21 March 2021

---

CCLADS: a helpful device for pediatric patients

Alessandra Abbà

---

Dentistry involves numerous procedures, first of all administration of anesthesia and dental extractions, which can be perceived as painful, mainly for children. 

The prevalence of dental anxiety in children varies from 5 to 40% and tends to decrease with age. Pain and anxiety are the principal obstacles for children undergoing dental procedures and can develop into dental phobia, leading patients to avoid dental controls or dental treatment with even worst results. 

Therefore reducing the level of anxiety and pain in child patients has been an issue for pediatric dentists.
Local anesthesia with periodontal ligament infiltration is one of the most widespread method. With the intraligamentary anesthesia (ILA), anesthetic solution is injected with pressure in the periodontal ligament (PDL) space of the tooth to be anesthetized. However high pressure is required to inject the anesthetic solution and this may lead to an unpleasant perception or even to a painful injection.
Even anesthetic in dentistry has benefitted from technological advances. In fact various computer-controlled local anesthetic delivery systems (CCLADSs) are now available to minimize the painful experience of ILA and to achieve a more precise and accurate delivery of local anesthetic solution to a single tooth via the intraligamental route.

The present study was conducted to compare pain perception and anesthetic efficacy of conventional ILA and the CCLADS ILA for extraction of primary molars.

Material and methods: 

82 children aged 6–13 years who were undergoing treatment- and in particular requiring a primary molar extraction- at the Department of Pediatric & Preventive Dentistry at ESIC Dental College were enrolled for this randomized controlled trial.
Half of the patients were given ILA of 2% lidocaine with 1:80,000 epinephrine with the conventional method, the other with a CCLADS.
Pain during injection and extraction was assessed using the Sound, Eye, Motor (SEM) scale and heart rate recording. Faces Pain Scale-Revised (FPS) scores were self-reported by patients. 

Results:
Treatment with conventional ILA registered values of both FPS and SEM significantly higher (p < .05).
Data referred to heart rate recording during conventional injection showed higher values, but not statistically relevant (p = .077). However significantly higher results were registered during extraction with anesthetic administered with conventional method (p = .009). 

Conclusions:
Pain is an experience that make dental treatment difficult for children and behavioral control is an essential part of the management of the pediatric patient. Dentists can take advantage of less traumatic local anesthesia techniques such as the CCLADS devices. ILA administered with CCLADS is an effective alternative for primary molar extractions.

For more info:  Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars