Assessment and Management of Pain in the Pediatric Patient

Comparative study of articaine 4% versus lidocaine 2% in the local anesthesia of permanent mandibular first molars affected by MIH: a randomized controlled trial

PURPOSE

The current study compares articaine 4% with lidocaine 2% in terms of injection pain and effectiveness of anesthesia when treating permanent mandibular first molars (PMFMs) affected by molar incisor hypomineralization (MIH). In addition to comparing the complications of local anesthesia for both solutions.

METHODS

The sample included 20 children. Each child was randomly assigned to either articaine 4% or lidocaine 2% in their first session with the other solution being used at the subsequent session. Injection pain and the effectiveness of anesthesia were assessed using the Wong-Baker Faces® Pain Rating Scale and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Parents were asked to report any complications of local anesthesia. The Wilcoxon-matched pairs signed-rank test was used to analyze the data.

RESULTS

Patients experienced greater pain when receiving articaine 4% injections according to both scales, differences were statistically significant when using the Wong-Baker Faces® Pain Rating scale (p < 0.05). Whereas, the FLACC scale did not show such differences (P > 0.05). Although there were no significant differences between the two solutions regarding the effectiveness of local anesthesia according to both scales (P > 0.05), articaine 4% was clinically found to be more effective than lidocaine 2%. No complications of local anesthesia were reported.

CONCLUSIONS

Articaine 4% injection was more painful than lidocaine 2%. However, both solutions were effective in anesthetizing PMFMs affected by MIH and without anesthetic complications in the studied sample.

TRIAL REGISTRATION

Clinical trial, NCT05200884, ( https://clinicaltrials.gov/ct2/show/NCT05200884 ).

Effectiveness of the "pain-free dental injection" (PaFein) teaching model in reducing children's pain: A randomized, controlled study

PURPOSE

This study explores the effectiveness of a comprehensive structured teaching model - the "PaFein" - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children.

METHODS

Ten postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9 hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections.

RESULTS

Children's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p < 0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p = 0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p = 0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p < 0.0001); (d) total means were 1.28 and 2.59, respectively (p = 0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p < 0.0001 and p = 0.005).

CONCLUSION

The "PaFein" teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones.

Design and synthesis of novel quinazolinone-pyrazole derivatives as potential α-glucosidase inhibitors: Structure-activity relationship, molecular modeling and kinetic study

In this study, a new series of quinazolinone-pyrazole hybrids were designed, synthesized and screened for their α-glucosidase inhibitory activity. The results of the in vitro screening indicated that all the molecular hybrids exhibited more inhibitory activity (IC₅₀ values ranging from 60.5 ± 0.3 µM-186.6 ± 20 μM) in comparison to standard acarbose (IC₅₀ = 750.0 ± 10.0 µM). Limited structure-activity relationship suggested that the variation in the inhibitory activities of the compounds affected by different substitutions on phenyl rings of diphenyl pyrazole moiety. The enzyme kinetic studies of the most potent compound 9i revealed that it inhibited α-glucosidase in a competitive mode with a Ki of 56 μM. Molecular docking study was performed to predict the putative binding interaction. As expected, all pharmacophoric moieties used in the initial structure design playing a pivotal role in the interaction with the binding site of the enzyme. In addition, by performing molecular dynamic investigation and MM-GBSA calculation, we investigated the difference in structural perturbation and dynamic behavior that is observed over α-glycosidase in complex with the most active compound and acarbose relative to unbound α-glycosidase enzyme.