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CTRI Number  CTRI/2024/05/067507 [Registered on: 16/05/2024] Trial Registered Prospectively
Last Modified On: 30/04/2024
Post Graduate Thesis  Yes 
Type of Trial  Interventional 
Type of Study   Dentistry 
Study Design  Randomized, Parallel Group, Active Controlled Trial 
Public Title of Study   Comparing Effect of TENS and Cryotherapy to Reduce Pain of Needle insertion in 7-10 year old children 
Scientific Title of Study   Comparative Evaluation of Effectiveness of Transcutaneous Electrical Nerve Stimulation (TENS) via Electronic Acupuncture Pen and Cryotherapy for Minimizing Pain Before Local Anesthesia Administration in 7-10-Year-Old Children: A Randomized Control Study 
Trial Acronym  NIL 
Secondary IDs if Any  
Secondary ID  Identifier 
NIL  NIL 
 
Details of Principal Investigator or overall Trial Coordinator (multi-center study)  
Name  Dr Waseem Fatima 
Designation  Post Graduate Resident 
Affiliation  Army College of Dental Sciences 
Address  Department of Pediatric and Preventive Dentistry, 1st floor, Room No.12, Army College of Dental Sciences, Chennapur CRPF road, Jai Jawaharnagar Post, Secunderabad

Hyderabad
TELANGANA
500087
India 
Phone  8341138193  
Fax    
Email  waseemfathima000@gmail.com  
 
Details of Contact Person
Scientific Query
 
Name  Dr Krishnapriya V 
Designation  Head of the Department of Pediatric and Preventive Dentistry 
Affiliation  Army College of Dental Sciences 
Address  Department of Pediatric and Preventive Dentistry, 1st floor, Room No.12, Army College of Dental Sciences, Chennapur CRPF road, Jai Jawaharnagar Post, Secunderabad

Hyderabad
TELANGANA
500087
India 
Phone  9440365736  
Fax    
Email  krishnapriyavllr@gmail.com  
 
Details of Contact Person
Public Query
 
Name  Dr Krishnapriya V 
Designation  Head of the Department of Pediatric and Preventive Dentistry 
Affiliation  Army College of Dental Sciences 
Address  Department of Pediatric and Preventive Dentistry, 1st floor, Room No.12, Army College of Dental Sciences, Chennapur CRPF road, Jai Jawaharnagar Post, Secunderabad

Hyderabad
TELANGANA
500087
India 
Phone  9440365736  
Fax    
Email  krishnapriyavllr@gmail.com  
 
Source of Monetary or Material Support  
Army College of Dental Sciences 
 
Primary Sponsor  
Name  Dr Waseem Fatima 
Address  Army College of Dental Sciences, Chennapur CRPF Road, Jai Jawaharnagar Post, Secunderabad 
Type of Sponsor  Other [self] 
 
Details of Secondary Sponsor  
Name  Address 
NIL  NIL 
 
Countries of Recruitment     India  
Sites of Study  
No of Sites = 1  
Name of Principal Investigator  Name of Site  Site Address  Phone/Fax/Email 
Dr Waseem Fatima  Army College of Dental Sciences  Department of Pediatric and Preventive Dentistry, 1st floor, Room No.12, Army College of Dental Sciences, Chennapur CRPF Road, Jai Jawaharnagar Post, Secunderabad
Hyderabad
TELANGANA 
8341138193

waseemfathima000@gmail.com 
 
Details of Ethics Committee  
No of Ethics Committees= 1  
Name of Committee  Approval Status 
ARMY COLLEGE OF DENTAL SCIENCES INSTITUTIONAL ETHICS COMMITTE  Approved 
 
Regulatory Clearance Status from DCGI  
Status 
Not Applicable 
 
Health Condition / Problems Studied  
Health Type  Condition 
Patients  (1) ICD-10 Condition: Z00-Z99||Factors influencing health status and contact with health services,  
 
Intervention / Comparator Agent  
Type  Name  Details 
Intervention  20% Benzocaine gel   Topical anesthetic gel at site of injection 
Comparator Agent  Cryotherapy  Application of ice cube at the site of injection  
Comparator Agent  Transcutaneous Electrical Nerve Stimulation(TENS)  Application of Transcutaneous Electrical Nerve Stimulation device i.e. electronic acupuncture pen at site of injection  
 
Inclusion Criteria  
Age From  7.00 Year(s)
Age To  10.00 Year(s)
Gender  Both 
Details  Healthy & cooperative children.
Children aged between 7 and 10 years.
Children with no prior experience of dental injection (LA).
Children requiring IANB for dental treatment.
Children with Frankl’s behaviour III & IV.
Children with informed parental consent.
 
