Effectiveness of Xylitol-based Lignocaine Ice Popsicle and Lignocaine Gel as a Method of Topical Anesthesia in 6–12-year-old Children: A Split-mouth Randomized Clinical Crossover Study

Abstract Background: Cryotherapy has been shown to be effective in decreasing pain and discomfort during intraoral injections. Oral administration of sweet-tasting solutions has been reported to suppress pain in neonates during vaccinations and blood sample collection. Xylitol is anticariogenic and a potent sugar substitute, and thus, it can be as effective as sucrose in stimulating the sweet taste. A synergistic combination of local anesthesia, cryotherapy, and sugar-induced pain suppression may provide excellent topical anesthesia, minimizing pain in children during intraoral nerve blocks. Aim: This study aims to compare the combined effect of xylitol, lignocaine, and cryotherapy in the form of Ice Popsicle (XyLiPop) © and Lignocaine Gel as a method of Topical anesthesia in 6–12-year-old children during Inferior alveolar block anesthesia. Materials and Methods: The split-mouth randomized clinical study included 20 children who required Inferior alveolar nerve block anesthesia bilaterally. Informed consent was taken before the study. Ice popsicle was made by freezing 2 ml of lignocaine hydrochloride with 1 g Xylitol Powder. Children were randomly allocated to XyLiPop © (Group I) and LA gel (Group II) using lottery method. On the first visit, XyLiPop © or Lignocaine Gel was placed at the site of needle insertion for 2 min before giving inferior alveolar block according to the group allocation. Pain during needle insertion was assessed using FLACC scale and VAS scale. Heart rate was monitored using a pulse oximeter as a measure of anxiety during injection administration. After a washout period of 15 days, each child who received XyLiPop © in the first visit was exposed to LA Gel in the second visit and vice versa. Results: On comparison of the mean FLACC scores among Group I (3.1 ± 0.79) and Group II (4.6 ± 0.68), there was statistically significant difference in FLACC Score between both the study groups ( P < 0.05). McNemar’s test used to compare the VAS score showed Group I being out rightly better than Group II. The mean heart rate for Group II (100.95 ± 5.02) was significantly higher than Group I (94.1 ± 3.3). The difference between heart rate was statistically significant ( P < 0.05). Conclusion: XyLiPop © provides superior topical anesthesia as compared to LA gel. Thus, XyLiPop © can be used as an effective topical anesthesia technique in reducing pain and anxiety in children during inferior alveolar nerve anesthesia.