title: The efficacy of distraction and counterstimulation in the reduction of pain reaction to intraoral injection by pediatric patients.
abstract: OBJECTIVE
  The aim of this clinical investigation was to determine the efficacy of distraction and counterstimulation in the reduction of pain during the administration of local anesthetics in pediatric dental patients.
  
  
  METHODS
  A total of 78 healthy children (male: 40, female: 38) ages four to five years (mean age: 4.72 years old) without any history of previous intraoral injection were included in the present study. The subjects had at least one carious primary molar. The subjects were randomly allocated into three groups. Group SA received topical anesthesia followed by an inferior alveolar nerve block (simple anesthesia). Group C+SA received counter stimulation using intraoral and extraoral finger vibration in addition to the Group SA protocol. Group CD+SA incorporated verbal distraction in addition to topical and local anesthesia and counterstimulation. A sound, eye, and motor (SEM) scale was used for quantification of pain reaction. Data were analyzed using an analysis of variance (ANOVA).
  
  
  RESULTS
  The SEM values for Groups SA, C+SA, and CD+SA was 8.25, 5.07, and 3.41, respectively. According to the SEM scale a severe pain reaction was observed in Group SA but not in the other groups. The pain reaction for Group SA was significantly higher than the two other groups (P<0.05). Moreover, the subjects in Group CD+SA exhibited significantly less pain compared to those in Group C+SA.
  
  
  CONCLUSIONS
  Both distraction and counterstimulation are effective in reducing pain reaction in a clinical setting. However, it may be more plausible to use both techniques simultaneously to achieve more favorable results with reference to a reduced pain reaction in pediatric dental patients.
authors.affiliation: Department of Pedodontics, Tabriz University, East Azerbaijan, Iran. aslaminabadi@gmail.com
authors.forename: Naser Asl
authors.initials: NA
authors.lastname: Aminabadi
authors.forename: Ramin Mostofi Zadeh
authors.initials: RM
authors.lastname: Farahani
authors.forename: Esrafil
authors.initials: E
authors.lastname: Balayi Gajan
mesh_terms: D000161:Acoustic Stimulation; D000766:Anesthesia, Dental / Q000009:adverse effects / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001288:Attention; D002675:Child, Preschool; D019140:Dental Care for Children / Q000379:methods*; D005157:Facial Pain / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D015999:Multivariate Analysis; D009407:Nerve Block / Q000379:methods; D010147:Pain Measurement / Q000379:methods; D016037:Single-Blind Method; D014732:Vibration
chemical_list: D000779:Anesthetics, Local