 
ExclusionCriteria 
Details  Children with systemic illness or medically compromised.
Children with special healthcare needs.
Children with history of dental injection.
Children allergic to LA agents.
Children with Frankl’s behaviour I & II.
 
 
Method of Generating Random Sequence   Permuted block randomization, fixed 
Method of Concealment   Case Record Numbers 
Blinding/Masking   Participant and Outcome Assessor Blinded 
Primary Outcome  
Outcome  TimePoints 
successfully administering painless local anesthesia in pediatric patients.  one and half year 
 
Secondary Outcome  
Outcome  TimePoints 
To compare all three groups i.e. TENS, Cryotherapy, Topical anesthetic gel, & to determine their effectiveness in minimizing pain during inferior alveolar nerve block in pediatric Patients.  one & half year 
 
Target Sample Size   Total Sample Size="60"
Sample Size from India="60" 
Final Enrollment numbers achieved (Total)= "60"
Final Enrollment numbers achieved (India)="60" 
Phase of Trial   Phase 3 
Date of First Enrollment (India)   19/07/2024 
Date of Study Completion (India) 04/02/2026 
Date of First Enrollment (Global)  Date Missing 
Date of Study Completion (Global) Date Missing 
Estimated Duration of Trial   Years="1"
Months="6"
Days="0" 
Recruitment Status of Trial (Global)   Not Applicable 
Recruitment Status of Trial (India)  Completed 
Publication Details   N/A 
Individual Participant Data (IPD) Sharing Statement

Will individual participant data (IPD) be shared publicly (including data dictionaries)?  

Response - YES
  1. What data in particular will be shared?
    Response - All of the individual participant data collected during the trial, after de-identification.

  2. What additional supporting information will be shared?
    Response -  Study Protocol
    Response -  Statistical Analysis Plan
    Response - Informed Consent Form
    Response - Clinical Study Report

  3. Who will be able to view these files?
    Response - Anyone

  4. For what types of analyses will this data be available?
    Response - To achieve aims in the approved proposal.

  5. By what mechanism will data be made available?
    Response (Others) -  In publication

  6. For how long will this data be available start date provided 20-04-2026 and end date provided 20-01-2026?
    Response - Immediately following publication. No end date.

  7. Any URL or additional information regarding plan/policy for sharing IPD? 
    Additional Information - NIL
Brief Summary  

The main concern of the pediatric dentist is to achieve the cooperation of the child in the dental clinic during various pediatric procedures. Administering anesthesia to pediatric patients proves to be the most challenging part of the process. The real fear of the child during a pediatric procedure is painful local anesthetic (LA) injections. Reducing the fear of pain during LA injections gains the confidence of the child toward the dentist, thus achieving the cooperation of the child during treatment [Patil et al., 2021]. Over the years, topical anesthetics have been used to prepare injection sites before needle penetration. Nakanishi et al. found that the site of injection plays an essential role in the efficacy of topical anesthetic agents as they produce surface anesthesia and have a limited capacity to penetrate deep into tissues. Although the discomfort due to surface penetration is reduced, they are ineffective at greater penetration depths which are required for regional block injections such as the IANB [Choudhari et al.,2017].

 Pediatric dentists are persistently in search of techniques, which may present a more relaxing dental experience. Cryotherapy application is one of the endorsed strategies for reducing pain perception in patients that would be effective, efficient, and cost-effective. It is the application of ice or refrigerant spray on the anesthetic site to counter nerve conduction of pain from the site [Lakshmanan et al.,2021]. The use of acupuncture is a traditional Chinese medical technique for treating pain. There are various types of acupuncture techniques, out of which electro-acupuncture is one where electrical stimulation of a point with acupuncture needles is used. However, pain due to needle insertion persists. So, acupuncture needles are replaced by TENS therapy to stimulate superficial nerves for localized pain relief. With this technology, an electronic acupuncture pen has been devised, and is a non-invasive method for producing local analgesia [Deulkar et al.,2023]. Allgood defined TENS as direct stimulation of the nerves by electrical impulses of short duration and small amplitude. Shane and Kessler in 1967 first described its use in various fields related to medicines. TENS and cryotherapy work on the principle of gate control theory given by Melzack and Wall in 1965. The application of ice and TENS provides physiological as well as psychological benefits to the patients as it may distract them from focusing on their discomfort. Thus, this study was planned to evaluate the effectiveness of TENS via electronic acupuncture pen, cryotherapy, and 2% benzocaine gel to alleviate pain before LA administration in children aged 7-10 years.

 
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