Acupressure vs topical gel as preanesthetic technique in children A split mouth study.

Local anesthetic injections are one of the most painful and disturbing dental procedures to be performed during pediatric dental treatment. Administration of local anesthesia (LA) is the first and foremost prerequisite for most invasive procedures in pediatric dentistry.  Local anesthesia needs to be deposited as close to the nerve as possible so that optimal diffusion of the drug may occur, providing profound  anesthesia and a pain-free dental experience for the kids. The importance of this is demonstrated by the fact that when pediatric patients’ parents were asked to list the most important factors used when selecting an exodontist, the two most important are: a pedodontist who does not hurt and a painless injection.  Cooperation of children, using proper pain control method during dental procedures, remains elusive in pediatric dentistry.  Effective pain control in children during regional dental injections is important to achieve comfort, cooperation, and compliance with dental care. For a comfortable treatment, it is important to have a pain-free method of administering local anesthesia for a dental patient. Topical anesthetics are an advantage to dentists in their attempts for pain-free injections. Topical anesthetics control pain perception and they have the ability to cross the oral mucosal membrane and produce analgesia. They block the conduction of signals from the terminal fibers of the sensory nerves, thereby producing surface anesthesia for a depth of 2–3 mm. Topical anesthetic gel/ointment is easily available and is not technique sensitive. Hence, topical anesthetic gel/ointment has become the “holy grail” of painless technique of local anesthesia in pediatric dentistry. There are various topical anesthetic agents available ranging from gels to sprays. Benzocaine is most widely used by dentists, and it is rapidly absorbed on the mucosal membrane. It is less soluble in water and is long acting with less toxicity. Topical benzocaine is commercially marketed in 10% and 20% concentrations.  So, in today’s era where several methods are available for pain management, acupuncture is also said to be one of the safe and effective method. Acupuncture uses acupressure to relieve blockage in “Qi” pronounced as “chee” and promotes the natural circulation of energy throughout the body. Stimulation of acupressure point LI4, also known as Hegu point, has been seen to provide an analgesic and antianxiety effect in the orofacial region, according to studies, thus decreasing pain in the region. It has been used as a substitute therapeutic procedure to control pain in dentistry, including facial pain, migraine, tension headaches, and dental pain.  Aculief is a wearable acupressure device which is available in the market as Aculief wearable acupressure. It is a manual acupressure device that is designed in the form of a clip to cause pressure on the LI4 point. It is easy to use, and there are no related side effects. Aculief has been in use as an acupressure device to relieve headaches and migraines in studies.  So, taking into consideration the advantages of topical gel and acupressure device, we plan to evaluate the effect of acupressure device vs. topical gel as pre-anesthetic technique in children.