COMPARISON OF LIDOCAINE/PRILOCAINE (EMLA) AND BENZOCAINE IN REDUCING IMMEDIATE PAIN DURING ELASTOMERIC SEPARATOR PLACEMENT: A QUASI-EXPERIMENTAL NON-RANDOMIZED CONTROLLED STUDY
DOI:
https://doi.org/10.70520/kjms.v18i4.825Keywords:
Orthodontic pain, Lidocaine-Prilocaine, Benzocaine, Elastomeric separators, Visual analogue scaleAbstract
Objective: To compare the effectiveness of 5% lidocaine/prilocaine cream (EMLA) and 20% benzocaine gel in reducing immediate pain during elastomeric separator placement in orthodontic patients.
Methods: This quasi-experimental non-randomized controlled study included 60 orthodontic patients aged 16–35 years. Participants received EMLA or benzocaine based on clinical allocation, and placebo was applied on the opposite side without random selection. Topical anesthetic was applied to the gingiva and separators. After 2 minutes, elastomeric separators were placed. Pain intensity was recorded using a Visual Analogue Scale (VAS) at 2, 4, 6, 8, and 10 minutes. Pain scores were analyzed using paired t-tests for within-group comparisons and independent t-tests for intergroup comparisons. Data were analyzed using paired t-tests and chi-square tests. A p-value <0.05 was considered significant.
Results: Group A showed significantly lower mean pain scores than placebo at all time intervals (p<0.05). Group B showed significantly lower pain at 2 and 4 minutes (p<0.05), but no significant difference at 6, 8, and 10 minutes. Intergroup comparison revealed that EMLA was more effective than benzocaine in reducing pain at all time intervals.
Conclusions: Topical application of EMLA before separator placement significantly reduced immediate pain compared with benzocaine and placebo. Using EMLA may improve patient comfort and compliance during the first orthodontic visit.
References
1. Sultan H, Pervez H, Maqsood S, Zeeshan WS. Evaluation of pain experienced by orthodontic patients following elastomeric separator insertion: A cross-sectional study. Korean J Orthod. 2023;53(5):298-306. doi:10.4041/kjod22.257
2. Minor V, Marris CK, McGorray SP, et al. Effects of preoperative ibuprofen on pain after separator placement. Am J Orthod Dentofacial Orthop. 2023;164(3):e95-e102. doi:10.1016/j.ajodo.2023.01.004
3. Li J, Li S, Chen H, et al. The effect of physical interventions on pain control after orthodontic treatment: a systematic review and network meta-analysis. PLoS One. 2024;19(2):e0297783. doi:10.1371/journal.pone.0297783
4. Guo Q, Liao C, Guan X, et al. Effect of chewing gum on orthodontic pain in patients receiving fixed orthodontic treatment: a systematic review and meta-analysis. Eur J Med Res. 2023;28:491. doi:10.1186/s40001-023-01467-y
5. Al-Melh MA, Andersson L. The effect of a lidocaine/prilocaine topical anesthetic on pain during orthodontic separator placement. Prog Orthod. 2023;24:14. doi:10.1186/s40510-023-00476-4
6. Herdevall BM, Klinge B, Persson L, et al. Safety of lidocaine-prilocaine dental gel during periodontal therapy: a multicenter trial. J Periodontol. 2022;93(2):234-240. doi:10.1002/JPER.21-0308
7. Karkoutly M, Alatassi L, Azrak L, Bshara N. Efficacy of topical anesthetics of lidocaine, benzocaine, and EMLA in reducing pain during inferior alveolar nerve block in schoolchildren: a randomized controlled trial. BDJ Open. 2024;10:87. doi:10.1038/s41405-024-00275-8
8. Naik VB, Sharma D, Jain AK, et al. Comparing the efficacy of 5% EMLA cream and 20% benzocaine gel during rubber dam clamp placement: a split-mouth randomized clinical trial. Cureus. 2024;16(7):e63893. doi:10.7759/cureus.63893
9. Zakai AM, Qurban E, Jabbar A, et al. Investigating the impact of 2% topical lidocaine gel on discomfort and pain attributed to the placement of orthodontic elastomeric separators. J Popul Ther Clin Pharmacol. 2024;31(7):1261-1269. doi:10.53555/jptcp.v31i7.7250
10. Singh S, Kalra N, Jena AK, et al. Chewing adjuncts and orthodontic pain: a randomized controlled trial and systematic review. Angle Orthod. 2023;93(6):745-752. doi:10.2319/010323-3.1
11. Ferrazzano GF, Di Fabio G, Gatto R, et al. Effectiveness and tolerability of a new topical anesthetic formulation in pediatric dentistry. Children (Basel). 2023;10(3):444. doi:10.3390/children10030444
12. Babakurd FM, Azzawi SK, Alkhouli M, et al. Evaluation of EMLA cream with microneedle patches in palatal anesthesia in children: a randomized controlled clinical trial. Sci Rep. 2024;14:15295. doi:10.1038/s41598-024-66212-9
13. World Medical Association. Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. doi:10.1001/jama.2013.281053
14. Des Jarlais DC, Lyles C, Crepaz N; TREND Group. Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health. 2004 Mar;94(3):361-6.
15. Al-Melh MA, Andersson L. The effect of a lidocaine/prilocaine topical anesthetic on pain during orthodontic separator placement. Prog Orthod. 2023;24:14. doi:10.1186/s40510-023-00476-4.
16. Klinge B, Hafström C, Björn AL, et al. Clinical safety of EMLA cream during oral use: data from controlled trials. Clin Oral Investig. 2022;26(8):5887-5894. doi:10.1007/s00784-022-04388-3
17. Guay J. Methemoglobinemia related to local anesthetics: a summary of 242 episodes. Anesth Analg. 2022;135(2):319-329. doi:10.1213/ANE.0000000000006012
18. Haefeli M, Elfering A. Pain assessment. Eur Spine J. 2006;15(Suppl 1):S17–S24. doi:10.1007/s00586-005-1044-x
