Open Journal of Stomatology, 2011, 1, 84-91
doi:10.4236/ojst.2011.13014 Published Online September 2011 ( OJST
Published Online September 2011 in SciRes.
Comparation of the eutectic mixture of lidocaine/prilocain
versus benzocaine gel in children
Ana Maria Leyda1, Carmen Llena2*
1Private practice in Pediatric Dentistry, Valencia, Spain;
2Department of Stomatology, University of Valencia, Valencia, Spain.
Email: *
Received 2 June 2011; revised 15 August 2011; accepted 25 August 2011.
Obje ctive: To compare the anesthetic effect of a non
commercial eutectic mixture of 4% lidocaine/
prilocaine (PLO 4%) and 20% benzocaine gel (Hur-
ricaine®), as topical anesthetic, prior to inferior al-
veolar nerve block and buccal infiltration anesthesia
in 5 - 12 year old children. Study design: Infiltrative
anesthesia was applied in 50 children, divided in two
groups (n = 25) using PLO 4% and Hurricaine® as
topical anesthesia prior to infiltration. Physical reac-
tions were registered using the Sound-Eyes-
Motor Scale. Physiological changes expressed by ar-
terial pressure and heart rate. Subjective pain re-
sponse was scored on a Facial Image Scale. Physical
physiological and subjective response was related to
the type of topical anesthetic, age and sex using χ2
and Mann-Whitney U test. Results: Physical resp-
onses to puncture were similar and localized in the
state of comfort with both anesthetics. Girls showed
more ocular response than boys. Subjective pain
perception and physiological reactions showed no
anesthetic- or sex-related differences, except for
heart rate before and after the procedure which was
significantly higher in girls. Conclusions: PLO 4%
showed the same capacity as Hurricaine® in reduc-
ing pain response to needle puncture. Girls ex-
pressed more needle puncture-related pain than boys.
The young children showed most prior comfort and
less discomfort to the puncture than older children.
Keywords: Lidocaine; Prilocaine; Benzocaine; Topical
In-office dental procedures are associated with discom-
fort and pain for most people. For the part of the popula-
tion which has to v isit the dentist, this association g ener-
ates fear and anxiety. If the patient is a child, controllin g
any discomfort and/or pain in dental procedures is fun-
damental and key to ensuring pleasant, safe and effective
treatment. For this purpose local anesthetics (LA) are
routinely used in pediatric dentistry [1].
However, the application of local anesthesia is often
frightening because it is associated with the use of nee-
dles, punctures and pain [2]. Together with cavity pre-
paration by turbine, the application of anesthesia is one
of the procedures which generate the greatest fear and
anxiety in pediatric patients and dentists themselves [3].
Local anesthesia is, however, a basic technique in han-
dling patient behavior because an effective anesthetic
technique will provide a relaxed patient, quality, effec-
tive work and satisfied parents.
To mitigate the sensation of discomfort produced by
needle insertion, various resources and procedures are
used [4-8]; some are psychological procedures, such as
distraction or suggestion, others physical procedures,
such as warming the anesthetic solution , administering it
very slowly (1 ml/min) to avoid the discomfort caused as
the anesthetic liquid distends the tissue and injecting the
anesthetics at a lower pressure of 306 mm/Hg [5]. Me-
chanical resources are also used such as generating other
simultaneous sensations to distract the child’s attention
and temporarily block the transmission of nociceptive
messages (Aδ and C fibres) or using needles with cali-
bers below N 27 because there is less perceived pain in
the mandibular block technique with smaller caliber
needles [6,7]. Another group of resources is based on the
prior surface anesthetic of oral mucosa by cooling,
transcutaneous electronic nerve stimulation or the use of
topical anesthetics (TA) [8].
The high concentrations of TA diffuse through the
epithelium and act on the mucosa nerve endings, block-
ing them. This decreases the painful sensation generated
by needle insertion. Currently, TA can be found in dif-
ferent presentations and compositions. However, they
still need to be combined with the other resources men-
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91 85
tioned above and even so, do not totally mitigate the
discomfort generated by needle insertion when applying
the local anesthetic [9].
Studies on topical anesthetics seek an agent which
meets a series of characteristics indicated as “ideal”. A
powerful, low dose TA is needed which is rapidly ab-
sorbed by the keratinized and non-keratinized mucosa,
remains in contact with the tissue to be anesthetized for a
long time to increase the depth of the action of the agent
and with characteristics which make it useful for pediat-
ric use: pleasant flavor, smell, color and texture [8].
