Comparative Evaluation of Anesthetic Delivery Systems on Pain, Anxiety, and Physiological Responses in Pediatric Dental Patients: A Randomized Clinical Trial

Injection-related pain and anxiety remain major challenges in pediatric dental care and may negatively influence cooperation and future dental attitudes. Alternative anesthetic delivery systems have been introduced to mitigate these responses, yet comparative evidence across behavioral, subjective, and physiological outcomes remains limited. This randomized clinical trial evaluated four anesthetic delivery techniques: conventional manual syringe, computer-controlled local anesthetic delivery (CCLAD), vibration-assisted injection, and jet injection. Pain perception was assessed using the Wong–Baker Faces Pain Rating Scale and the FLACC scale, anxiety using Venham’s Picture Test, physiological responses using heart rate and oxygen saturation, cooperation using Houpt’s scale, and parental satisfaction via questionnaire. Outcomes were analyzed separately for mandibular and maxillary arches across predefined procedural phases. In the mandibular arch, heart rate differed significantly among groups only during anesthesia, with higher values in the Manual syringe group compared with the Jet injection and CCLAD groups (P ≤ 0.05), while oxygen saturation remained stable across all techniques (P > 0.05). The Manual syringe group demonstrated significantly higher Wong–Baker pain scores after anesthesia, and in the mandibular arch also after treatment compared with all alternative techniques (P ≤ 0.05), and higher FLACC scores during anesthesia compared with the CCLAD and Jet injection groups (P ≤ 0.05). Venham anxiety scores were also significantly elevated in the Manual syringe group (P ≤ 0.05). In the maxillary arch, the Manual syringe group consistently showed higher Wong–Baker and anxiety scores than all other groups (P ≤ 0.05), whereas the Jet injection group exhibited higher FLACC scores during treatment (P ≤ 0.05). Houpt scores were comparable among groups, while parental satisfaction was significantly lower in the Manual syringe group (P ≤ 0.05). Injection-related distress in pediatric dentistry is primarily technique-dependent and concentrated during anesthesia administration. Alternative anesthetic delivery systems reduce pain and anxiety without compromising physiological safety or cooperation, supporting their clinical utility in pediatric practice. The study was registered at ClinicalTrials.gov (NCT07106138) on August 2, 2025.