Abstract
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).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
The data used and/or analyzed during the current study available from the corresponding author on reasonable request.
Code availability
Not applicable.
References
Alzahrani F, Duggal MS, Munyombwe T, Tahmassebi JF. Anaesthetic efficacy of 4% articaine and 2%lidocaine for extraction and pulpotomy of mandibular primary molars: an equivalence parallel prospective randomized controlled trial. Int J Paediatr Dent. 2018;28(3):335–44. https://doi.org/10.1111/ipd.12361.
American Academy of Pediatric Dentistry. Use of local anesthesia for pediatric dental patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry. 2021; 332–7.
Arali V, Mytri P. Anaesthetic efficacy of 4% articaine mandibular buccal infiltration compared to 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis. J Clin Diagn Res. 2015;9(4): ZC65–ZC67. https://doi.org/10.7860/JCDR/2015/12821.5856
Arrow P. A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J. 2012;57(3):325–33. https://doi.org/10.1111/j.1834-7819.2012.01699.x.
Bonzanini LI, Arduim AD, Lenzi TL, Hugo FN, Hilgert JB, Casagrande L. Molar-incisor hypomineralization and dental caries: a hierarchical approach in a populational-based study. Braz Dent J. 2022;32:74–82. https://doi.org/10.1590/0103-6440202104511.
Cabasse C, Marie-Cousi A, Huet A, Sixou JL. Computer-assisted intraosseous anaesthesia for molar and incisor hypomineralisation teeth. Odontostomatol Trop. 2015;38(149):5–9.
Chinn S. A simple method for converting an odds ratio to effect size for use in meta-analysis. Stat Med. 2000;19(22):3127–31. https://doi.org/10.1002/1097-0258(20001130)19:22%3c3127::aid-sim784%3e3.0.co;2-m.
Chopra R, Marwaha M, Bansal K, Mittal M. Evaluation of buccal infiltration with articaine and inferior alveolar nerve block with lignocaine for pulp therapy in mandibular primary molars. J Clin Pediatr Dent. 2016;40(4):301–5. https://doi.org/10.17796/1053-4628-40.4.301
Committee on Psychosocial Aspects of Child and Family Health, Task Force on Pain in Infants, Children, and Adolescents. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–7 https://doi.org/10.1542/peds.108.3.793
Coté CJ, Wilson S (2019) American Academy of Pediatrics, American Academy of Pediatric Dentistry. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatrics. 143(6): e20191000. https://doi.org/10.1542/peds.2019-1000
de Castro CR, Lima CC, Costa LC, Silva RN, Pascotto RC, de Moura MS, Almeida de Deus Moura LD, Moura de Lima MD. Hypomineralized teeth have a higher frequency of dental hypersensitivity. Pediatr Dent. 2021; 43(3):218–22.
Discepolo KE, Suher Baker DM. Adjuncts to traditional local anesthesia techniques in instance of hypomineralized teeth. N Y State Dent J. 2011;77(6):22.
Dixit UB, Joshi AV. Efficacy of intraosseous local anesthesia for restorative procedures in molar incisor hypomineralization-affected teeth in children. Contemp Clin Dent. 2018;9(Suppl 2):S272–7. https://doi.org/10.4103/ccd.ccd_252_18.
Elhennawy K, Rajjoub O, Reissmann DR, Doueiri MS, Hamad R, Sierwald I, Wiedemann V, Bekes K, Jost-Brinkmann PG. The association between molar incisor hypomineralization and oral health-related quality of life: a cross-sectional study. Clin Oral Investig. 2022;26(5):4071–7. https://doi.org/10.1007/s00784-022-04375-3.
Fagrell TG, Lingström P, Olsson S, Steiniger F, Norén JG. Bacterial invasion of dentinal tubules beneath apparently intact but hypomineralized enamel in molar teeth with molar incisor hypomineralization. Int J Paediatr Dent. 2008;18(5):333–40. https://doi.org/10.1111/j.1365-263X.2007.00908.x.
