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Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 | 173
Shilpapriya, et al.: Dental vibe in pediatric dentistry
pressure applied from subject to subject over time. dental vibe or the topical anesthesia. The children
Recently, the Dental vibe® (Dental Vibe Inc.) was requiring at least two clinical sessions of operative
introduced into dentistry by Dr. Steven Goldberg, procedures preceded by a local anesthetic injection,
which delivers vibration in a sustained frequency as a one on either side of the same jaw were included
counter stimulation on to the site of injection thereby in the study. Fifteen children received Precaine Gel
alleviating pain. (Pascal International™) (containing 8% lignocaine
and 0.8% dibucaine) topical anesthetic gel prior to
It is a cordless, rechargeable, hand-held device that administration of local anesthesia injection, whereas
delivers soothing, pulsed, percussive micro-oscillations the remaining 15 received Dental vibe® (Dental Vibe
to the site where an injection is being administered and Inc.) during the first appointment and vice versa
gently stimulates sensory nerves [Figure 1]. It sends during the subsequent second appointment. Children
intermittent micro-sonic oscillations to the brain’s with a history of eventful dental experiences with
neurological pain sensors, closing the pain gate, local anesthesia injection and children with special
blocking the pain of injections and is also more useful health care needs were excluded.
for pediatric patients and those who have a phobia
of intraoral injection or pain as there is an audible Subjects were informed, and parental consent for the
distraction (70-75db) provided. Additionally, the same was obtained. Using basic behavior management
comfort tip provides gentle massaging of the injection techniques and euphemisms in the first appointment
site, through Vibra-Pulse Technology and prevents a the site of injection was isolated using cotton swab
swelling of the bolus of the anesthetic solution as it is and the topical Precaine anesthetic gel was applied
injected. This causes dissipation of the solution faster, with applicator tip for 30 s and then 2 ml of local
and causes a profound anesthetic effect and further anesthetic solution was deposited with the help of a
on application of increased pressure the device shuts 27 gauge needle (unilock, dispovan). In the second
down automatically. appointment on the opposite side of the same arch,
using tell show do technique the Dental vibe® (Dental
With this background, the present study was done Vibe Inc.) was introduced and applied to the injection
to evaluate and compare the efficacy of Dental vibe® site 1 min prior to the local anesthesia administration.
(Dental Vibe Inc.) and topical local anesthetic in The local anesthesia is administered by keeping the
split-mouth randomized clinical trial. needle as close as possible to one of the prongs and
the application of vibration continued for 10 s after the
removal of the needle as this helps in the dissipation of
Materials and Methods the local anesthetic solution.
The study was conducted by the Department of Universal pain assessment tool [Figure 2] was used
Pedodontics and Preventive Dentistry of Ragas to assess the pain for both the appointments during
Dental College and Hospital, Chennai. Thirty the administration of local anesthesia.[12,13] The patient
patients aged 6-12 years old of both the genders was asked to describe his/her pain verbally and it
with Frankel’s behavior rating scale as positive was marked according to his/her own subjective
and definitely positive requiring bilateral Local perception of pain on the universal pain rating scale
anesthesia injections for dental treatment were and the results obtained were statistically analyzed
included in the study. A random crossover design and tabulated.
was used so that each child served as his/her
own control with 15 children in each group. The
local anesthesia was delivered using either the
Results
Table 1 shows the comparison between the pain
intensity with and without the use of dental vibe.
Mann–Whitney test shows that reported mean pain
scores were significantly lower in children who had
174 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |
Shilpapriya, et al.: Dental vibe in pediatric dentistry
Table 1: Comparison between the pain score one sensation at a time. Therefore, the sensation that
with and without the use of dental vibe arrives at the brain first is the one that will be felt.
