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      Pain perception following computer-controlled versus conventional dental anesthesia: randomized controlled trial

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          Abstract

          Background

          The administration of local anesthesia (LA) in dental practice requires an injection which is the leading cause of patients’ fear and anxiety. Computer-controlled local anesthetic injector, designed to reduce the pain of performing local anesthesia by controlling the speed of injection. This single-blind randomised control trial aimed to compare the pain perception after computer-controlled local anesthesia (CCLA) and conventional LA.

          Methods

          Dental students were both test and operator group versus an experienced dentist as additional operator of the LA. Data were collected regarding gender, age, medical condition, smoking habits. Additionally, operator feedback about the handling, pain at insertion and during infiltration, excitement (Dental Anxiety Scale), and complications were assessed.

          Results

          Out of the 60 included participants, the majority were females ( n = 41; 68.3%), medically healthy ( n = 54; 90%), and did not receive medications ( n = 54; 90%). While the participating students administered 62 (51.7%) injections, the experienced dentist administered 58 (48.3%) injections. The difference in pain perception on puncture between CCLA and conventional injections was not statistically significant ( Sig. = 0.285); however, pain perception during injection was significantly different ( Sig. = 0.029) between CCLA (1.65 ± 1.93) and conventional injections (2.49 ± 2.31).

          Conclusion

          The professional experience influenced the pain perception while applying the LA. CCLA did not reduce pain on puncture significantly; however, pain perception during the injection was significantly reduced in the case of using CCLA devices compared to the conventional syringe.

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          Most cited references60

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          CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials

          The CONSORT statement is used worldwide to improve the reporting of randomised controlled trials. Kenneth Schulz and colleagues describe the latest version, CONSORT 2010, which updates the reporting guideline based on new methodological evidence and accumulating experience. To encourage dissemination of the CONSORT 2010 Statement, this article is freely accessible on bmj.com and will also be published in the Lancet, Obstetrics and Gynecology, PLoS Medicine, Annals of Internal Medicine, Open Medicine, Journal of Clinical Epidemiology, BMC Medicine, and Trials.
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            Human brain mechanisms of pain perception and regulation in health and disease.

            The perception of pain due to an acute injury or in clinical pain states undergoes substantial processing at supraspinal levels. Supraspinal, brain mechanisms are increasingly recognized as playing a major role in the representation and modulation of pain experience. These neural mechanisms may then contribute to interindividual variations and disabilities associated with chronic pain conditions. To systematically review the literature regarding how activity in diverse brain regions creates and modulates the experience of acute and chronic pain states, emphasizing the contribution of various imaging techniques to emerging concepts. MEDLINE and PRE-MEDLINE searches were performed to identify all English-language articles that examine human brain activity during pain, using hemodynamic (PET, fMRI), neuroelectrical (EEG, MEG) and neurochemical methods (MRS, receptor binding and neurotransmitter modulation), from January 1, 1988 to March 1, 2003. Additional studies were identified through bibliographies. Studies were selected based on consensus across all four authors. The criteria included well-designed experimental procedures, as well as landmark studies that have significantly advanced the field. Sixty-eight hemodynamic studies of experimental pain in normal subjects, 30 in clinical pain conditions, and 30 using neuroelectrical methods met selection criteria and were used in a meta-analysis. Another 24 articles were identified where brain neurochemistry of pain was examined. Technical issues that may explain differences between studies across laboratories are expounded. The evidence for and the respective incidences of brain areas constituting the brain network for acute pain are presented. The main components of this network are: primary and secondary somatosensory, insular, anterior cingulate, and prefrontal cortices (S1, S2, IC, ACC, PFC) and thalamus (Th). Evidence for somatotopic organization, based on 10 studies, and psychological modulation, based on 20 studies, is discussed, as well as the temporal sequence of the afferent volley to the cortex, based on neuroelectrical studies. A meta-analysis highlights important methodological differences in identifying the brain network underlying acute pain perception. It also shows that the brain network for acute pain perception in normal subjects is at least partially distinct from that seen in chronic clinical pain conditions and that chronic pain engages brain regions critical for cognitive/emotional assessments, implying that this component of pain may be a distinctive feature between chronic and acute pain. The neurochemical studies highlight the role of opiate and catecholamine transmitters and receptors in pain states, and in the modulation of pain with environmental and genetic influences. The nociceptive system is now recognized as a sensory system in its own right, from primary afferents to multiple brain areas. Pain experience is strongly modulated by interactions of ascending and descending pathways. Understanding these modulatory mechanisms in health and in disease is critical for developing fully effective therapies for the treatment of clinical pain conditions.
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              Biostatistics 104: correlational analysis.

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                Author and article information

                Contributors
                sameh.attia@dentist.med.uni-giessen.de
                thomas.austermann@uniklinikum-giessen.de
                andreas.may@dentist.med.uni-giessen.de
                mekhemar@konspar.uni-kiel.de
                conrad@konspar.uni-kiel.de
                michael.knitschke@uniklinikum-giessen.de
                sebastian.boettger@uniklinikum-giessen.de
                HP.Howaldt@uniklinikum-giessen.de
                abanoub.riad@med.muni.cz
                Journal
                BMC Oral Health
                BMC Oral Health
                BMC Oral Health
                BioMed Central (London )
                1472-6831
                22 September 2022
                22 September 2022
                2022
                : 22
                : 425
                Affiliations
                [1 ]GRID grid.8664.c, ISNI 0000 0001 2165 8627, Department of Oral and Maxillofacial Surgery, , Justus-Liebig-University, ; Klinikstrasse 33, 35392 Giessen, Germany
                [2 ]GRID grid.9764.c, ISNI 0000 0001 2153 9986, Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, , Kiel University, ; Arnold-Heller-Str. 3, Haus B, 24105 Kiel, Germany
                [3 ]GRID grid.10267.32, ISNI 0000 0001 2194 0956, Department of Public Health, Faculty of Medicine, , Masaryk University, ; Kamenice 5, 625 00 Brno, Czech Republic
                [4 ]GRID grid.10267.32, ISNI 0000 0001 2194 0956, Czech EBHC: JBI Centre of Excellence, Institute of Biostatistics and Analyses, Faculty of Medicine, Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Masaryk University GRADE Centre), , Masaryk University, ; Kamenice 5, 625 00 Brno, Czech Republic
                Article
                2454
                10.1186/s12903-022-02454-1
                9502910
                36138388
                848a8090-96b6-432f-9504-a038bd74ba2f
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 11 December 2021
                : 9 September 2022
                Funding
                Funded by: Masaryk University grants
                Award ID: MUNI/A/1608/2020
                Funded by: Justus-Liebig-Universität Gießen (3114)
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Dentistry
                computed-controlled local anesthesia,dental anesthesia,dental education,local anesthesia,nerve block,pain perception,rct,split-mouth

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