Overcoming local anesthesia failure during routine dental treatments in children

Abstract

AbstractBackgroundLocal anesthesia (LA) during routine dental treatment in children fails in 5%–35% of first attempts. No data, however, are available on the success rates of subsequent attempts.AimTo evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P‐LA, S‐LA, and T‐LA, respectively) for anesthetizing molars during routine dental treatments in children.DesignWe retrospectively analyzed dental records of all children (2–18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer‐controlled local anesthetic delivery (CCLAD) system.ResultsThe failure rate of P‐LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S‐LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P‐LA.ConclusionThe optimal choice of S‐LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS‐CCLAD system.