These studies focus on the design and evaluation of
new TA preparations which meet these conditions [10]
and the present study has a similar aim, as its purpose is
to compare the anesthetic effect of a non commercial
eutectic mixture of 4% lidocaine and prilocaine (LPO
4%) as topical anesthetic on the oral mucosa, prior to
inferior mandibular and buccal nerve block anesthesia in
5-12 year old children, comparing the results with 20%
benzocaine gel (H u rri cai n e®).
2.1. Subjects
The study population w as children be tween the ages of 5
and 12 who attended two private dental clinics in the
province of Valencia, Spain and the Dental Clinic at the
Faculty of Dentistry at CEU Cardenal Herrera Univer-
sity in the town of Moncada (Valencia, Spain) between
May and November 2008.
The sample was chosen using a consecutive sampling
system. Children who met the following criteria were
included in the study: at least 5 years old but under the
age of 13, needing clinical procedures which involved
mandibular nerve block and understanding Spanish. Ex-
clusion criteria were: having physical limitations which
might alter or require modifications in the local troncular
anesthesia, having psychological or sensorial limitations,
emotional limitations or a history of non collaborative
behavior with the dental treatment, having a systemic
pathology which contraindicated the use of local anes-
thetics and arriving for treatment with pain or dental
2.2. The Anesthetic and the Needle
The anesthetics used in the study were 20% benzocaine
gel (Hurricaine®) and 4% lidocaine and prilocaine
ointment (LPO 4%), both prepared for this study in sin-
gle dose 0.5 gram tubes.
Local anesthesia was applied in all cases with dispos-
able sterile 25 mm 30 caliber dental anesthesia needles
(Normon jet plus®).
2.3. Measurement of Arterial Pressure, Heart
Rate, Physical Reactions and Subjective
Pain Perception
Patient physiology was measured using a hand-held
pulse oximeter (LTD810, Moretti) and a wrist device to
measure arterial pressure (Omrom, RX 3).
Physical reactions were measured on the Sound-Eyes-
Motor scale (Table 1) designed by Doctor Wright [11], a
scale frequently used in pediatric dentistry studies as it
enables an assessment of the relationship between pain
and the reactions the sensation of pain generates in the
patient’s eyes, movements and verbal expressions of
discomfort and also the degree of intensity of the sensa-
tion of pain [11].
Subjective pain perception was scored on the facial
images scale (FIS) [12] (Figure 1) which has 5 faces
with a number assigned from 1 to 5.1 coincides with the
face expressing the most happiness and 5 with the most
sadness.The intermediate numbers express intermediate
emotions between these two. Scoring is towards which
face the child most identifies with at that moment [12].
2.4. Registered Variables
The variables registered on the patient record were: sex,
age, clinical center, variables used to evaluate patient
physical reactions to puncture on the Sound-Eyes-Motor
scale, variables to record each patient’s subjective per-
ception of puncture on the Facial Images Scale, variables
related to physiological changes; heart rate, recorded at
the beginning of the session, at the moment of puncture
and arterial pressure recorded at the start and end of the
2.5. Procedures
In all the patients the process of adapting to the dental
clinic was respected and treatments were progressively
introduced by order of difficulty, but in all cases the ap-
pointment included in the study was the first mandibular
nerve block done on the patient .
The type of topical anesthesia applied to each patient
was chosen alternatively by the operator, without bear-
ing in mind age and sex of the patients. All odd-num-
bered patients in the study received 20% benzocaine gel
and all even-numbered patients received the LPO 4%.
All the anesthesia was carried out by the same operator
unifying the manner of applying the injection and the
pre- and post-injection instructions and information
given to the patients. A prior study was carried out in 10
patients with the same characteristics to systematize and
protocolize the process.
We take in mind ethical considerations of Helsinki
declaration in 1975 revised in 2000. Before the start of
the session and after checking that the child met the cri-
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91
Table 1. Sound-Eyes-Motor scale [12].
Observations 1.- Comfort 2.-Slight discomfort 3.- Moderate pain 4.-Pain
Sound No sounds
indicating pain Non specific sounds which may
indicate pain. Specific verbal complaints
raising voice. Verbal complaints
indicating intense pain.