Hence as counter stimulation vibration reduces pain
Groups Mean Mean pain score P
age (mean ± SD) perception.[4,10]
Group I – (without vibe) (n=30) 7.5 2.73±0.87 0.001***
Group II – (with vibe) (n=30) 7.5 1.27±0.78 The utilization of this theory may be important
SD = Standard deviation; *** Statistically significant
especially in the very sensitive oral region where more
than a third of the cells in the somatosensory cortex
of the brain are devoted to sensory inputs from the
Dental vibe® (Dental Vibe Inc.) application during the mouth. In the orofacial region vibration, stimuli are
local anesthesia delivery compared to the other group easily applied and have been used to raise the pain
(P = 0.001). threshold to relieve pain of dental origin whether
pulpal, periodontal, or postsurgical.[17] Furthermore,
Discussion it has been suggested that pain reduction is greatest
in the orofacial region if the source of vibration is
The present study was undertaken to evaluate and applied not only within the area directly affected by
compare the efficacy of dental vibe with that of pain, but when the firmness of vibration application
topical local anesthetic (Precaine) in reduction of pain stimulates the underlying bone on the same side as
perception during the administration of local anesthesia the pain.[2,18-20]
injection. A split-mouth crossover design was planned
to standardize the patient pain threshold and the carry Based on this theory, several methods were developed
over effect. Further patients with Frankel’s behavior but they have been restricted to a vibrating needle or
rating scale as positive and definitely positive were only vibrating swab[21] or VibraJect®. VibraJect® enables a
included in the study to rule out the emotional factors less painful palatal injection because it delivers small
such as anxiety, previous eventful dental experiences amounts of anesthetic solution over a period.[7] They
and depression from influencing the study outcome also point out that dental vibe has improvements in
as emotional factors such as anxiety, worry, tension several structural features including vibration mode
and depression opens the pain gate thus increasing the bringing enhanced effectiveness to the method of
pain perception. using vibration in dental anesthesia injection. Keeping
these facts in mind, the present study was undertaken
In our study, topical anesthesia was chosen for and the results showed a significantly lesser pain score
comparison with the dental vibe as it is a standard (P < 0.001) in children who had dental vibe application
routine procedure followed prior to local anesthesia compared to topical anesthetic application (mean pain
administration.[11] Studies of the effectiveness of this score 1.27 ± 0.78 vs. 2.73 ± 0.87). Similar findings were
technique have had conflicting results, Minasian and observed by Blair using of VibraJect®.[20] In contrast;
Yagiela suggested that topical anesthesia might be Yoshikawa et al. found no significant pain reduction
more effective if the charged ions of an anesthetic agent when VibraJect® was applied with a conventional
were driven through the tissue by iontophoresis before dental syringe.[22] Saijo et al. found no statistically
insertion of a needle.[14] Other studies have suggested significant difference in pain perception when he
that topical anesthetics may be associated with toxic compared between VibraJect® and a conventional
sequelae because of the amounts of drug absorbed syringe in combination with anaject.[7]
through the mucosa and the relative toxicity of some
of the topical agents, Because of these problems, a However, no similar comparative studies were found
predictable means of pain control for injections is in relation to dental vibe. Hence, future studies can
desirable. Use of vibration was stated to be an effective be aimed to compare the effectiveness of Dental
alternative. The vibration might also be more effective vibe® (Dental Vibe Inc.) with similar kind of other
if it was continued during the injection or if a more devices available to reduce pain perception during the
effective vibration transfer device than the foam swab administration of local anesthesia.
were employed.[15]
Conclusion
The effects of vibration on pain have been reported in
both clinical and experimental settings. Interference Dental vibe® (Dental Vibe Inc.) is a useful accessory
stimulation such as vibration can relieve pain on device prior to the use of dental injection syringe and
the basis of the gate control theory.[13] Based on gate conventional intramuscular injections to alleviate
control theory mechanisms of pain relief induced by pain and stress of injection. From the aspect of the
vibration can be reduced by simultaneous activation patient pain management, this device contributes both
of nerve fibers that conduct nonnoxious stimuli.[15,16] physiologically (based on Gate Control Theory of pain)
When vibration is applied as a counter stimulation to and psychologically (based on the audible distraction
an anesthetic injection, it will reach the brain before of the device) and has shown to be a useful tool in
the pain sensation does. The brain can perceive only patient management.
Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 | 175
Shilpapriya, et al.: Dental vibe in pediatric dentistry
176 Journal of Indian Society of Pedodontics and Preventive Dentistry | Jul-Sep 2015 | Vol 33| Issue 3 |
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