Pain assessment of two palatal anesthetic techniques and their effects on the child's behavior

The purposes of the study were to: compare the pain perception and the behavior of children, who received palatal anesthesia by the direct and indirect infiltration anesthetic techniques, correlate between pain scores and behavior, and to make some recommendations for clinical practice. Sixty-two cooperative children aged 6 to 7 years participated successfully in the study. Each child received palatal anesthesia by both injection techniques to extract their badly destructed upper primary molars in two visits. Immediately after injection, the Wong and Baker pain faces scale was used for pain scoring by children. There were 32 boys and 30 girls (mean age 6 years and 3 months). The tested parameters were; pain perception and children's behavior during injection and pain perception during extraction. Comparisons between the effects of the two techniques within the gender and the tooth type were statistically performed using Chi-square test. Generally, no significant differences were found between the genders regarding neither pain perception nor behavior. For all children, the indirect technique significantly revealed lower anesthesia pain scores, and significantly more children displayed good behavior (P = 0.031, P = 0.004). No significant difference was reported in extraction pain scores between the two techniques, indicating the same efficacy of anesthesia was obtained. The second primary molar, significantly revealed lower pain scores of both anesthesia and extraction and a better behavior display of children anesthetized by the indirect rather than the direct technique (P = 0.04, P = 0.019, P = 0.046). On the other hand, no differences were revealed on anesthetizing the first primary molar. Children's behavior was negatively correlated (r = -0.294) with anesthesia pain scores (P≤0.001). The results of the study recommend the use of the indirect palatal anesthetic technique for extracting the second primary molars and the use of the direct technique for extracting the first primary molars of young children.