Effectiveness of control strategies for injection pain in local anesthesia in pediatric dentistry: a network meta-analysis

Abstract

Background : Pain associated with anesthesia in pediatric dentistry poses significant challenges, often leading to poor treatment compliance and dental anxiety. The effectiveness of various pre-emptive analgesic interventions remains uncertain. Therefore, this network meta-analysis aimed to systematically compare the relative effectiveness of interventions for reducing injection pain during local anesthesia in pediatric dentistry and to rank their efficacy. The findings are expected to guide the selection of optimal clinical strategies. Methods : We searched PubMed, Cochrane, Embase, and Web of Science from database inception up to 12 August 2025, for English-language studies. The risk of bias was assessed using the Cochrane Risk of Bias Assessment Tool 2.0. The GeMTC package in R version 4.4.2 was utilized to perform the network meta-analysis. Results : Forty-five studies involving 3124 patients were included. The effects of interventions on subjective and objective pain, heart rate, and oxygen saturation were statistically analyzed. The network meta-analysis revealed that acupressure was most effective in controlling objective pain (SMD (standardized mean difference) −3.01, 95% CrI (credible interval) −5.66, −0.35), whereas the combination of cold stimulation, vibration, and benzocaine gel was most effective in controlling subjective pain (SMD −3.71, 95% CrI −6.87, −0.63), and Cold stimulation was most effective in reducing HR (Heart Rate) (MD (Mean Difference) −12.59, 95% CrI −20.74, −4.45). No statistically significant differences were observed concerning oxygen saturation. Conclusion : Acupressure, the combination of cold stimulation, vibration, and benzocaine gel, and cold stimulation were the optimal strategies for reducing objective pain, subjective pain, and HR in local anesthesia in pediatric dentistry, respectively. Further international, multicenter, prospective randomized controlled trials using standardized objective/subjective pain assessment scales are required to more comprehensively evaluate the efficacy of different interventions. The PROSPERO Registration : The study protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) (CRD420251126987).