title: Cartridge syringe vs computer controlled local anesthetic delivery system: Pain related behaviour over two sequential visits - a randomized controlled trial.
abstract: BACKGROUND
  Local anesthetic injection is one of the most anxiety provoking procedure in dentistry. Knowledge about change in pain related behaviour during consecutive visits helps in and scheduling of treatment procedures and management of children in dental clinic.
  
  
  OBJECTIVE
  To compare the pain perception, behavioural response and the associated change in physiological parameters while receiving local anesthesia injection with cartridge syringe and computer controlled local anesthetic delivery system (CCLAD) over two consecutive visits.
  
  
  METHODS
  In this randomized controlled cross over trial, 120 children aged 7 - 11 years were randomly divided into group A: receiving injections with CCLAD during first visit; group B: receiving injections with cartridge syringe during first visit. The physiological parameters (heart rate and blood pressure) were recorded before and during injection procedure. Objective evaluation of disruptive behaviour and subjective evaluation of pain perceived were done using Face Legs Activity Cry Consolability (FLACC) scale and modified facial image scale (FIS) respectively.
  
  
  RESULTS
  No statistical difference in pain response (p= 0.164) and disruptive behaviour (p = 0.120) between cartridge syringe and CCLAD injections were seen during the first visit although the latter showed lesser scores. However, during the second visit there were significant increase in pain response (p = 0.004) and disruptive behaviour (p = 0.006) in cartridge syringe group with an associated increase in heart rate.
  
  
  CONCLUSIONS
  Injections with CCLAD produced lesser pain ratings and disruptive behaviour than cartridge syringe in children irrespective of order of visit.
  
  
  BACKGROUND
  Behaviour, cartridge syringe, CCLAD, local anesthesia.
authors.affiliation: Senior Lecturer, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: Yogesh-Kumar
authors.initials: YK
authors.lastname: Thoppe-Dhamodhara
authors.affiliation: Professor, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: Sharath
authors.initials: S
authors.lastname: Asokan
authors.affiliation: Professor and Head of Department, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: Baby-John
authors.initials: BJ
authors.lastname: John
authors.affiliation: Reader, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: GeethaPriya
authors.initials: G
authors.lastname: Pollachi-Ramakrishnan
authors.affiliation: Reader, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: Punithavathy
authors.initials: P
authors.lastname: Ramachandran
authors.affiliation: Senior Lecturer, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, TamilNadu, India.
authors.forename: Praburajan
authors.initials: P
authors.lastname: Vilvanathan