Farias L, Laureano IC, Fernandes LH, Forte FD, Vargas-Ferreira F, Alencar CR, HonÓrio HM, Cavalcanti AL. Presence of molar-incisor hypomineralization is associated with dental caries in Brazilian schoolchildren. Braz Oral Res. 2021;1:35. https://doi.org/10.1590/1807-3107bor-2021.vol35.0013.
Fatturi AL, Menoncin BL, Reyes MT, Meger M, Scariot R, Brancher JA, Küchler EC, Feltrin-Souza J. The relationship between molar incisor hypomineralization, dental caries, socioeconomic factors, and polymorphisms in the vitamin D receptor gene: a population-based study. Clin Oral Investig. 2020;24(11):3971–80. https://doi.org/10.1007/s00784-020-03263-y.
Frankl SN, Shiere FR, Fogels HR. Should the parent remain in the operatory? J Dent Child. 1962;29(1):150–63.
Galler KM, Weber M, Korkmaz Y, Widbiller M, Feuerer M. Inflammatory response mechanisms of the dentine–pulp complex and the periapical tissues. Int J Mol Sci. 2021;22(3):1480. https://doi.org/10.3390/ijms22031480.
Ghadimi S, Shahrabi M, Khosravi Z, Behroozi R. Efficacy of articaine infiltration versus lidocaine inferior alveolar nerve block for pulpotomy in mandibular primary second molars: a randomized clinical trial. J Dent Res Dent Clin Dent Prospects. 2018;12(2):97–101. https://doi.org/10.15171/joddd.2018.015
Ghanim A, Silva MJ, Elfrink MEC, Lygidakis NA, Mariño RJ, Weerheijm KL, Manton DJ. Molar incisor hypomineralisation (MIH) training manual for clinical feld surveys and practice. Eur Arch Paediatr Dent. 2017;18(4):225–42. https://doi.org/10.1007/s40368-017-0293-9.
Gosnell ES, Thikkurissy S. Assessment and management of pain in the pediatric patient. In: Nowak AJ, editor. Pediatric dentistry: infancy through adolescence. Philadelphia: Elsevier; 2019. p. 97–115.
Jablonski-Momeni A, Stachniss V, Ricketts DN, Heinzel-Gutenbrunner M, Pieper K. Reproducibility and accuracy of the ICDAS-II for detection of occlusal caries in vitro. Caries Res. 2008;42(2):79–87. https://doi.org/10.1159/000113160.
Jälevik B, Klingberg GA. Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent. 2002;12(1):24–32.
Jälevik B, Klingberg G. Treatment outcomes and dental anxiety in 18-year-olds with MIH, comparisons with healthy controls–a longitudinal study. Int J Paediatr Dent. 2012;22(2):85–91. https://doi.org/10.1111/j.1365-263X.2011.01161.x.
Jones JE, Scully AC. Local anesthesia and pain control for the child and adolescent. In: Dean JA, editor. McDonald and Avery’s dentistry for the child and adolescent. St. Louis: Elsevier; 2022. p. 327–39.
Jorgenson K, Burbridge L, Cole B. Comparison of the efficacy of a standard inferior alveolar nerve block versus articaine infiltration for invasive dental treatment in permanent mandibular molars in children: a pilot study. Eur Arch Paediatr Dent. 2020;21(1):171–7. https://doi.org/10.1007/s40368-019-00496-8.
Keetley A, Moles DR. A clinical audit into the success rate of inferior alveolar nerve block analgesia in general dental practice. Prim Dent Care. 2001;4:139–42. https://doi.org/10.1308/135576101322462174.
Klingberg G, Ridell K, Brogårdh-Roth S, Vall M, Berlin H. Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents. Eur Arch Paediatr Dent. 2017;18(5):323–9. https://doi.org/10.1007/s40368-017-0302-z.
