Evaluation of pain response in children to the SoftClamp™ as an alternative to the metal rubber dam clamp: A randomized clinical trial

Abstract

Background: The use of a rubber dam is more important than ever in today’s COVID‑19 era
to limit cross infections. In children, the placement of the metal clamp to retain the rubber dam
is perceived to be painful and often requiring a local anesthetic injection. This dissuades many
clinicians from placing the rubber dam. Hence, this study evaluated the pain response of children
to a SoftClamp™ compared to the conventional metal clamp.
Materials and Methods: This was a randomized controlled, equal allocation ratio, split‑mouth
clinical trial. Forty‑two children aged between 8 and 12 years, having two permanent mandibular
molars in need of sealants, were divided into Groups A and B (metal clamp and SoftClamp™,
respectively). The pain response was recorded using both an objective and a subjective scale
i.e., the Faces Legs Activity Cry Consolability (FLACC) scale and the Wong Baker Faces Pain Rating
Scale (WBFPRS). The level of significance was set at 5% (P < 0.05). The pain response recorded
from the WBFPRS and the FLACC scale for the metal and the SoftClamp™ were analyzed using
the Wilcoxon signed rank test. The difference in pain response between genders and between
two age groups (below and above 10 years of age) was analyzed using the Mann–Whitney U‑test.
Results: The children reported mild discomfort to clamp placement in both the scales. The P values
for the FLACC and WBFPRS scores comparing the pain response to the metal and SoftClamp™
were 0.311 and 0.149, respectively.
Conclusion: There was no significant difference in the pain response of children to both the clamps. Good
rubber dam application practices in children through the use of behavior guidance and a proper topical
anesthesia technique may play a far more important role regardless of the clamp used. But the SoftClamp™,
with its more child friendly appearance could be a viable alternative to the metal clamp in children.
Key Words: Child, pain, rubber dams