**/
Munshi. A K The Journal of Clinical Pediatric Dentistry Volume 37, Number2/2012
PAIN ASSESSMENT TOOLS

5.  NEONATAL INFANT PAIN SCALE(NIPS)
 CRIES
 Crying
 Requires oxygen to maintain sat > 95%
 Increased vital signs
 Expression level of sleep
 Level of Sleep
INFANTS

6. WONG-BAKER FACES PAIN RATING SCALE
WONG

7. FLACC SCALE

8. VISUAL ANALOUGE SCALE

9. Points to be kept in mind regarding the differences
between child and adult patient
 Density and calcification of maxillary and mandibular bone.
 Anatomic structures.
 Penetration of the needle.
 Depth of needle penetration.
 Emotional aspect

10. LOCALANESTHESIA
 DEFINITION
Transient loss of sensation in a circumscribed area of the body
caused by a depression of excitation in nerve endings or an
inhibition of the conduction process in peripheral nerves

11. METHODS OF REDUCING PAINDURING USAGE OF
LOCAL ANESTHETICAGENTS
1)PRECOOLING THE INJECTION SITE:
 Cooling the site prior to the block at injection site reduced the pain
perceived during the local anesthesia.
 Ice pre treatment of the soft tissue at injection site before the
procedure.
 According to Harbert etal precooling the injection site reduced pain
perception during palatal injections.
Effect of precooling the injectionsite on pediatric pain perception during local anesthesia.Journal of
contemporary dental practice volume10,no.3 may2009

12. 2) APPLICATIONOFTOPICALANESTHETICS
GEL FORM SPRAY FORM LIQUID FORM
PATCH OINTMENT
Intraoral topical anesthesia
JOHN G. MEECHAN Vol. 46,
2008, 56–79

13.  Mixture of 5% lidocaine & Prilocaine.
 It is used more often for skin than intra orally.
 According toSvennson et al observed more effective results
when applied at incisve foramen region and greater palatine
region.
 In children under 6 months is contraindicated due to the
possibility for developing methemoglobinemia due to
prilocaine.
3) EMLA(EUTECTIC MIXTURE OF LA):

14.  Oraqix contains 25 mg ⁄ g lidocaine and 25 mg ⁄ g prilocaine.
 Thermosetting agent.
 The material is liquid at room temperature but when injected
into the gingival crevice it forms an elastic gel.
 Fast onset in 30 seconds with duration of 20 minutes
approximately
ORAQIX

15.  To approach the palatal mucosa via the already an
anesthetised buccal inter dental papilla. This is the called
“chasing” technique
A)
B) C)
D)
E)
European Archives of Paediatric
Dentistry // 10 (2). 2009
J. G. Meechan
CHASING TECHNIQUE:

16. DEVICES USED FOR REDUCING PAIN
 VIBROTACTILE DEVICES: Based on gate control theory
 VIBROJECT
 DENTALVIBE
 ACCUPAL
 VIBROJECT : Small battery-operated attachment that snaps on to
the standard dental syringe.
Pain perception by vibrating needle (VibrajectTM) and conventional syringe anesthesia . International Dental
& Medical Journal of Advanced Research ● Vol. 1 ● 2015

17. DENTALVIBE
 It is a cordless, rechargeable, hand held device that delivers soothing,
pulsed, percussive micro-oscillations to the site where an injection
being administered.
 Stimulates the sensory receptors at the injection site, effectively
closing the neural pain gate, blocking the painful sensation.
Effect of the DentalVibe Injection System on Pain During Local Anesthesia Injections
InAdolescent PatientsDavid Ching, DMD' • Matthew Finkelman, PhD^ •
PEDIATRIC DENTISTRY V 36 ; NO 1 JAN / EEB 14

18.  Cordless device that uses both vibration and pressure to precondition
the oral mucosa.
 Accupal provides pressure and vibrates the injection site 360°
proximal to the needle penetration, which shuts the “pain gate.”
. Murray P, Terrett K, Lynch E, Hussey DL. Efficacy of a vibrating dental syringe
attachment on pain levels. Paper presented at: 81st General Session of the International
Association for Dental Research; June 26, 2003; Göteborg, Sweden.
ACCUPAL:

