ABSTRACT
Objective:
The present study aims to conduct a comparative analysis of different local anesthetic techniques for pain management in pediatric dental procedures. Goal is to evaluate and compare the efficacy and safety of various local anesthetic methods to identify the most effective approach in reducing pain and discomfort during dental treatments in children.
Methods:
A prospective, randomized clinical trial was conducted with 60 pediatric patients (aged 3 to 10 years) undergoing dental procedures in a single dental clinic. The participants were randomly assigned into three groups: Group A received conventional infiltration anesthesia (lidocaine 2% with epinephrine 1:100,000), Group B received topical anesthesia followed by the same infiltration anesthesia, and Group C received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The patients’ demographic data, treatment details, and pre-procedure anxiety levels were recorded.
Results:
The study demonstrated that all three local anesthetic techniques effectively managed pain during pediatric dental procedures. However, Group C, which received intraosseous anesthesia, showed significantly lower pain scores (mean ± standard deviation) compared to Group A and Group B: 1.5 ± 0.6, 2.3 ± 0.8, and 2.1 ± 0.7, respectively (P < 0.05). Additionally, Group C exhibited a shorter onset of anesthesia compared to Group A and Group B, with mean onset times of 1.8 ± 0.4, 3.2 ± 0.6, and 2.9 ± 0.5 minutes, respectively (P < 0.001). No significant differences in adverse events or post-procedure complications among the groups.
Conclusion:
Intraosseous anesthesia (articaine 4% with epinephrine 1:100,000) was found most effective local anesthetic technique for pain management during pediatric dental procedures.
KEYWORDS: Local anesthetic, pain management, pediatric dental procedures
INTRODUCTION
Effective pain management is of paramount importance in pediatric dentistry to ensure a positive and comfortable dental experience for young patients.[1] Local anesthesia plays a critical role in alleviating pain and discomfort during dental procedures, enabling dentists to provide necessary treatments while minimizing patient anxiety and fear.[2]
Various local anesthetic methods have been employed in pediatric dental practice, including conventional infiltration anesthesia, topical anesthesia, and intraosseous anesthesia. Conventional infiltration anesthesia, administered by injecting the anesthetic agent into the soft tissues surrounding the treatment area, is a widely used technique.[3] Topical anesthesia, applied to the mucous membrane before infiltration, aims to reduce the discomfort associated with the needle insertion.[4] On the other hand, intraosseous anesthesia involves the direct injection of the anesthetic agent into the bone near the dental treatment site, allowing for profound anesthesia.[5]
Several studies have individually evaluated the different local anesthetic techniques, highlighting their benefits and limitations.[6,7,8] However, a direct comparative analysis is essential to identify the most effective approach for pain management in pediatric dental patients.
The present study aims to conduct a prospective, randomized clinical trial to compare the efficacy and safety of conventional infiltration anesthesia, topical anesthesia followed by infiltration, and intraosseous anesthesia in pediatric dental procedures.
MATERIALS AND METHODS
Study design
This study employed a prospective, randomized clinical trial design to compare the efficacy and safety of different local anesthetic techniques for pain management during pediatric dental procedures.
Participants
A total of 60 pediatric patients, aged 3 to 10 years, who required dental procedures were recruited from a single dental clinic. Informed consent was obtained from the parents or legal guardians of all participants before enrollment. The inclusion criteria included children requiring dental treatments in the mandibular region (e.g., deciduous molars) that necessitated local anesthesia. Participants with a history of allergies to local anesthetics, systemic illnesses, or contraindications to the study drugs were excluded.
Local anesthetic techniques
The three study groups and their respective local anesthetic techniques were as follows:
Group A (Infiltration Group): Patients in this group received conventional infiltration anesthesia using lidocaine 2% with epinephrine 1:100,000 [Table 1].
Table 1.
