Evaluating Child Behavior and Preference Toward NumBee and Traditional Syringe (a Randomized Clinical Trial)


  • Duaa Kamal Naji
  • Zainab Juma Jafar




Syringes, Anesthesia, Local, Mental health, Child Behavior, NumBee


BACKGROUND: Local anesthetics are the gold standard for pain control in dentistry. Most patients still view the “needle” as a source of anxiety and disruptive behavior rather than relief. The patient’s cooperation and comfort level will increase with the administration of painless local anesthetic injection using appropriate technique. The purpose of this study was to assess the patient cooperation and behavior after receiving local anesthesia injection and to compare patients’ acceptance and preference of needleless NumBee anesthetic delivery device to conventional dental syringe.

MATERIALS AND METHODS: 30 non-fearful 6-8-year-olds who had never been to the dentist were selected for the study using a split-mouth design. They underwent a simple class I restoration on both mandibular permanent first molar teeth in two separated dental visits. The Frankl behavior rating scale was used to assess patient behavior following injection. Patients expressed their preference and acceptance of the used syringes by answering a questionnaire.

RESULTS: After injection by either method, 25 patients had Frankl behavior rating score of 4. Patients that had a negative response with the traditional method, showed a score of 2, following NumBee injection (p=0.035).

CONCLUSION: Patients accepted both methods, and NumBee may induce less fear, with minimum stinging and unpleasant taste.

Author Biographies

Duaa Kamal Naji

Master degree student, Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad

Zainab Juma Jafar

Professor (MSc.), Department of Pedodontics and Preventive Dentistry, College of Dentistry, University of Baghdad


Attia S, Austermann T, May A, Mekhemar M, Conrad J, Knitschke M, Böttger S, Howaldt HP, Riad A. Pain perception following computer-controlled versus conventional dental anesthesia: randomized controlled trial. BMC Oral Health. 2022 Dec;22(1):1-3. doi: 10.1186/s12903-022-02454-1. PMID: 36138388; PMCID: PMC9502910.

Aghababaie ST, Monteiro J, Stratigaki E, Ashley PF. Techniques for effective local anaesthetic administration for the paediatric patient. British Dental Journal. 2020 Dec;229(12):779-85. PMID: 33339924

Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2018;10(10):CD005179. Published 2018 Oct 4. doi:10.1002/14651858.CD005179.pub4. PMC6517234

Al Haidar A. Influence of Nonnutritive Sucking Habits on the Oral Carriage of Escherichia coli. International Journal of Dentistry. 2022 Nov 14;2022. PMCID: PMC9678441

Diab BS, Huda S. Khiala. Depression status in relation to caries experience and salivary physiochemical characteristics among 15 years old students in Al-Swera city–Wassit Governorate-Iraq. J Bagh College Dentistry. 2015, June, Vol. 27(2),158-162

Bagherian A, Sheikhfathollahi M. Children's behavioral pain reactions during local anesthetic injection using cotton-roll vibration method compared with routine topical anesthesia: a randomized controlled trial. Dental research journal. 2016 May;13(3):272. PMCID: PMC4878213

Jamil FA, Asmael HM, Al-Jarsha MY. The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study. BMC Oral Health. 2020 Dec;20(1):1-8. PMCID: PMC7457358

Koja DB, Bede SY. Evaluation of buffered local anaesthesia in dental extraction: A randomized controlled study. Oral Surgery. 2022 Nov;15(4):489-95.

Kämmerer PW, Palarie V, Schiegnitz E, Ziebart T, Al-Nawas B, Daubländer M. Clinical and histological comparison of pulp anaesthesia and local diffusion after periodontal ligament injection and intrapapillary infiltration anaesthesia. J Pain Relief. 2012;1(10.4172):2167-0846.

Klingberg G, Broberg AG. Dental fear/anxiety and dental behaviour management problems in children and adolescents: a review of prevalence and concomitant psychological factors. International journal of paediatric dentistry. 2007 Nov;17(6):391-406. PMID: 17935593

Christensen C, Arnason SC, Oates R, Crabtree M, Kersey Jr JW, Vandewalle KS. Efficacy of Pulpal Anesthesia Using a Needle-less Syringe. Anesthesia Progress. 2020 Dec 1;67(4):200-6. PMCID: PMC7780256

Frankl SN. Should the parent remain with the child in the dental operatory? J. Dent. Child. 1962;29:150-63.

