Could cooled distilled water help children cope with a dental injection? A randomized clinical trial reported by Emine Zehra Aydın Çetin and B. Özmen found no statistically significant differences in pain or anxiety scores between children given cooled water and those given topical anesthetics. The researchers also found a difference in cooperation scores, but said that result was exploratory and needs confirmation.
The trial, conducted in the Department of Pediatric Dentistry at Ondokuz Mayıs University, enrolled 100 children aged 7–10 who were having their first dental treatment. Each child was randomly assigned to one of four applications before an injection: 10% lidocaine spray, 20% benzocaine gel, distilled water cooled to 4 °C, or lidocaine spray cooled to 4 °C. All children then received a local anesthetic injection. The study therefore tested what was applied before the injection; it did not test whether cold water could replace injected anesthetic.
For the primary outcome, children’s reported pain during injection, scores did not differ significantly among the four groups. Measures of dental anxiety and taste acceptability also showed no significant group differences. Pulse rate rose between the pre-treatment and injection measurements across the study, but that change did not differ significantly by group. Oxygen saturation showed no significant changes over time or between groups.
Cooperation scores, measured with the FRANKL behavior scale, were higher in the cooled-water group than in the benzocaine-gel and cooled-lidocaine-spray groups. The difference from the regular lidocaine-spray group did not reach statistical significance. Because the researchers treated secondary outcomes as exploratory and did not adjust for the many comparisons, the cooperation result could be due to chance and should be tested in further trials.
The findings do not show that cooled water and topical anesthetics work equally well. The trial was not designed to establish equivalence or non-inferiority, and a lack of statistically significant differences is not proof that treatments perform the same. The researchers also noted that the study may have lacked power to detect smaller but meaningful differences in pain: its pain-score confidence intervals were wide enough that differences of about 3.5 points could not be ruled out.
The results apply to a specific group and procedure: children aged 7–10 with no previous dental treatment, positive baseline behavior, and teeth requiring a particular type of upper-jaw injection. The authors say larger, adequately powered studies are needed to confirm whether cooled distilled water has a practical role. For now, this single-centre trial offers a comparison of children’s reported experience and behavior, not a basis for personal treatment decisions.
<a href="https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0362074">Source: the clinical trial report in PLOS ONE</a>