Kolli NK, Nirmala SV, Nuvvula S. The effectiveness of articaine and lidocaine single buccal infiltration versus conventional buccal and palatal injection using lidocaine during primary maxillary molar extraction: a randomized control trial. Anesth Essays Res. 2017;11(1):160–4. https://doi.org/10.4103/0259-1162.186589.
Kühnisch J, Daubländer M, Klingberg G, Dougall A, Spyridonos Loizides M, Stratigaki E, Amar JL, Anttonen V, Duggal M, Gizani S. Best clinical practice guidance for local analgesia in paediatricdentistry: an EAPD policy document. Eur Arch Paediatr Dent. 2017;18(5):313–21. https://doi.org/10.1007/s40368-017-0311-y.
Kupietzky A, Schwartz S. Local Anesthesia. In: Kupietzky A, editor. Wright’s behavior management in dentistry for children. Hoboken: Wiley; 2022. p. 141–61.
Linner T, Khazaei Y, Bücher K, Pfisterer J, Hickel R, Kühnisch J. Hypersensitivity in teeth affected by molar-incisor hypomineralization (MIH). Sci Rep. 2021;11(1):1–8. https://doi.org/10.1038/s41598-021-95875-x.
Lygidakis NA, Wong F, Jälevik B, Vierrou AM, Alaluusua S, Espelid I. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an EAPD policy document. Eur Arch Paediatr Dent. 2010;11(2):75–81. https://doi.org/10.1007/BF03262716.
Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FS. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European academy of paediatric dentistry policy document. Eur Arch Paediatr Dent. 2021;23(1):3–21. https://doi.org/10.1007/s40368-021-00668-5.
Malamed SF. Handbook of Local Anesthesia. 7th ed. Missouri: Elsevier; 2020.
Malamed SF, Gagnon S, Leblanc D. A comparison between articaine HCl and lidocaine HCl in pediatric dental patients. Pediatr Dent. 2000;22(4):307–11.
Massignan C, Silveira Santos P, Cardoso M, Bolan M. Efficacy and adverse events of 4% articaine compared with 2% lidocaine on primary molar extraction: a randomised controlled trial. J Oral Rehabil. 2020;47(8):1031–40. https://doi.org/10.1111/joor.12989.
McGrath PJ, Unruh AM. Measurement and assessment of pediatric pain. In: McMahon S, Koltzenburg M, Tracey I, Turk DC, editors. Wall & Melzack’s textbook of pain. Philadelphia: Elsevier; 2013. p. 455–64.
McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Eccleston C, Finley GA, Goldschneider K, Haverkos L, Hertz SH. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain. 2008;9(9):771–83. https://doi.org/10.1016/j.jpain.2008.04.007.
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293–7.
Nakai Y, Milgrom P, Mancl L, Coldwell SE, Domoto PK, Ramsay DS. Effectiveness of local anesthesia in pediatric dental practice. J Am Dent Asso. 2000;131(12):1699–705. https://doi.org/10.14219/jada.archive.2000.0115
Ogle OE, Mahjoubi G. Local anesthesia: agents, techniques, and complications. Dent Clin North Am. 2012;56(1):133–48. https://doi.org/10.1016/j.cden.2011.08.003.
Özgül BM, Sakaryalı D, Tirali RE, Cehreli SB. (2022). Does MIH affects preoperative and intraoperative hypersensitivity?. J Clin Pediatric Dentistry. 2022;46(3):204–10. https://doi.org/10.17796/1053-4625-46.3.6
Park SH, Lee YS, Lee DS, Park JC, Kim R, Shon WJ. CPNE7 induces biological dentin sealing in a dentin hypersensitivity model. J Dent Res. 2019;98(11):1239–44. https://doi.org/10.1177/0022034519869577.
Ram D, Amir E. Comparison of articaine 4% and lidocaine 2% in paediatric dental patients. Int J Paediatr Dent. 2006;16(4):252–6. https://doi.org/10.1111/j.1365-263X.2006.00745.x.