Eyes No ocular signs of
Eyes wide open.
Shows concern.
No tears.
Watery eyes.
Blinking eyes. Crying.
Tears rolling
down the face.
Relaxed hands
apparently relaxed.
Hands show stress or tension.
Grasps hold of chair.
Muscular tension.
Arm or body movements
with no aggressive intention
Physical contact.
Pulling faces or grimacing.
Hand movement for
aggressive contact.
Figure 1. Facial image scale [13].
teria for inclusion in the study, the father, mother or
guardian was given an information sheet and a verbal
explanation by the operator. After the information, in-
formed consent was requested and when signed was
added to the patient data record card.
When the patient was comfortably seated in the dental
chair, the operator asked about his/her level of pain and
feeling of comfort at that moment, the assistant took the
arterial pressure and checked heart rate with the pulse
oximeter. Then the patient was given the necessary in-
structions and information about all procedures and
placed in the supine position in the dental chair. The
operator dried the area for topical anesthetic with sterile
gauze for 60 seconds to eliminate the saliva and mucins
which cover oral mucosa and the keratinzed layer of the
epithelium was swabbed to favor subsequent TA absorp-
tion. While the operator dried the mucosa, the assistant
collecte d the con tent of the s ingle dose of TA on a swab.
The operator applied the TA on the dry and swabbed
area for 2 minutes, placing an aspirator in lingual side of
the jaw to prevent TA contact with saliva and movement
in the place of application. After the established time, the
area was washed with abundant water to eliminate TA
Local anesthesia was administered using the distrac-
tion technique, preventing the patient from seeing the
needle. The puncture was made with a vibrating move-
ment of the cheek; at that moment the assistant recorded
the heart rate marked on the pulse oximeter. This value,
together with ocular, motor or verbal reaction generated
at the moment of the puncture, was recorded on the card.
On finishing injection of local anesthetic, the pulse oxi-
meter was withdrawn from the patient’s finger and the
patient was allowed to rinse his/her mouth. When the
treatment had finished, the operator asked the patient
again about his/her level of pain and feeling of comfort
at that moment, and the assistant took his/her arterial
pressure. All the values were recorded on the card.
2.6. Statistical Analysis
Data were analyzed using SPSS 15.0 software (SPSS,
Inc, Chicago, Ill); a descriptive analysis of the results
was made. Age was recoded in two groups: children
from 5 to 8 years old, and children from 9 to 12 years
old. The variables for physical reactions and the patient’s
subjective sensation and the type of anesthesia were
compared with recoded age, sex and type of anesthetic
using the Chi-Square test. Mann-Whitney’s U test was
used to relate physiological reactions with sex, recoded
age and type of anesthesia, for a confidence level of
3.1. Sample Description
Of the 53 patients chosen to take part in the study, 3
were not included because of a background of disruptive
behavior in office, the three were girls and so a total of
50 individuals took part in the study: 24 males (48%)
and 26 females (52%) between the ages of 5 years and
one month and 12 years and 11 months, with an average
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91 87
age of 8 years and 5 months (standard dev iation = 2.29).
During treatment, half the patients received benzocaine
gel as TA and the ot her half, LPO 4%.
Physical reactions to puncture were grouped accord-
ing to the three variables in the sound-eyes-motor scale.
For the variable sound, 90% (45) of the participants had
expressions compatible with well being; of the remain-
ing 10%, 4 had expressions compatible with slight dis-
comfort and one with moderate pain. For the variable
“eyes”, 90% (45) of the patients had reactions compati-
ble with well being; of the remaining 10%, 4 showed
reactions compatible with slight d iscomfort and one with
moderate pain. Finally, for the variable “motor”, 86%
(43) of the patients had reactions compatible with well
being; of the remaining 14%, 4 showed reactions com-
patible with slight discomfort and 3 with moderate pain.
The patients’ own perception of well being and pain,
collected on the facial image scale gave the following
results: 86% of the patients (43) felt very well when they
sat down on the dental chair and had no pain (value 1 on
the scale). The remaining 14% (7) felt simply well
(value 2 on the scale). At the end of the session 74% of
the patients (37) felt v ery well and without pain (value 1
on the scale); while 22% (11) felt simply well (value 2
on the scale) and 4% felt not well (value 3 on the scale).
