Comparative evaluation of anesthetic delivery systems on pain, anxiety, and physiological responses in pediatric dental patients: A randomized clinical trial

Injection-related pain and anxiety remain major challenges in pediatric dental care and may negatively influence cooperation and future dental attitudes. This randomized clinical trial compared four anesthetic delivery techniques; conventional manual syringe, computer-controlled local anesthetic delivery (CCLAD), vibration-assisted injection, and needle-free jet injection, in 112 children (6-10 years) undergoing pulpotomy. Pain was measured with the Wong-Baker Faces Pain Rating Scale and FLACC; anxiety with Venham's Picture Test; physiological responses with heart rate and oxygen saturation; cooperation with Houpt's scale; and parental satisfaction by questionnaire. Outcomes were assessed at prespecified procedural phases and analyzed separately for mandibular and maxillary arches. During anesthesia administration the Manual syringe group consistently demonstrated higher self-reported pain (Wong-Baker), greater behavioral distress (FLACC), and higher Venham anxiety scores compared with the three alternative techniques (P ≤ 0.05 for key comparisons). CCLAD was associated with more stable attenuation of both subjective and behavioral pain and relatively lower autonomic responses (heart rate), particularly during anesthesia. Jet injection and Vibration-assisted techniques generally reduced distress relative to the Manual syringe but with some site-dependent variability. Oxygen saturation remained stable across all groups, and Houpt cooperation scores were similar across techniques. Parental satisfaction was significantly higher in the alternative technique groups than in the Manual syringe group (P ≤ 0.05). In conclusion, alternative anesthetic delivery systems reduce injection-related pain and anxiety in children compared with conventional manual syringe administration without compromising physiologic safety or treatment feasibility; among the tested devices, CCLAD showed the most consistent benefit. These findings support selective adoption of alternative delivery techniques to improve the pediatric dental experience. Injection-related distress in pediatric dentistry is technique-dependent and concentrated during local anesthetic administration. The findings of this study support the clinical use of alternative anesthetic delivery systems as effective strategies for reducing pain and anxiety in children without adversely affecting treatment feasibility or safety. Selection of an appropriate anesthetic delivery technique may improve the overall dental experience for pediatric patients, enhance parental satisfaction, and contribute to more positive long-term attitudes toward dental care.