| “Brace yourself, a 5-year old is coming for a filling.” |
| Treating a pediatric patient can go one of two ways: a) average without any special events, or b) horribly wrong. There is no in-between. When your sweet little 5-year old patient transforms into the monster that turned the operatory upside down, you can only promise yourself that you will never treat another pediatric patient again. You have many hurdles to jump through to make it to the other side of a pediatric appointment, but it always starts with the freezing. Dentistry has tried everything to calm pediatric patients; distraction, hypnosis, reducing needle size to reduce pain, prolonging injection duration, even electronic or computer based assist systems. None of these ways have completely eliminated the fear of a dental appointment for kids. And thinking of the long term effects – creating dental anxiety in a child will potentially lead to a patient avoiding oral health care for life. Another approach has shown promise, as practiced by our colleagues in ophthalmology and plastic surgery: warming the anesthesia to body temperature before injection. It’s been reported by Hogan et al. that warming up the local anesthetic solution to body temperature (37 °C) significantly reduces perceived pain by the patient. However this had never been studied in pediatric dentistry. In 2019, pain due to anesthetic injection was studied in a double-blind, split-mouth, and randomized clinical trial with 100 pediatric patients from 5-8 years old. These pediatric patients had no prior experience with dental anesthesia, required bilateral maxillary molar treatment, and were seen to be cooperative in the dental office. In one group, articaine 4% with 1:200,00 epinephrine was warmed to 37 °C using a composite heater (CALSET). In the other group, the same anesthetic was warmed in a water bath to 21 °C. Both groups had anesthesia slowly injected for an average of 2 minutes, approximately 1mL per minute, while the buccal mucosa was slightly stretched. The pain perceived was noted by a dental assistant, observing for face, activity, leg, cry and consolability of the patient. Also heart rate was also measured as an objective method of anxiety and pain. The perceived level of pain was significantly lower in both boys and girls when using 37 °C anesthetic. Furthermore, the heart rate of both boys and girls were lower when warm anesthetic was used. Similar results were reported in other studies, one involving dental students ages 22-32 – who reported significantly lower pain when receiving injections with body temperature solutions. This method is even being used by maxillofacial surgeons, as 34% of all UK surgeons reported using this method for better patient comfort. So the next time you have a 5-year old coming into the office at the end of a long day, the method of warming the anesthetic to body temperature can offset the tears. Now you just have to get through the terrifying sound of the drill, keeping tooth isolation, and the helicopter parent in the background. |
| Today’s Morning Huddle was brought to you by Dr. Kasra Eghbaldar – Toronto, Canada |