Comparative Evaluation of Pain Management Techniques in Paediatric Dental Surgical Procedures

Abstract

Pain and anxiety are major barriers to successful paediatric dental care. Conventional local anaesthesia (LA) alone often fails to adequately control pain or reduce fear during dental extractions in children. Adjunctive approaches such as nitrous oxide/oxygen (N 2 O/O 2 ) sedation, computer-controlled local anaesthetic delivery (CCLAD) and pre-emptive analgesia with ibuprofen have shown potential individually but have rarely been compared directly. This single-blind randomised controlled trial randomised 150 healthy children (ages 6–10) into three groups: conventional LA (control), sedation or CCLAD with pre-operative ibuprofen. Researchers assessed intraoperative and post-operative pain using the Wong–Baker FACES Pain Rating Scale while evaluating procedural behaviour (Frankl Scale) and parental satisfaction (Likert Scale) following mandibular molar extractions. Both the intervention groups showed significantly lower intraoperative pain than the control ( P < 0.001). Mean injection pain scores were 5.1 ± 1.8 (Group A), 2.2 ± 0.9 (Group B) and 2.5 ± 1.1 (Group C). Group B demonstrated the most favourable behaviour (88% ‘definitely positive’), while Group C had the lowest post-operative pain scores at 2 h (1.7 ± 0.7) and 6 h (1.9 ± 0.8) and the least rescue analgesic use (12%). Parental satisfaction was significantly higher in Groups B and C ( P < 0.001). Both N 2 O/O 2 inhalation sedation and CCLAD with pre-operative ibuprofen significantly enhanced pain control and behavioural outcomes compared to conventional LA. N 2 O/O 2 provided optimal intraoperative comfort through anxiety reduction, while CCLAD with ibuprofen offered superior post-operative pain relief.