Young DA, Nový BB, Zeller GG, Hale R, Hart TC, Truelove EL, Ekstrand KR, Featherstone JD, Fontana M, Ismail A, Kuehne J. The American Dental Association caries classification system for clinical practice: a report of the American Dental Association Council on Scientific Affairs. The Journal of the American Dental Association. 2015 Feb 1;146(2):79-86. PMID: 25637205

Patra P. Sample size in clinical research, the number we need. Int J Med Sci Public Health 2012;1:5-9.

Chen H, Cohen P, Chen S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Communications in Statistics—simulation and Computation®. 2010 Mar 31;39(4):860-4.

Ferguson CJ. An Effect Size Primer: A Guide for Clinicians and Researchers. Professional Psychology Research and Practice. October 2009. 40 (5), 532–538.

Rosnow, R. L., & Rosenthal, R. Statistical procedures and the justification of knowledge in psychological science. American Psychologist, 1989, 44, 1276-1284.

Cohen J. Statistical power analysis for the behavioural sciences. Hillsdale, New Jersey: L. Lea. 1988;56:102.

Haghighat A, Jafari Z, Hasheminia D, Samandari MH, Safarian V, Davoudi A. Comparisons of success rate and onset time of two different anesthesia techniques. Medicina oral, patologia oral y cirugia bucal. 2015 Jul;20(4):e459. PMCID: PMC4523259

Thiem DGE, Schnaith F, Van Aken CME, Köntges A, Kumar VV, Al-Nawas B, Kämmerer PW. Extraction of mandibular premolars and molars: comparison between local infiltration via pressure syringe and inferior alveolar nerve block anesthesia. Clin Oral Investig. 2018;22(3):1523-1530. doi:10.1007/s00784-017-2251-7. PMID: 29043507

Arapostathis KN, Dabarakis NN, Coolidge T, Tsirlis A, Kotsanos N. Comparison of acceptance, preference, and efficacy between jet injection INJEX and local infiltration anesthesia in 6 to 11 year old dental patients. Anesthesia progress. 2010 Mar 1;57(1):3-12. PMCID: PMC2844236

Riba H, Al-Zahrani S, Al-Buqmi N, Al-Jundi A. A review of behavior evaluation scales in pediatric dentistry and suggested modification to the Frankl scale. EC Dental Science. 2017 Dec 30;16(6):269-75.

Enad HH, Al-Mizraqchi AS. Salivary Cortisol as a Stress Biomarker and Total Viable Count of Salivary Bacterial Microbiome among COVID-19 Patients. J Bagh Coll Dent. 2021 Sep.15.33(4):6-10. Available from: https://jbcd.uobaghdad.edu.iq/index.php/jbcd/article/view/3013

Jafar Z. Interaction of dental anxiety and ABO secretor status of blood group on dental caries in a group of children. Braz. Dent. Sci.2022;25(1):e2928. doi:https://doi.org/10.4322/bds.2022.e2928

Singh B, Deshmukh S. Cognitive Contemporary Behaviour Management Outline. Journal of Evolution of Medical and Dental Sciences. 2021 Oct 4;10(40):3548-54.

Khalaf MS, Khalaf BS, Abass SM. Management of trauma to the anterior segment of the maxilla: alveolar fracture and primary incisors crown and root fracture. Journal of Baghdad College of Dentistry. 2021 Jun 11;33(2):16-20.

Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G. A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesthesia progress. 2005 Dec 1;52(4):122-7.

Narayan VK, Samuel SR. Appropriateness of various behavior rating scales used in pediatric dentistry: A Review. J Global Oral Health 2019;2(2):112-7


Hashim Abd Ali A, D. TE, V. BO, V. KG, P. ST. Investigation of the association of AGTR1 A1166C rs5186 and FTO rs9939609 polymorphisms with the obesity in children and adolescents. Baghdad Sci.J [Internet]. 2022 Dec. 1 [cited 2023 Apr. 18];19(6):1228. Available from: https://bsj.uobaghdad.edu.iq/index.php/BSJ/article/view/6540






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