Interventions to facilitate delivery of local anaesthetic in children and adolescents during dental treatment

Joana Monteiro, Ajit Tanday, Paul F. Ashley, Susan Parekh, Hamdan Alamri

Review question

With this Cochrane Review we tried to find out the best way to get children to accept receiving an injection of local anaesthetic during dental treatment.


It is important that children and adolescents receive dental treatment without pain so they have less anxiety and fear. It will also help them accept treatment in the future. Giving local anaesthetic, medication that temporarily stops the sense of pain in one small area of the body while the child stays awake and alert, will help to achieve this. However, it is not always easy to give children local anaesthetic. Some children do not cope well with the injection. There are a number of interventions that may help children accept dental local anaesthetic, however, there is no agreement over which is the best method.

Study characteristics

This review is up‐to‐date as of 24 May 2019. We included 26 studies with a total of 2435 children aged between 2 and 16 years. The studies were carried out between 2002 and 2019 in dental clinics in the UK, USA, the Netherlands, Iran, India, France, Egypt, Saudi Arabia, Syria, Mexico, and Korea.

We included studies comparing the use of different equipment like audiovisual glasses or a computerised device for injection called the wand, or dentist interventions like hypnosis, counter‐stimulation/distraction, video modelling, to increase the acceptance of delivery of local anaesthetic. These interventions were compared against delivery of local anaesthetic using a conventional syringe (usual care), or any other dental equipment or dentist intervention. Interventions were given just before the injection and others were given just before, during the injection, and continued during the dental treatment.

Key results

The evidence was uncertain for audiovisual distraction (using 3D video glasses as distraction) compared to conventional treatment. The evidence was uncertain when comparing the wand to conventional treatment. The evidence was also uncertain for counter‐stimulation/distraction compared to conventional treatment and for hypnosis compared to conventional treatment.

Other comparisons considered included pre‐cooling of the injection site, the wand versus another electronic system called Sleeper One, the use of a camouflage syringe, use of an electrical counter‐stimulation device, and video modelling. They had a single study each. The findings from these other comparisons were not enough to be able to decide on their effectiveness.

The included studies did not mention if there were any harmful effects of the different interventions.

Certainty of the evidence

The level of belief we have in these findings is very low. This was due to high risk of bias and the small number of people studied in the included trials.


We do not have enough evidence to say which intervention works better to increase acceptance of local anaesthetic in children and adolescents. We suggest that more well‐conducted studies should be done in this area.

Read the full review.

Monteiro  J, Tanday  A, Ashley  PF, Parekh  S, Alamri  H. Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment. Cochrane Database of Systematic Reviews 2020, Issue 2. Art. No.: CD011024. DOI: 10.1002/14651858.CD011024.pub2.