Effect of Topical Anesthesia with Lidocaine-prilocaine (EMLA) Cream and Local Pressure on Pain during Infiltration Injection for Maxillary Canines: A Randomized Double-blind clinical trial.
OBJECTIVE
This study compared the effect of local pressure and topical lidocaine-prilocaine (EMLA) cream on pain during infiltration injection for maxillary canine teeth.


METHODS
A total of 140 volunteer students participated in this split-mouth design randomized clinical trial. The subjects were randomly divided into four groups (n = 35). Before administration of anesthesia, in each group, one side was randomly selected as the experimental and the opposite side as the control. In group 1, finger pressure was applied on the alveolar mucosa on the experimental side and on the tooth crown on the control side. In group 2, 5% EMLA cream and placebo; in group 3, finger pressure and 5% EMLA cream; and in group 4, 5% EMLA cream and 20% benzocaine gel were applied. In all the groups, a buccal infiltration procedure was carried out. Pain during injection was recorded with visual analog scale (VAS). Wilcoxon and McNemar tests were used for statistical analysis of the results. Statistical significance was set at p < 0.05.


RESULTS
The results showed that EMLA reduced the injection pain significantly more than benzocaine (p = 0.02). Also, injection pain was significantly lower with the use of EMLA in comparison to placebo (p = 0.00). Application of local pressure reduced the injection pain, but the difference from the control side was not significant (p = 0.05). Furthermore, the difference between application of local pressure and EMLA was not statistically significant (p = 0.08).


CONCLUSIONS
Topical anesthesia of 5% EMLA was more effective than 20% benzocaine in reducing pain severity during infiltration injection. However, it was not significantly different in comparison to the application of local pressure.
Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Amin S
AS
Milani
Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Vahid
V
Zand
Postgraduate Student, Dental and Periodontal Research Center, Department of Endodontics, Student Research Committee, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran, Phone: +989144091317, e-mail: ardalan_2000a@yahoo.com.
Amir A
AA
Abdollahi
Dental and Periodontal Research Center, Faculty of Dentistry Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Mohammad
M
Froughreyhani
Department of Pharmaceutics, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Parvin
P
Zakeri-Milani
Department of Biostatistics, Department of Statistics and Epidemiology, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
Mohammad A
MA
Jafarabadi
D000287:Administration, Topical; D000328:Adult; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001566:Benzocaine / Q000008:administration & dosage; D003481:Cuspid; D004311:Double-Blind Method; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008437:Maxilla; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011312:Pressure; D011318:Prilocaine / Q000008:administration & dosage*; D016896:Treatment Outcome
D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine; D001566:Benzocaine
Anesthesia; EMLA; Injection; Pain; Pressure; Topical; Visual analog scale.