Saeedi Pooya, Sarraf Shirazi Alireza, Ghorbani Mahsa
Department of Pediatric Dentistry, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
Int J Paediatr Dent. 2025 Jul;35(4):655-674. doi: 10.1111/ipd.13275. Epub 2024 Oct 6.
Injection pain remains a significant concern in dental procedures, often leading to patient anxiety and reluctance to seek necessary care.
This study aimed to assess the effectiveness of cryotherapy in reducing injection pain compared with topical anesthesia during intraoral local anesthesia.
MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL databases were searched up to November 2023. Inclusion criteria involved randomized clinical trials aligned with the PICO question. Study selection, data extraction, and risk of bias assessment using the ROB-2 tool were performed. The results were synthesized through a random-effects inverse variance meta-analysis. The primary outcomes assessed were the Visual Analogue Scale (VAS) and Sound Eye Motor (SEM). Subgroup analysis was conducted for children and adults.
In the meta-analysis, 31 RCTs involving 2470 subjects were included. Twenty-seven studies demonstrated cryotherapy's significant superiority over topical anesthesia in reducing injection pain via VAS in adults (p = .01), children (p = .01), and combined age groups (p < .001). Additionally, cryotherapy significantly outperformed topical anesthesia in reducing pain via SEM in children (p = .04) and combined age groups (p = .03) across 13 studies, with no significant difference in adults (p = .51). Furthermore, cooled topical anesthesia also outperformed room temperature topical anesthesia (p < .001). The certainty of the results, however, is of very low quality.
Our results indicate that cryotherapy significantly reduces injection pain compared with topical anesthesia, especially in children and combined age groups, but is less effective in adults. Additionally, cooled topical anesthesia is more effective than room temperature topical anesthesia. Thus, cryotherapy is a and potentially superior alternative to topical anesthesia, particularly for children.
注射疼痛仍是牙科手术中的一个重要问题，常常导致患者焦虑并不愿寻求必要的治疗。
本研究旨在评估与口腔内局部麻醉时使用表面麻醉相比，冷冻疗法在减轻注射疼痛方面的有效性。
检索了截至2023年11月的MEDLINE、科学网、EMBASE、Scopus和Cochrane中心数据库。纳入标准包括与PICO问题相符的随机临床试验。进行了研究选择、数据提取，并使用ROB-2工具进行偏倚风险评估。结果通过随机效应逆方差荟萃分析进行综合。评估的主要结局指标是视觉模拟量表（VAS）和声眼运动（SEM）。对儿童和成人进行了亚组分析。
在荟萃分析中，纳入了31项涉及2470名受试者的随机对照试验。27项研究表明，冷冻疗法在减轻成人（p = 0.01）、儿童（p = 0.01）和综合年龄组（p < 0.０01）通过VAS测量的注射疼痛方面显著优于表面麻醉。此外，在13项研究中，冷冻疗法在减轻儿童（p = 0.04）和综合年龄组（p = 0.03）通过SEM测量的疼痛方面显著优于表面麻醉，在成人中无显著差异（p = 0.51）。此外，冷却的表面麻醉也优于室温表面麻醉（p < 0.０01）。然而，结果的确定性质量非常低。
我们的结果表明，与表面麻醉相比，冷冻疗法能显著减轻注射疼痛，尤其是在儿童和综合年龄组中，但在成人中效果较差。此外，冷却的表面麻醉比室温表面麻醉更有效。因此，冷冻疗法是表面麻醉的一种潜在优越替代方法，特别是对儿童而言。
