A trial involving 100 children found no statistically significant difference in pain or anxiety across four methods used before a dental injection. Children receiving chilled-water cooling nevertheless received higher cooperation ratings than those given two of the topical-anaesthetic approaches.
What researchers studied
Researchers in Türkiye studied healthy children aged seven to ten who were attending their first dental treatment. The question was whether cooling the injection area could provide a practical alternative to topical numbing agents while affecting pain, anxiety or cooperation.
Participants were randomly allocated to four groups: 10% lidocaine spray, 20% benzocaine gel, distilled water cooled to 4°C, or 10% lidocaine spray cooled to 4°C. Each child subsequently received a local anaesthetic injection. The team recorded self-reported pain and anxiety, pulse rate, oxygen saturation, taste acceptance and dentist-rated cooperation.
What they found
Pain, anxiety, pulse rate, oxygen saturation and taste acceptability did not differ significantly between the four groups. This is not the same as proving that the treatments were clinically equivalent.
Cooperation scores on the Frankl Behaviour Rating Scale were higher in the chilled-water group than in the benzocaine-gel and cooled-lidocaine-spray groups. The reported comparison had a p-value of 0.001. Pulse rate increased from before to after treatment across the groups, but the pattern of change did not differ significantly by treatment.
The authors described the cooperation result as exploratory rather than definitive evidence that cooling is superior.
What it means
The findings raise an interesting possibility for paediatric dentistry: a simple cooling procedure might be acceptable to some children even without adding another medication. For clinicians, a child’s willingness to cooperate can matter alongside immediate pain ratings.
However, choices about local anaesthesia still require professional assessment. The trial does not establish that cooling provides the same analgesic effectiveness as a licensed topical anaesthetic or that the results apply to older children, repeated procedures or more invasive dental care.
Important limitation
Each comparison involved only a subgroup of the 100 children, and the trial did not establish non-inferiority against standard topical anaesthesia. Its cooperation finding requires confirmation in larger trials. The narrow age range and first-treatment setting also limit generalisation.
Source Information
Study: Pain, sensory acceptability, and treatment compliance following cryotherapy and topical anesthetics in children: A randomized clinical trial
Authors: Emine Zehra Aydın Çetin and Bilal Özmen
Journal / Source: PLOS ONE
Published: 3 November 2026