3.2. Relationship between Anesthetic and
Physical Reactions
The variables registered on the sound-eyes-motor scale
showed no significant differences in relation to the an-
esthetic used with 90% in the situation of comfort (Table
3.3. Relationship between Sex and Physical
Analysis by sex, shows a greater motor, ocular and ver-
bal reaction to puncture in females than males, and ac-
quired statistical significance in the variable “eyes”
where it was found that males experience significantly
greater comfort than females (p = 0.03) (Table 2).
3.4. Relationship between Age and Physical
Using the “sound, eyes, motor” scale for the expression
of discomfort through sounds, no 5 - 8 years old children
showed discomfor t after punctur e, but 21 .1% (4) of the 9
- 12 years old children expressed a uncomfortable per-
ception through unspecific sounds (p = 0.017).
3.5. Relationship between Anesthetic and
Subjective Perception of Pain
Comparison of the two TA, in relation to the subjective
perception of pain and comfort recorded by applying the
facial image scale at the beginning and end of treatment
gave practically the same results, mainly located in the
state of comfort (Table 3).
3.6. Relationship between Sex and Subjective
Perception of Pain
The results were also very similar for males and females
mainly located in th e state of comfor t (Table 3).
3.7. Relationship between Age and Subjective
Perception of Pain
Depending on the age of patients, we found a significant
association for comfort perception and pain, through the
pain facial scale used; so, 96.98% of the 5 - 8 years old
children (30) felt very well and without pain when sited
at the clinical chair (score 1 from the scale); the rest,
3.2% (1), felt simply well (score 2); while in the group
of 9 - 12 years old, 68.4% of the ch ild ren showed a scor e
1 and 31.6% a score 2 (p = 0.009).
Table 2. Comparison by type of anesthestic and sex of the Sound-Eyes-Motor scale’s scoring (significant value in bold).
n Comfort Slight discomfort Moderate pain p
LPO4% 25 23 (92%) 1 (4%) 1 (4%) 0.52
Hurricaine 25 22 (88%) 3 (12%) 0
Male 24 23 (95.8%) 1 (4.2%) 0 0.34
Female 26 22 (84.6%) 3 (11.5) 1 (3.8%)
LPO4% 25 23 (92%) 2 (8%) 0 0.62
Hurricaine 25 22 (88%) 2 (8%) 1 (4%)
Male 24 24 (100%) 0 0 0.02
Female 26 21 (80.8%) 4 (15.4%) 1 (3.8%)
LPO4% 25 22 (88%) 1 (4%) 2 (8%) 0.51
Hurricaine 25 21 (84%) 3 (12%) 1 (4%)
Male 24 23 (95.8%) 1 (4.2%) 0 0.14
Female 26 20 (76.9%) 3 (11.5%) 3 (11.5%)
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91
Table 3. Subjective perception of pain using the “Facial Image Scale” by type of anesthetic and sex.
n 1 2 3 4 5 p
LPO4% 25 21 (84%) 4 (16%) 0 0 0
Hurricaine 25 23 (88%) 3 (12%) 0 0 0 0.50
Male 24 22 (91.7%) 2 (8.3%) 0 0 0
Female 26 21 (80.8%) 5 (19.25%) 0 0 0 0.24
LPO4% 25 20 (83%) 4 (16%) 0 0 0
Hurricaine 25 17 (68%) 7 (28%) 1 (4%) 0 0 0.36
Male 24 18 (75%) 5 (20.8%) 1 (4.2%) 0 0
Female 26 19 (76%) 6 (24%) 0 0 0 0.57
3.8. Relationship between Anesthetic and
Arterial Pressure Modification
The initial and final measurement of arterial pressure
provided six values for each patient: systolic pressures
(initial and final) and the difference between the two;
two diastolic pressures (initial and final) and the differ-
ence between the two. After the procedure a clear modi-
fication of arterial pressure was observed but with no
significant differences between them (Table 4).
3.9. Relationship between Sex and Arterial
Pressure Modification
In relation to sex, patients of both sexes experienced
similar modifications in arterial pressure (Table 4).
3.10. Relationship between Anesthetic and Heart
Rate Modification
Analysis of heart rate modification on puncture gave
similar results. After the procedure a clear modification
of heart rate was observed but with no significant dif-
ferences between them (Table 5).
