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Year : 2020  |  Volume : 11  |  Issue : 1  |  Page : 6-10

A comparative evaluation of ice and topical anesthetic gel in the reduction of pain before the injection: A clinical trial

Department of Dentistry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India

Date of Submission22-Sep-2019
Date of Acceptance12-Dec-2019
Date of Web Publication11-Mar-2020

Correspondence Address:
Disha Bansal
Department of Dentistry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_66_19

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Background: Lateral cephalogram can now be traced using android-based smartphones making dentist's work easier and time saving. Various orthodontic analysis can also be carried out using these smart apps. This study was undertaken to assess the reliability of the android smartphone-based app with the manual tracing using Tweed analysis. Materials and Methods: A total of 40 lateral cephalometric radiographs were taken randomly from patients below 15 years reported for orthodontic problems. Tweed analysis was carried out for each radiograph; incisal mandibular plane angle, facial mandibular angle, and facial mandibular incisal plane angle were recorded, first manually traced, followed by digitally using android-based OneCeph digital cephalometric tracer. Values obtained by android-based OneCeph and manual methods are compared. Results: The values showed normal distribution, therefore parametric test was used to analyze the data; there was no statistically significant difference between the values obtained for Tweed analysis by android-based tracing and manual cephalometric tracing. Conclusion: This study showed that the digital tracing with the OneCeph software had the same accuracy in comparison to manual tracing and could be used instead of the traditional methods for various orthodontic analysis.

Keywords: Ice, infiltration injection, pain, precooling, topical anesthesia

How to cite this article:
Bansal D, Mahajan M, Mathur S. A comparative evaluation of ice and topical anesthetic gel in the reduction of pain before the injection: A clinical trial. SRM J Res Dent Sci 2020;11:6-10

How to cite this URL:
Bansal D, Mahajan M, Mathur S. A comparative evaluation of ice and topical anesthetic gel in the reduction of pain before the injection: A clinical trial. SRM J Res Dent Sci [serial online] 2020 [cited 2023 May 28];11:6-10. Available from:

  Introduction Top

The local anesthetic injection is one of the most fearful and anxiety-inducing experiences in patients. The fear and anxiety of the patients act as a hindrance in providing proper dental care.[1]

Reduction in pain perception during the injection of local anesthetic will provide relief in anxiety and discomfort.[2]

Harbert et al. concluded that cooling the palatal region before injection reduced pain perception.[3] Aminabadi andFarahani found that the injection site precooling before the local anesthesia administration reduced the perception of pain.[4]

Hence, this study was performed to compare the effect of cooling topically versus the topical usage of local anesthetic gel in reducing pain before the infiltration of local anesthesia in the maxillary anterior teeth region before endodontic treatment.

  Materials and Methods Top

The study was conducted in the outpatient department with a sample size of 100 patients.

Consent was obtained from the patients to participate in the study.

On the first visit, the oral examination was done; the patients requiring the infiltration anesthesia before endodontic treatment of the anterior maxillary teeth region were randomly chosen to undergo this study.

Criteria for inclusion

  1. Patients requiring infiltration anesthesia before endodontic treatment in the maxillary anterior region
  2. Patients between the age group of 17 and 30 years
  3. Individuals those were able to understand and follow the instructions given.

Criteria for exclusion

  1. Patients with psychiatric and systemic diseases
  2. Patients who were unable to follow instructions.

Ethics followed

The procedures were followed according to the standards of the Institutional Ethical Committee on human experimentation (Registration no. ECR/710/Inst/UK/2015/RR-18).


One hundred patients (males 50 and females 50) were divided into two groups.

Materials used

Group 1: ICE FINGERS: The ice fingers were prepared by filling water in the small finger of latex gloves and freezing it.

Group 2: Topical anesthetic gel [Figure 1].
Figure 1: Material used

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Group distribution

  • Group 1 (n = 50): The injection site was precooled with ice [Figure 2] in these patients
  • Group 2 (n = 50): Over the injection site, the topical anesthetic gel (Lox-2% jelly, NEON) was applied.

In Group 1, the precooling was done using ice fingers [Figure 2] for 60 s over the infiltration injection site before the injection [Figure 3].
Figure 2: Precooling of the injection site with ice

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Figure 3: Infiltration injection after precooling

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In Group 2, the topical anesthetic gel was applied [Figure 4] for 60 s before the injection [Figure 5]. Prefabricated cotton rolls were used to apply anesthetic gel.
Figure 4: Application of anesthetic gel

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Figure 5: Infiltration injection after anesthetic gel application

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Participants from both the groups were instructed to rate their individual pain experience using a visual analog scale (VAS). Their individual scores were noted, tabulated, and statistically analyzed. Unpaired t-test was used for the statistical analysis.