Repp AC, Nieminen GS, Olinger E, Brusca R. Direct observation: factors affecting the accuracy of observers. Except Child. 1988;55(1):29–36. https://doi.org/10.1177/001440298805500103.
Rodd HD, Boissonade FM, Day PF. Pulpal status of hypomineralized permanent molars. Pediatr Dent. 2007;29(6):514–20.
Rodd HD, Graham A, Tajmehr N, Timms L, Hasmun N. Molar incisor hypomineralisation: current knowledge and practice. Int Dent J. 2021;71(4):285–91. https://doi.org/10.1111/idj.12624.
Samdrup T, Kijsamanmith K, Vongsavan K, Rirattanapong P, Vongsavan N. The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1: 100,000 on blood flow and anesthesia of human mandibular teeth. J Dent Sci. 2021;16(1):249–55. https://doi.org/10.1016/j.jds.2020.05.013.
Shapiro MR, McDonald NJ, Gardner RJ, Peters MC, Botero TM. Efficacy of articaine versus lidocaine in supplemental infiltration for mandibular first versus second molars with irreversible pulpitis: a prospective, randomized, double-blind clinical trial. J Endod. 2018;44(4):523–8. https://doi.org/10.1016/j.joen.2017.10.003.
Soysa NS, Soysa IB, Alles N. Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: a systematic review and meta‐analysis. J Investig Clin Dent. 2019;10(3): e12404. https://doi.org/10.1111/jicd.12404
Steffen R. Treatment of children with MIH: a challenge in pain control and behaviour management. In: Bekes K, editor. Molar Incisor Hypomineralization. Cham: Springer; 2020. p. 99–111.
Tomlinson D, Von Baeyer CL, Stinson JN, Sung L. A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics. 2010;126(5):e1168–98. https://doi.org/10.1542/peds.2010-1609.
Veerkamp JS, Wright GZ. Children’s Behavior in the Dental Office. In: Kupietzky A, editor. Wright’s behavior management in dentistry for children. Hoboken: Wiley; 2022. p. 23–35.
Von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007;127(1–2):140–50. https://doi.org/10.1016/j.pain.2006.08.014.
Wall A, Leith R. A questionnaire study on perception and clinical management of molar incisor hypomineralisation (MIH) by Irish dentists. Eur Arch Paediatr Dent. 2020;21(6):703–10. https://doi.org/10.1007/s40368-020-00519-9.
Weerheijm KL, Jalevik B, Alaluusua S. Molar-incisor hypomineralisation. Caries Res. 2001;35(5):390. https://doi.org/10.1159/000047479.
Widbiller M, Schmalz G. Endodontic regeneration: hard shell, soft core. Odontology. 2021;109(2):303–12. https://doi.org/10.1007/s10266-020-00573-1.
Acknowledgements
The staff at the Department of Pediatric Dentistry is acknowledged for their assistance.
Funding
The authors did not receive support from any organization for the submitted work.
Author information
Authors and Affiliations
Contributions
We declare that all authors have made substantial contributions. Dr. Raslan designed the research study. MS. Haider conducted the research including local anesthesia, dental treatment and data collection. Dr. Raslan and MS. Haidar analyzed the data. MS. Haidar prepared the manuscript draft with important intellectual input from Dr. Raslan. Dr. Raslan revised the manuscript. All authors approved the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval
The IRB of Tishreen University had approved the study. Approval No. 1969 was obtained in session (No.22), held on June-16–2020.
Consent to participate
A written consent was obtained from all of the parents on behalf of their children included in this study.
Consent for publication
A written consent was obtained from all of the parents on behalf of their children included in this study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Haidar, M., Raslan, N. Comparative study of articaine 4% versus lidocaine 2% in the local anesthesia of permanent mandibular first molars affected by MIH: a randomized controlled trial. Eur Arch Paediatr Dent 24, 621–630 (2023). https://doi.org/10.1007/s40368-023-00827-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40368-023-00827-w