Reactions of children to maxillary infiltration and mandibular block injections

Resident: Cho

Author(s): Ram D, Peretz B.

Journal: Pediatric Dentistry

Year. Volume (number). Page #’s: 2001. 23. 343-346.

Major topic: Maxillary infiltration injection, Mandibular block injection

Minor topic: Facial Pain Scale

Type of Article: Scientific Article

Main Purpose: The purpose of this study was to assess children’s reactions to the administration of local anesthetic injection in the mandible and maxilla, and to study their sensation of pain after each type of injection.

Overview of method of research:

26 children between the ages of 4-6 years and 34 children between the ages of 7-10 years participated in the study. All patients were ASA I, no prior dental treatment, needed at least two clinical non-emergency sessions of operative procedures preceded by local anesthetic injection one in the mandible and the other in the maxilla. Based on the Frankl Scale, all children demonstrated positive or definitely positive behavior during pretreatment evaluation. Euphemisitic phrases such as “putting tooth to sleep” were used to describe the injection to all the children.

5% lignocaine on a cotton-wool roll was applied as a topical anesthetic prior to the injection. A short needle was used for both maxillary infiltration and mandibular block. Injection of the local anesthetic 2% lidocaine 1:100,000 was slow at an average of 1mL per minute. All injections were carried out by the same dentist.

Each patient was randomly assigned to receive either maxillary infiltration for the first visit and mandibular block for the second visit OR mandibular block for the first visit and maxillary infiltration for the second visit. During the injection, the modified Behavioral Pain Scale by Taddio et al was used to evaluate the children by observing: 1) facial display, 2) arm/leg movements, 3) torso movements, 4) crying. A trained dental assistant, who did not participate in the treatment, recorded the behavior.

Immediately after the injections, the children were asked to complete the Facial Pain Scale (FPS) for subjective evaluation of feeling after the injection. FPS is a set of nine cartoon faces with varying facial expressions ranging from a smile/laughter (value 9) to that of tears (value 1). The child was asked to select the face “which looks like how you feel deep down inside, not the face you show to the world.”

Findings:

No significant differences were found whether the maxillary infiltration or the mandibular block was given the first visit vs. second visit. No significant differences were found between boys and girls. The majority of the patients did not cry at all during the procedure.

Key points/Summary: Administration of local anesthetic in the maxillary teeth has been traditionally considered less painful than a mandibular bock for pediatric dental patients. This study showed that:

1. Mandibular block and maxillary infiltration are accepted similarly by children when first administered.
2. Children may feel inconvenience or pain and react by crying, yet may report a positive feeling in general.

Assessment of Article: Good article. However, it is not reflective of pediatric patients in general since they only surveyed patients that were positive and definitely positive patients.