3.11. Relationship between Sex and Heart Rate
Difference between initial and final heart rate was sig-
nificantly higher in females (p = 0.04) (Table 5).
Although currently the effectiveness of TA in reducing
pain associated to intraoral injection of LA is much de-
bated, it is certainly much used in pediatric dentistry
Multiple factors are involved in pain perception, in-
cluding psychological factors such as personality, fear,
anxiety and the sensation of control over pain producing
agents or pain itself [2].
The results of this present study sho wed no difference
between the puncture pain felt and perceived with the
two TA studied.
20% Benzocaine gel is an ester-type anesthetic, with a
fast onset of action of approximately 3 0 second s [13,14],
a pleasant taste, a longer duration than other TA and a
low level of systemic absorption making it safe for use
in children [11]. However, its main disadvantage is low
bioadhesivity [4,15,16].
LPO4% is a non commercial eutectic mixture of 4%
lidocaine and prilocaine. Both these anesthetics, which
belong to the amide family, are less likely to provoke
allergic reactions than ester anesthetics and are ex-
tremely similar to the anesthetic used for infiltration an-
esthesia (2% lidocaine with epinephrine at 1:100,000),
also an amide. The galenic formula of LPO4% is
achieved with high occlusive, self-emulsifying bases,
thanks to the inclusion of ethoxylated lanolin and a
commercialized cosmetic base oil in water emulsion. It
is a greasy product which waterproofs the mucosa, fa-
voring greater localization and concentration of the
product in the area to be anesthetized. The euctectic
mixture of lidocaine and prilocaine significantly in-
creases the anesthetic power of the two components in-
dividually and solves the problem of solubility in these
anesthetic molecules so they can be included in their
most effective but least soluble base form, the only form
which can cross the nervous fiber membrane, and so pKa
must be greater than 7.4. The topical anesthetic “LPO4%”
has a pH of 8.4 [13]. Its pink color and strawberry-
pineapple taste make it acceptable to the pediatric popu-
lation [16]. As LPO4% is a non commercialized anes-
thetic preparation there are no previous studies on its
effectiveness in comparison to other TA for the same
uses. In contrast, there are many studies on benzocaine
gel as it is currently the most popular topical anesthetic,
the most used and the most recommended in general and
pediatric dentistry [13, 16] as it is well accepted by chil-
dren and professionals.
Studies in children show in some cases a slight supe-
riority of 20% benzocaine gel over other agents [13,17].
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91 89
In contrast, some studies show greater effectiveness
against pain of other agents, in particular 20% lidocaine
patches [16]. Other studies found that 20% benzocaine
gel was effective but not more than the other agents
which it was compared with [9,14]. This present study
can be included in this group of studies as it compares
the effectiveness of reducing injection pain of 20% ben-
zocaine gel and the eutectic mixture of 4% lidocaine and
prilocaine in a group of children between the ages of 5
and 12. The authors found no objective evidence for the
greater effectiveness of either of the two agents in re-
ducing needle insertion pain.
Table 4. Arte ria l pre ssure changes by type of anesthetic an d se x. ISP: initaial systolic presure, FSP: final systolic presure, IDO: initial
diastolic presure, FDP: final diastolic presure.
n Mean SD p
LPO4% 25 54.60 13.9
Hurricaine 25 58.90 16.38
Total 50 56.75 14.95
Male 24 56.50 16.74
Female 26 57.13 12.88
Total 50 56.75 14.95
LPO4% 25 54.00 9.62
Hurricaine 25 60.00 22.22
Total 50 57.00 16.95
Male 24 60.75 20.02
Female 26 51.38 9.45
Total 50 57.00 16.95
LPO4% 25 97.10 14.34
Hurricaine 25 90.60 11.99
Total 50 93.85 13.29
Male 24 92.00 15.29
Female 26 96.63 9.85
Total 50 93.85 13.29
LPO4% 25 98.40 12.25
Hurricaine 25 92.00 18.57
Total 50 95.20 15.66
Male 24 99.00 18.40
Female 26 89.50 8.50
Total 50 95.20 15.66
LPO4% 25 –0.60 11.87
Hurricaine 25 1.10 18.65
Total 50 0.25 15.24
Male 24 4.25 12
Female 26 –5.75 18.32
Total 50 0.25 15.24
LPO4% 25 1.30 10.28
Hurricaine 25 1.40 28.02
Total 50 1.35 20.54
Male 24 7.00 22.05
Female 26 –7.13 15.64
Total 50 1.35 20.54
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91
Table 5. Heart rate modification by type of anesthetic and sex IHR: initial hearth rate, FHR: final heart rate.
