Ice versus lidocaine 5% gel for topical anaesthesia of oral mucosa - a randomized cross-over study

Nishma Hindocha, Filip Manhem, Emmanuel Bäckryd, Mats Bågesund, Nishma Hindocha, Filip Manhem, Emmanuel Bäckryd, Mats Bågesund

Abstract

Background: Topical anaesthesia is important to optimize pain control during dental injection. Our aim was to describe a new simple method for topical anaesthesia of oral mucosa and to compare the effectiveness of ice and lidocaine 5% gel for topical anaesthesia of oral mucosa.

Methods: A total of 40 patients aged 10.7-19.5 years were included. The side and method of application were both randomized. Heart rate was recorded, and discomfort and pain were evaluated with a visual analogue scale (VAS). A paired t-test was used to compare mean values, a chi2 test was used to compare proportions, and a Pearson correlation test was used to examine correlations between variables.

Results: When ice was used, buccal injection VAS pain was rated lower (p = 0.044), and VAS discomfort was rated higher (p = 0.001), in comparison to when lidocaine 5% gel was used. There was no significant difference in relative heart rate change between ice and lidocaine 5% gel at either needle stick or injection. Lidocaine 5% gel produced a relative heart rate reduction after palatal injection (0.99 ± 0.06) while buccal injection produced an increased relative heart rate (1.02 ± 0.08) (p = 0.010). Unpleasant taste was more frequently reported when lidocaine 5% gel was used (p = 0.025). An application time of 1 min was sufficient for both ice and lidocaine 5% gel to achieve pain reduction from needle stick in buccal mucosa.

Conclusion: The cheap and readily available described method using ice for topical anaesthesia of oral mucosa before dental injection is an effective alternative to lidocaine 5% gel.

Trial registration: The European Union Drug Regulating Authorities Clinical Trials Database EudraCT201300530531. Date of registration: February 10th, 2014.

Keywords: Administration; Anaesthesia; Ice; Lidocaine; Topical.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart describing the time schedule at each visit. Visual analogue scale (VAS) was used for evaluation of pain and discomfort according to the questionnaire presented in Table 1
Fig. 2
Fig. 2
Lidocaine 5% gel applied on the buccal mucosa
Fig. 3
Fig. 3
The 2.5 ml syringe was filled with ordinary tap water which was frozen at the clinic. A scalpel was used to cut off the tip of the syringe
Fig. 4
Fig. 4
Ice-filled syringe after cutting off the tip
Fig. 5
Fig. 5
The ice-filled applicator in the hand of the operator
Fig. 6
Fig. 6
Ice applied on the buccal mucosa

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