title: Effect of Topical Anesthesia on Pain from Needle Insertion and Injection and Its Relationship with Anxiety in Patients Awaiting Apical Surgery: A Randomized Double-blind Clinical Trial.
abstract: BACKGROUND
  We aimed to simultaneously investigate the effects of topical anesthesia on needle insertion and injection pain in the labial mucosa of the maxillary central incisors of patients awaiting apical surgery and to assess the relationship between patients' anxiety and pain scores.
  
  
  METHODS
  Forty-four patients scheduled for apical surgery of the maxillary anterior incisor or canine were included, and all completed the Modified Dental Anxiety Scale (MDAS) questionnaire. One piece of Xylocaine (AstraZeneca, Sodertalje, Sweden) gauze was applied to the right or left side of the labial vestibule below the central incisor according to a randomization process, and 1 piece of water gauze was applied to the contralateral side of the labial vestibule. Each piece of gauze remained in place for 2 minutes. The subjects were asked to rate their pain according to the numeric rating scale immediately after needle insertion and anesthetic solution injection.
  
  
  RESULTS
  Topical anesthetic application significantly reduced both insertion- and injection-related pain. Injection pain was significantly higher than insertion pain throughout the experiment. The difference in pain scores between the placebo and topical anesthetic groups was significantly greater for insertion pain than injection pain. The group with higher MDAS scores showed significantly higher pain scores, except for insertion pain reported by the topical anesthetic group, which did not show a significant difference between MDAS score groups.
  
  
  CONCLUSIONS
  The topical anesthetic was highly effective for both insertion and injection pain during infiltration anesthesia in the maxillary central incisors. Highly anxious patients reported higher pain scores; however, topical anesthetics reduced the effect of anxiety on increasing pain.
authors.affiliation: Department of Dentistry and Institute for Translational and Clinical Research, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea.
authors.forename: Sin-Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Euiseong
authors.initials: E
authors.lastname: Kim
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Park
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Byoung-Duck
authors.initials: BD
authors.lastname: Roh
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Chan-Young
authors.initials: CY
authors.lastname: Lee
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.
authors.forename: Seung-Jong
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea. Electronic address: juen@yuhs.ac.
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001007:Anxiety / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control / Q000523:psychology*; D010147:Pain Measurement; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local
keywords: Anxiety; maxillary central incisors; pain; topical anesthesia