  Results Top

The comparison of the mean VAS scores between Group 1 (precooling with ice) and Group 2 (preanesthetic gel) using the unpaired t-test showed that the scores were significantly more among Group 2 (preanesthetic gel) as compared to Group 1 (precooling with ice) [Table 1] and [Graph 1].
Table 1: VAS score Comparison Between Group 1 and Group 2

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The comparison of the mean VAS scores between males and females using the unpaired t-test showed that the mean VAS score was significantly more among the females as compared to males [Table 2] and [Graph 2].
Table 2: VAS score comparison Between Males and Females

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The comparison of the mean VAS scores between males and females in Group 1 using the unpaired t-test showed that the mean VAS score was significantly more among the females as compared to males [Table 3] and [Graph 3].
Table 3: VAS score comparison between Males and Females in Group 1

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The comparison of the mean VAS scores between males and females in Group 1 using the unpaired t-test showed that the mean VAS score was significantly more among the females as compared to males [Table 4] and [Graph 4].
Table 4: VAS score comparison between Males and Females in Group 2

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  Discussion Top

Precooling is also called as cryoanesthesia, which is defined as the cold application to a localized portion of the individual's body to block the local nerve conduction for impulses of pain. Cryoanesthesia can be given either by refrigerant spray or by ice.[2],[4],[5] In this study, the ice was used to precool the site of injection.

From very long, ice has been a source of therapeutic effect in the medicine and is considered an important part of the treatment of injury and rehabilitation. Various theories have come into light for explaining the mechanism of ice in the pain reduction. The application of ice is believed to raise the pain threshold by inhibiting the pain pathways and stimulating the myelinated A fibers.[6]

Usually, there exists no condition to worry, as the temperature of ice is not too low and the prolonged contact with vital tissue is not necessary.[7]

Cryoanesthesia is reported to be more efficient when compared to the conventional topical anesthetics in relieving the needle prick pain because it acts on all the cells unlike topical anesthetics which acts only on nerve cells.[2],[4],[5]

This study showed that precooling the site of injection effectively reduced the perception of pain, fear, and anxiety of the patient when compared to the conventional topical anesthetics, which is in accordance with the previous studies by Harbert et al.,[3] Aminabadi andFarahani,[4] Kuwahara and Skinner,[8] and Kosaraju and Vandewalle.[9] The precooling of the injection site causes amplification of the threshold of pain to the stimulus and helps in better pain management in patients during routine dental treatment.[10]

The present study also showed a higher VAS score for females when compared with males, and this might be due to elevated level of fear together with anxiety in female individuals and goes in support and accordance with the old study by Hosseini and Khazali.[11]

A variety of topical anesthetic agents have been reportedly used on the oral mucosa with varying results; the property of the anesthetic agent used topically has led to a decrease in pain perception by patients, thus resulting in the greater acceptance during the dental treatment.[12]

The results of the topical anesthetic gel were uncertain in this study, and the results seemed to be of mixed nature; on top of this, the gels were unacceptable in taste for some patients and made them anxious. The uncertain results were in support with the previous old study by Adriani et al.[13]

  Conclusion Top

The precooling method for the reduction of pain due to injection is an effective, economical, and easily available method, which can serve benefits to almost all the patients.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Leff DR, Nortley M, Dang V, Bhutiani RP. The effect of local cooling on pain perception during infiltration of local anaesthetic agents, a prospective randomised controlled trial. Anaesthesia 2007;62:677-82.  Back to cited text no. 1
Ghaderi F, Banakar S, Rostami S. Effect of pre-cooling injection site on pain perception in pediatric dentistry: A randomized clinical trial. Dent Res J (Isfahan) 2013;10:790-4.  Back to cited text no. 2
Harbert H. Topical ice: A precursor to palatal injections. J Endod 1989;15:27-8.  Back to cited text no. 3
Aminabadi NA, Farahani RM. The effect of pre-cooling the injection site on pediatric pain perception during the administration of local anesthesia. J Contemp Dent Pract 2009;10:43-50.  Back to cited text no. 4
Lathwal G, Pandit IK, Gugnani N, Gupta M. Efficacy of different precooling agents and topical anesthetics on the pain perception during intraoral injection: A comparative clinical study. Int J Clin Pediatr Dent 2015;8:119-22.  Back to cited text no. 5
Barlas D, Homan CS, Thode HC Jr.In vivo tissue temperature comparison of cryotherapy with and without external compression. Ann Emerg Med 1996;28:436-9.  Back to cited text no. 6
Davoudi A, Rismanchian M, Akhavan A, Nosouhian S, Bajoghli F, Haghighat A, et al. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures. Anesth Essays Res 2016;10:13-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
Kuwahara RT, Skinner RB. Emla versus ice as a topical anesthetic. Dermatol Surg 2001;27:495-6.  Back to cited text no. 8
Kosaraju A, Vandewalle KS. A comparison of a refrigerant and a topical anesthetic gel as preinjection anesthetics: A clinical evaluation. J Am Dent Assoc 2009;140:68-72.  Back to cited text no. 9
Mohiuddin I, Setty JV, Srinivasan I, Desai JA. Topical application of local anaesthetic gel vs. ice in pediatric patients for infiltration anaesthesia. J Evol Med Dent Sci 2015;4:12934-40.  Back to cited text no. 10
Hosseini L, Khazali H. Comparing the level of anxiety in male & female school students. Procedia social and behavioral sciences 2013;84:41-6.  Back to cited text no. 11
Bendgude V, Walimbe H, Bijle MN, Muchandi S, Deshpande R. Comparative evaluation of the efficacy of topical anesthetics in reducing pain during administration of injectable local anesthesia in children. World J Dent 2014;5:129-33.  Back to cited text no. 12
Adriani J, Zepernick R. Clinical effectiveness of drugs used for topical anesthesia. JAMA 1964;188:711-6..  Back to cited text no. 13


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1], [Table 2], [Table 3], [Table 4]

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