Evaluating the impact of camouflaged and insulin syringes with and without counter-stimulation on anxiety and behavior in children during administration of local anesthesia.

Background: Fear of injections and dental anxiety are the major barriers to successful pediatric dental treatment. Visual threats associated with conventional syringes can increase anxiety and pain perception in children, necessitating the use of child-friendly strategies. This study aimed to evaluate and compare the impact of camouflaged and insulin syringes, with and without counter-stimulation, on anxiety levels, pain perception, and behavioral responses during local anesthesia administration in children. Methods: A clinical trial involving 120 children aged 8-10 years who required bilateral maxillary local anesthesia was performed. Local anesthesia with camouflaged and insulin syringes was administered to each child once with and without thumb pressure counter-stimulation. Anxiety was measured using pulse rates, pain was measured using the Wong-Baker Faces Pain Rating Scale, and behavior was measured using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Statistical analyses were performed using the independent t-test and chi-square test. Results: Both groups were demographically comparable with no significant differences in age (independent t-test, P = 0.539) or sex distribution (chi-square test, P = 0.854). At first appointment, camouflaged syringes showed significantly lower pain scores (3.58 ± 0.74 vs. 4.17 ± 1.37; P = 0.005), lower pulse rates (89.10 ± 5.84 vs. 99.00 ± 1.80 bpm; P < 0.001), and better behavioral responses (FLACC score: 2.27 ± 0.78 vs. 2.80 ± 0.68; P < 0.001) compared with insulin syringes, as assessed by the independent t-test. These effects were further enhanced by counter-stimulation. At second appointment, although overall scores improved in both groups, post-treatment differences between the syringe types were not statistically significant (P > 0.05). Conclusion: Camouflaged syringes combined with counter stimulation represent an effective, simple, and non-pharmacological method for reducing anxiety and improving cooperation during local anesthesia administration in pediatric dental patients. However, the findings are limited by the use of a homogenous sample of healthy, cooperative children aged 8-10 years and potential bias due to the inability of blind operators or participants. Future studies should evaluate a broader population and incorporate blind assessment protocols.