title: Effectiveness of various modes of computerized delivery of local anesthesia in primary maxillary molars.
abstract: OBJECTIVE
  The purpose of this study was to compare the effectiveness of infiltration and intrasulcular injection, delivered by a computerized delivery system (CDS), to primary maxillary molars.
  
  
  METHODS
  The study population consisted of 178 children (2-14 years old) who received local infiltration (buccal and palatal) or intrasulcular injection to primary maxillary molars with the use of a CDS. Behavior was managed using: (1) behavioral management techniques; (2) N2O inhalation; or (3) sedation. Measured dependent variables included the: (1) child's subjective perception of well-being before and immediately after anesthesia (scale = 0-100); (2) child's pain behavior during anesthesia, as measured by Children's Hospital of Eastern Ontario pain scale (CHEOPS; range = 4-13); and (3) effectiveness of anesthesia during dental treatment.
  
  
  RESULTS
  Low stress levels were shown for most children before and immediately after anesthesia (range = 12-23). The CHEOPS rating for pain-distractive behavior associated with palatal and buccal infiltration and intrasulcular anesthesia by CDS was similar (6.0 +/- 1.9, 5.8 +/- 1.7, and 5.9 +/- 1.6, respectively). Children treated under sedation, compared to behavioral management techniques, showed higher CHEOPS scores (P = .004). The effectiveness of anesthesia using a CDS (infiltration and intrasulcular) had a downward trend, but was not significantly different for restoration (91%), pulpotomy and preformed crowns (79%), or extraction (74%; mean = 86%). There was no significant difference between infiltration and intrasulcular effectiveness or for age, gender, or tooth location (primary maxillary first vs second molars).
  
  
  CONCLUSIONS
  CDS caused low levels of stress and pain reaction after palatal infiltration equal to that for buccal infiltration. All procedures achieved anesthesia effectiveness (86%), with no differences between primary maxillary first and second molars.
authors.affiliation: Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel. shkenazi@post.tau.ac.il
authors.forename: Malka
authors.initials: M
authors.lastname: Ashkenazi
authors.forename: Sigalit
authors.initials: S
authors.lastname: Blumer
authors.forename: Ilana
authors.initials: I
authors.lastname: Eli
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001521:Behavior Therapy; D002648:Child; D002675:Child, Preschool; D019140:Dental Care for Children / Q000379:methods*; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008442:Maxillary Nerve; D008963:Molar; D010147:Pain Measurement; D017060:Patient Satisfaction; D025321:Surgery, Computer-Assisted; D014094:Tooth, Deciduous
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine