Local anesthesia is a common and essential procedure for the majority of dental treatments. The most frequently used method of administration is needle injection. Although this technique effectively controls pain, the sight of the needle and the pain experienced during injection often cause fear and anxiety, especially in children. This can lead to negative attitudes toward dental treatment, highlighting the need for less painful alternatives for delivering local anesthesia.

This randomized clinical trial aimed to evaluate the effectiveness of the needle-free INJEX 30 device in reducing pain and anxiety in children aged 6 to 9 years.

Eligible children requiring local anesthesia in the mandibular primary molar region for therapeutic dental procedures were randomly assigned to two groups according to the type of injection system used (INJEX or conventional syringe).

Immediately after the administration of local anesthesia, anxiety was assessed using a physiological measure (plus rate), and pain was evaluated using a self-reported scale (Wong-Baker Faces Pain Scale). Pain was also assessed using a non-self-reported behavioral scale (FLACC) based on video recordings taken during anesthesia administration.

The findings of this study provide clinical evidence about the effectiveness of the INJEX device in reducing pain and anxiety during local anesthesia in pediatric dental patients, which thereby improving clinical decision-making and enhancing the quality of dental care for children.

Local anesthesia is a cornerstone of pediatric dental treatment, allowing clinicians to perform restorative and preventive procedures while minimizing pain and discomfort. Nevertheless, administering local anesthesia in children presents several challenges. Achieving profound anesthesia can be difficult in some cases due to anatomical variations, while the risk of local anesthetic toxicity is increased because of the child's lower body weight. Most importantly, fear of needles and pain during injection often provoke anxiety and unpredictable behavioral responses, which can complicate dental treatment and negatively affect the child's overall experience.

The inferior alveolar nerve block is commonly used for pulp therapy of lower primary molars, as it provides relatively deep and long-lasting anesthesia. However, this technique is associated with several disadvantages, including a higher risk of soft tissue injury, prolonged numbness, and greater discomfort during injection. Additionally, inferior alveolar nerve block injections are generally perceived as more painful than infiltration anesthesia techniques, particularly in pediatric patients.

Despite the effectiveness of conventional nerve block techniques, their limitations in children highlight the need for alternative anesthesia methods that are less painful while maintaining adequate anesthetic efficacy. Therefore, a different anesthetic approach with a shorter duration but comparable effectiveness was considered. For this purpose, a needle-free, pressure-based injection system was used in the present study.

Needleless injection devices, such as the INJEX system, deliver local anesthetic solutions into the tissues using high pressure, eliminating the need for conventional needles.

This study aimed to evaluate and compared the effectiveness of the INJEX device and the conventional syringe technique in administering local anesthesia for lower primary molars, with a particular focus on pain perception and anxiety reduction. Both subjective pain assessment scales and objective physiological and behavioral measures were employed to provide a comprehensive evaluation. By identifying anesthetic techniques that reduce pain and anxiety while maintaining clinical effectiveness, this research seeked to improve the quality of pediatric dental care and promote more positive dental experiences for children

Inclusion Criteria:

1. Children aged 6-9 years with no previous dental experience.
2. Children classified as positive or definitely positive according to the Frankl behavior rating scale.
3. Children requiring local anesthesia in the lower primary molar region for therapeutic dental procedures

Exclusion Criteria:

1. Children with systemic diseases that contraindicate the administration of local anesthesia or the required dental treatment.

2. Children who have received sedative or analgesic medications within the 3 hours preceding the dental visit

   -