Pain perception during injection of local anesthesia in pedodontics.

OBJECTIVE: Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry. METHOD AND MATERIALS: In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland-Altman method was used to quantify the comparison between pain ratings. RESULTS: The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner's rating and the self--reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment. CONCLUSION: As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient's pain perception.

Success rates of preformed metal crowns placed with the modified and standard hall technique in a paediatric dentistry setting.

BACKGROUND: The Hall Technique is a less invasive caries management technique for treating carious primary molars. It has become a routine treatment at specialists' practices. AIM: To retrospectively evaluate the clinical success and survival rates of preformed metal crowns placed on primary molars using the Hall Technique in a Paediatric Dentistry Setting. DESIGN: Patient records of children receiving Hall crowns (with or without proximal slicing) between 2011 and 2017 were reviewed. Teeth with no clinical or radiographic evidence of pulp involvement at baseline and at least six months' follow-up were included. Kaplan-Meier survival analyses and Mantel-Cox statistics were carried out. RESULTS: In total, 181 Hall crowns performed in 2- to 10-year-olds with a mean follow-up period of 22 months were included for analysis. Mean d3 mft/D3 MFT was 6.55 ± 3.48/0.18 ± 0.66. The majority of crowns were successful (92.3%; n = 167), four presented at least one minor failure (2.2%; reversible pulpitis, crown lost, or secondary caries) and ten were major failures (5.5%; irreversible pulpitis or abscess). When comparing crowns performed with no tooth preparation to crowns performed with proximal slicing, no differences were observed (P = 0.70, CI = 0.68-0.83). CONCLUSION: The survival rate and clinical efficacy of Hall crowns were high in a secondary care-based setting. The HT is an effective and less invasive management option for asymptomatic carious primary molars.