n Mean SD p
LPO4% 25 80.90 9.32
Hurricaine 25 83.70 14.97
Total 50 82.30 12.22
Male 24 82.75 10.00
Female 26 81.63 15.73
Total 50 82.30 12.22
LPO4% 25 91.70 18.99
Hurricaine 25 92.80 12.77
Total 50 92.25 15.76
Male 24 88.92 11.09
Female 26 97.25 20.82
Total 50 92.25 15.76
LPO4% 25 10.80 17.56
Hurricaine 25 9.10 13.49
Total 50 9.95 15.27
Male 24 6.17 10.84
Female 26 15.63 19.68
Total 50 9.95 15.27
Although our study shows no objective evidence of
greater effectiveness of LPO4% than Hurricaine® in
reducing needle insertion pain; it was not found to be
less efficient and, therefore, more studies are required to
analyze other parameters such as greater safety, as it is
fully similar to the anesthesia used for infiltration anes-
thesia and has a greater capacity to waterproof the mu-
cosa favoring better localization and concentration of
product in the area to be anesthetized, preventing it from
being mixed with saliva. This would solve the greatest
problem found with 20% benzocaine gel which is the
lack of bioadhesivity to the oral mucosa which generates
movement from the site of application to the surrounding
mucosa, reducing the anesthetic effect on the tissue and
sometimes causing patient discomfort [4,15,16]. Another
possible advantage of LPO4% is its pink color and
strawberry-pineapple taste which would favor accep-
tance by the pediatric population.
Analysis of the data has shown an interesting rela-
tionship between sex of the participants and their reac-
tion to puncture of the mucosa previously treated with
TA, with more intense ocular reaction in females than
males. In our study, 5 of the 26 girls showed ocular and
motor expressions which did not coincide with comfort,
and 4 of them were between the ages of 7 and 9. No boy
at that age showed any level of discomfort during the
local anesthesia procedure.
The children between 5 and 12 years old show typical
characteristics of this stage in the different areas of de-
velopment, such as desire for productive work, thereby
increasing feelings of competition; children are afraid of
the imaginary, of bodily harm, loss of image and dete-
riorated self-esteem. They are intensely preoccupied and
anxious about imaginary rather than real causes.
Related to dental fear, differences between sexes seem
to be inexistent, at least in the occidental societies, al-
though studies show different results, sex and age are in
fact co-factors modulated by other variables such as the
patient’s culture, socio-economic situation, etc. In fact,
only after reaching certain ages do differences in behav-
ior and anxiety levels among girls and boys become
evident [18,19]. Taylor et al. compared the behavior of
boys and girls and only after the age of 7 and during the
application of local anesthesia did they find that boys
showed fewer expressions of discomfort and negative
behaviors than gi rl s [2 0] .
Studies concluded that girls showed more fear than
boys. Not that they felt more fear, but that they showed it,
because boys behave better than girls when they are
given strict instructions about how to behave [21],
opyright © 2011 SciRes. OJST
A. M. Leyda et al. / Open Journal of Stomatology 1 (2011) 84-91 91
showing that girls had significantly higher levels of den-
tal anxiety than boys even in adolescent patients with
greater levels of personal maturity [22].
As a result of this study we can conclude that LPO4%
was as capable as Hurricaine® in reducing pain gener-
ated by needle puncture for local anesthesia infiltration.
When faced with needle puncture for local infiltration
anesthesia by mandibular and buccal nerve block in 5 to
12 years old, girls expressed more pain by ocular ex-
pression than boys and a significant increase in heart rate
was found in girls at the end of the therapeutic treat ment.
By age, children from 9 to 12 years old expressed more
discomfort by sound expression than children from 5 to
8 years old. In the same way the younger children ex-
pressed more wellness before the procedure than older
[1] Meechan, J.G. (2009) Pain control in local analgesia.
European Archives of Paediatric Dentistry, 10, 71-76.
[2] Kudo, M. (2005) Initial injection pressure for dental local
anesthesia: Effects on pain and anxiety. Anesthesia Pro-
gress, 52, 95-101.
