The Effect of Topical Anesthetic Gel versus Relaxation Exercise in Controlling the Pain of Anterior Maxillary Injection

The Open Dentistry Journal 31 December 2020 DOI: 10.2174/1874210602014010752


Background and Aim:

Adequate intraoral anesthesia is a major prerequisite for many dental procedures. Bubble breath exercise, distraction, and play therapy technique may be used as relaxation exercises to decrease pain. This study aimed to compare the efficacy of bubble breath exercise versus topical anesthetic gel in controlling the pain of anterior maxillary infiltration.


This crossover clinical trial was performed on 50 children aged 10-12 years. Subjects received a total of 100 maxillary injections (two per person) in the buccal mucosal area of canine teeth of both sides at intervals of 2 to 3 days. On one side, the injection was performed after applying 20% benzocaine gel. On the other side, a similar injection was performed after the bubble breath exercise. The injection solution was 1/4 of 1.8 mL cartridge of 2% lidocaine containing 1:200,000 epinephrine using a 30-gauge needle. The pain was measured immediately after anesthesia injection using a Visual Analogue Scale (VAS). Data analysis was carried out using SPSS Version 18.0 (IBM Inc., Chicago, IL, USA). Wilcoxon signed-rank tests were used to compare with the 10-mm visual analog scale (VAS) scores obtained from all participants. The level of significance was considered at 5% (p <0.05). The correlation between gender and pain score (VAS) for the two methods was analyzed using the Mann-Whitney U test.


The results showed no statistically significant difference between injection pain after topical anesthetic gel application and injection pain after bubble breath exercise (p value=0.30). Also, no statistically significant difference was found between injection pain after gel application and injection pain after bubble breath exercise in boys (p value=0.59) or girls (p value=0.32). There were statistically significant differences between boys and girls in terms of injection pain after gel application (p value=0.001) and also injection pain after e bubble breath exercise (pvalue=0.004).


There is no significant difference between perceived injection pain after bubble breath exercise and after applying the topical anesthetic gel. Furthermore, future studies should explore the role of age, dental fear, and anxiety, previous painful experiences, the pain thresholds.

Keywords: Pain, Injection, Infiltration, Relaxation exercise, Gender, Pain.
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