{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:28:06Z","timestamp":1787120886272,"version":"build-2736575974"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T00:00:00Z","timestamp":1787097600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Dent. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Pain management during local anesthesia administration is a critical factor in pediatric dentistry. This assessor-blind, parallel-group, superiority randomized controlled trial (\n                      <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link>\n                      : NCT06011005) aimed to determine whether ethyl chloride (EC) spray applied via a cotton pellet provides superior pain reduction compared to 20% benzocaine (BC) gel during intra-oral local anesthetic injections in children.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Fifty-seven healthy children aged 7\u201310 years requiring routine dental local anesthesia were randomized to Group A (20% BC gel,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) or Group B (EC spray via cotton pellet,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200928). The primary outcome was physiological stress measured by change in heart rate (HR). Secondary outcomes included self-reported pain (Faces Pain Scale, FPS) and observed behavioral response (Sound-Eye-Motor scale, SEM). The outcomes assessor was blinded to the topical agent used. Between-group differences in change scores were analyzed using the Mann\u2013Whitney\n                      <jats:italic>U<\/jats:italic>\n                      test with Hodges\u2013Lehmann median differences and bootstrap 95% confidence intervals.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Both groups demonstrated slight increases in HR following the injection; however, the magnitude of change was not significantly different between the groups (BC: +4.03\u2005bpm vs. EC: +2.14\u2005bpm; Mann\u2013Whitney\n                      <jats:italic>U p<\/jats:italic>\n                      \u2009=\u20090.310; 95% CI of mean difference: \u22121.53 to 5.35). Additionally, there were no statistically significant differences between the groups regarding self-reported pain levels (FPS change: BC +1.31 vs. EC +1.25;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.546; 95% CI: \u22121.03 to 1.08) or behavioral responses (SEM change: BC +0.10 vs. EC +0.11;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.971; 95% CI: \u22120.22 to 0.21).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The superiority trial did not reveal a statistically significant difference between the use of ethyl chloride spray and 20% benzocaine gel across any of the measured outcomes. Both anesthetic agents produced comparable physiological responses, self-reported experiences, and behavioral reactions during intra-oral local anesthetic injections in cooperative children aged 7\u201310 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fdmed.2026.1925109","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:48:31Z","timestamp":1787118511000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of ethyl chloride topical anesthesia application on pain perception during intra-oral injections in children compared to benzocaine gel\u2014a single-blind randomized controlled trial"],"prefix":"10.3389","volume":"7","author":[{"given":"Nagah","family":"Abdelrahman","sequence":"first","affiliation":[{"name":"Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manal","family":"Al Halabi","sequence":"additional","affiliation":[{"name":"Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mawlood","family":"Kowash","sequence":"additional","affiliation":[{"name":"Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iyad","family":"Hussein","sequence":"additional","affiliation":[{"name":"Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas","family":"Salami","sequence":"additional","affiliation":[{"name":"Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health","place":["Dubai, United Arab Emirates"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1626","DOI":"10.14219\/jada.archive.1996.0098","article-title":"Analgesic efficacy and safety of an intraoral lidocaine patch","volume":"127","author":"Hersh","year":"1996","journal-title":"J Am Dent Assoc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"213","DOI":"10.14219\/jada.archive.1979.0476","article-title":"A double-blind crossover comparison of topical anesthetics","volume":"98","author":"Gill","year":"1979","journal-title":"J Am Dent Assoc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1001\/jama.1964.03060340009003","article-title":"Clinical effectiveness of drugs used for topical anesthesia","volume":"188","author":"Adriani","year":"1964","journal-title":"J Am Med Assoc"},{"key":"B4","article-title":"Reducing children\u2019s injection pain: lidocaine patches versus topical benzocaine gel","volume":"23","author":"Kreider","year":"2001","journal-title":"Pediatr Dent"},{"key":"B5","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1080\/00325481.2015.992719","article-title":"Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury","volume":"127","author":"Malanga","year":"2015","journal-title":"Postgrad Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"215","DOI":"10.2310\/6620.2007.06059","article-title":"Contact allergy to lidocaine: a report of sixteen cases","volume":"18","author":"Amado","year":"2007","journal-title":"Dermatitis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/0885-3924(94)90150-3","article-title":"Ice freezes pain? 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