[3] Peretz, B. and Efrat, J. (2000) Dental anxiety among
young adolescent patients in Israel. International Journal
of Paediatric Dentistry, 10, 126-132.
[4] Hersh, E., Houpt, M.I., Cooper, S.A., Fedman, R.S., Wolf,
M.S. and Levin, L.M. (1996) Analgesic efficacy and
safety of an intraoral lidocaine patch. Journal of the
American Dental Association, 127, 1626-1634.
[5] Ram, D. and Peretz, B. (2001) Administering local an-
aesthesia to paediatric dental patients—current status and
prospects for the future. International Journal of Paedi-
atric Dentistry, 12, 80-89.
[6] Ram, D., Hermida, B.L. and Amir, E. (2007) Reaction of
children to dental injection with 27- or 30-gauge needles.
International Journal of Paediatric Dentistry, 17, 3 83-387.
[7] Flanagan, T., Wahl, M.J., Schmitt, M.M. and Wahl, J.A.
(2007) Size doesn’t matter: Needle gauge and injection
pain. General Dentistry, 55, 216-217.
[8] Meechan, J.G. (2002) Effective topical anesthetic agent
and techniques. Dental Clinics of North America, 46, 759-
766. doi:10.1016/S0011-8532(02)00035-6
[9] Kreider, K.A., Stratmann, R.G., Milano, M., Agostini, F.
and Munsell, M. (2001) Reducing children’s injection
pain: Lidocaine patches versus topical benzocaine gel.
Paediatric Dentistry, 23, 19-23.
[10] Kohli, K., Crout, R. and Linscott, C. (2000) A survey of
local and topical anesthesia use by pediatric dentists in
the United States. Paediatric Dentistry, 23, 265-269.
[11] Wright, G.Z., Weinberger, S.J., Marti, R. and Plotzke, O.
(1991) The effectiveness of infiltration anesthesia in the
mandibular primary molar region. Paediatric Dentistry,
113, 278-283.
[12] Buchanani, H. and Niven, N. (2002) Validation of a Fa-
cial Image Scale to asses child dental anxiety. Interna-
tional Journal of Paediatric Dentistry, 12, 47-52.
[13] Primosch, R.E. and Rolland-Asensi, G. (2001) Compari-
son of topical EMLA 5% oral adhesive to benzocaine
20% on the pain experienced during palatal anesthetic
infiltration in children. Paediatric Dentistry, 23, 11-14.
[14] Stecker, S.S., Swift, J.Q., Hodges, J.S. and Erickson, P.R.
(2002) Should a mucoadhesive patch (Dentipatch®) be
for gingival anesthesia in children? Anesthesia Progress,
49, 3-8.
[15] Lim, S. and Julliard, K. (2001) Evaluating the efficacy of
EMLA topical anesthetic in sealant placement with rub-
ber dam. Paediatric Dentistry, 26, 497-500.
[16] Wu, S.J. and Julliard, K. (2003) Children’s preference of
benzocaine gel versus the lidocaine patch. Paediatric
Dentistry, 25, 401-405.
[17] Tulga, F. and Mutlu, Z. (1999) Four types of topical an-
esthetic agents: Evaluation of clinical effectiveness.
Journal of Clinical Paediatric Dentistry, 23, 217-220.
[18] Folayan, M.O., Idehen, E.E. and Ojo, O.O. (2004) The
modulating effect of cultura on the expresión of dental
anxiety in children: A literatura review. International
Journal of Paediatric Dentistry, 19, 225-232.
[19] Corkey, B. and Freeman, R. (1994) Predictors of dental
anxiety in six-year-old children: Findings from a pilot
study. Journal of Dentistry for Children, 5, 267-271.
[20] Taylor, M.H., Moyer, I.N. and Peterson, D.S. (1983)
Effect of appointment time, age and gender on children´s
behavior in dental setting. Journal of Dentistry for Chil-
dren, 50, 106-110.
[21] Malamed, S. (2009) What’s new in local anaesthesia?
Society for the Advancement of Anaesthesia in Dentistry,
25, 4-14.
[22] Kawamura, M., Takase, N., Sasahara, H. and Okada, M.
(2008) Teenagers’ oral health attitudes and behavior in
Japan: Comparison by sex and age group. Journal of
Oral Science, 2, 167-174. doi:10.2334/josnusd.50.167
opyright © 2011 SciRes. OJST