Pain Scores
| Group | Anesthetic Technique | Mean Pain Score (±SD) |
|---|---|---|
| Group A | Conventional Infiltration | 2.3±0.8 |
| Group B | Topical + Infiltration | 2.1±0.7 |
| Group C | Intraosseous | 1.5±0.6 |
Group B (Topical + Infiltration Group): Patients in this group received topical anesthesia applied to the mucous membrane before receiving the same conventional infiltration anesthesia as Group A [Table 2].
Table 2.
Onset of Anesthesia
| Group | Anesthetic Technique | Mean Onset Time (±SD) |
|---|---|---|
| Group A | Conventional Infiltration | 3.2±0.6 min |
| Group B | Topical + Infiltration | 2.9±0.5 min |
| Group C | Intraosseous | 1.8±0.4 min |
Group C (Intraosseous Group): Patients in this group received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The anesthetic agent was directly injected into the bone near the dental treatment site [Table 3].
Table 3.
Adverse Events and Complications
| Group | Adverse Events and Complications |
|---|---|
| Group A | No significant differences |
| Group B | No significant differences |
| Group C | No significant differences |
Data collection
Demographic data, including age and gender, were recorded for each participant. Pre-procedure anxiety levels were assessed using a validated anxiety scale for pediatric patients.
Outcome measures
The primary outcome measures were pain scores and the onset of anesthesia. Pain scores were recorded immediately after the dental procedure using a numerical rating scale (NRS) ranging from 0 (no pain) to 10 (worst imaginable pain). The onset of anesthesia was defined as the time elapsed from the completion of local anesthesia administration to the onset of effective anesthesia, assessed using standardized dental testing procedures.
Statistical analysis
Statistical analysis was performed using SPSS version 22 software. The mean ± standard deviation (SD) was calculated for continuous variables. The comparison of pain scores and onset times among the three groups was analyzed using the one-way analysis of variance (ANOVA) followed by post-hoc tests with Bonferroni correction. A P value less than 0.05 was considered statistically significant.
RESULTS
Comparison: Group C (Intraosseous) showed significantly lower pain scores compared to Group A (Infiltration) and Group B (Topical + Infiltration) (P < 0.05).
Comparison: Group C (Intraosseous) exhibited a significantly shorter onset of anesthesia compared to Group A (Infiltration) and Group B (Topical + Infiltration) (P < 0.001).
The table shows that no significant differences in adverse events or post-procedure complications were observed among the three groups. This suggests that all three local anesthetic techniques were equally safe in managing pain during pediatric dental procedures.
DISCUSSION
The present study aimed to compare different local anesthetic techniques for pain management during pediatric dental procedures and identify the most effective approach in reducing pain and discomfort in young patients. Results demonstrated that all three local anesthetic techniques (conventional infiltration anesthesia, topical anesthesia followed by infiltration, and intraosseous anesthesia) effectively managed pain during dental procedures in children.
Among three groups, Group C (intraosseous anesthesia) exhibited significantly lower pain scores compared to Group A (conventional infiltration anesthesia) and Group B (topical anesthesia followed by infiltration). This finding is consistent with previous studies that have reported the superiority of intraosseous anesthesia in achieving profound anesthesia and minimizing discomfort during dental treatments.[1,2] Direct injection of the anesthetic agent into the bone allows for better diffusion and faster onset of anesthesia, resulting in reduced pain perception.[3] The shorter onset time observed in Group C further supports the clinical advantages of intraosseous anesthesia in pediatric dental practice.
Intraosseous anesthesia has shown to be safe and well-tolerated in children, with no significant differences in adverse events or post-procedure complications observed among the three groups. This finding aligns with the existing literature, which suggests that intraosseous anesthesia is a reliable and predictable technique with a favorable safety profile.[4,5]
Effective pain management is crucial not only for successful dental procedures but also for fostering positive attitudes toward oral health maintenance from an early age.[6]
CONCLUSION
The implementation of intraosseous anesthesia in pediatric dental practice has the potential to optimize pain management and improve the overall dental experience for young patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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