Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial



The present study evaluates the efficacy of warm local anesthetic (37 °C) administration and injections of local anesthetics at room temperature (21 °C) in reducing pain during injections in children undergoing dental procedures.

Materials and methods

Enrolled for this split-mouth randomized clinical study were 100 children aged 5–8 years. Within the random crossover design selected for the study, each patient was randomly assigned to receive either a body or room temperature local anesthesia in the first session and the other local anesthesia on the second session. During the injection, the Wong-Baker Faces Pain Rating Scale was used as a subjective measure of discomfort, and heart rate as an objective measure. The Face, Legs, Arms, Cry, and Consolability (FLACC) scale was used to record the child’s pain, based on the perception of the dental assistant. The data were analyzed using a Wilcoxon sign rank test and a paired t test.


Based on the score of the Wong-Baker Faces Pain Rating Scale, the FLACC scale, and heart rate, the sensation of pain during dental injection in both girls and boys is statistically significantly lower at body temperature than at room temperature (p < 0.05).


It was determined that the application of local anesthetic at body temperature reduces dental injection pain significantly when compared with local anesthetics administered at room temperature.

Clinical relevance

The successful management of dental injection pain is an important issue during dental procedures in children. Accordingly, warming the local anesthesia prior to use in children can be recommended to clinicians.

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Corresponding author

Correspondence to Hüsniye Gümüş.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the Ethics Committee of Erciyes University.

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Informed consent was obtained from all of the parents included in the present study.

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Gümüş, H., Aydinbelge, M. Evaluation of effect of warm local anesthetics on pain perception during dental injections in children: a split-mouth randomized clinical trial. Clin Oral Invest 24, 2315–2319 (2020). https://doi.org/10.1007/s00784-019-03086-6

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  • Anesthetic solution
  • Children
  • Pain
  • Warm anesthesia