19. COMPUTER CONTROLLED LOCALANESTHETIC
DELIVERYSYSTEM (CCLAD)
• WAND/COMPUDENT SYSTEM:
• The light weight hand piece is held in a pen-like grasp that
provides the user with greater tactile sensation.
• The available flow rates of LA delivery are controlled by a
computer
• COMFORT CONTROLSYRINGE:
• It has two main components: A base unit and a syringe.
• functions of the unit- most importantly injection and aspiration-
can be controlled directly from the syringe.
Advanced Techniques and Armamentarium for Dental Local Anesthesia Taylor
M. Clark, DDS, DCNA October 2010Volume 54, Issue 4, Pages 757-768

20. JET INJECTORS
SYRIJET:
Features of the device is
that it accepts the
standard 1.8 mL cartridges
of LA solution (thereby
ensuring sterility of the
solution).
Completely autoclavable
MED-JET H III:
Extremely small stream of
liquid under pressure
pierces and then the
remainder of the dose will
be dispersed into the
desired layer of tissue.
Ability to utilize low
pressure delivery methods
without compromising
accuracy, convenience and
ease of use - while
ensuring patient comfort.

21. INJURY
 PREVENTS NEEDLE STICK
1) Ultra Safety Plus XLsyringe
2) Ultra Safe Syringe
3) Hypo Safety Syringe
4) RevVac safety syringe
SAFETY DENTALSYRINGES

22. ELECTRONIC DENTAL ANESTHESIA
Uses the principle of Transcutaneous
Electrical Nerve Stimulation (TENS).
It increases salivary blood flow. Requires
good patient co-operation

23. DISCUSSION The use of topical application to obtain anesthesia for
intraoral operative procedures is appealing.
The patch was applied for 15 minutes and the gel for
30 seconds.
When the different jaws were compared the lidocaine
patch was more effective than the benzocaine gel.
Effectiveness of EMLA when applied apical to
deciduous teeth showed significant results.
Significant reduction of pain was observed when using
topical anesthetic and reduced anxiety in children.
Devices used while during the procedures results
shown that there is decrease in Pain and more comfort
compared to conventional syringes.

24. CONCLUSION
 Sight of large syringe being injected into tender gums can bring
tears to the eyes of most of the children.
 Achievement of successful local anesthesia is a continual
challenge in dentistry.
 Adjuvant techniques and devices can effectively reduce the pain
in children during dental treatment.

25.  MALAMED SF. HANDBOOK OF Local anesthesia.5th edition. St.Louis,
Mo:CV Mosby;2004:274-2754TH .
 Measurement and Assessment of Pain In Children – A Review Amit Jain*/
Ramakrishna Yeluri**/ Munshi. A K The Journal of Clinical Pediatric
Dentistry Volume 37, Number 2/2012.
 Effect of precooling the injectionsite on pediatric pain perception during local
anesthesia.Journal of contemporary dental practice volume10,no.3 may2009.
 Intraoral topical anesthesia, JOHN G. MEECHAN Vol. 46, 2008, 56–79
 Pain perception by vibrating needle (VibrajectTM) and conventional syringe
anesthesia . International Dental & Medical Journal of AdvancedResearch
● Vol. 1 ● 2015.
 Effect of the DentalVibe Injection System on Pain During Local Anesthesia
Injections InAdolescent PatientsDavid Ching, DMD' Matthew Finkelman,
PhD^ • PEDIATRIC DENTISTRY V 36 ; NO 1 JAN / EEB 14.
REFERENCES

26.  Murray P,Terrett K, Lynch E, Hussey DL. Efficacy of a vibrating dental
syringe attachment on pain levels. Paper presented at: 81st GeneralSession
of the International Association for Dental Research; June 26, 2003;
Göteborg, Sweden.
 Advanced Techniques and Armamentarium for Dental Local Anesthesia
Taylor M. Clark, DDS, DCNA October 2010Volume 54, Issue 4, Pages 757-
768
 European Archives of Paediatric Dentistry // 10 (2). 2009 J. G. Meechan