Reactions of children to maxillary infiltration and mandibular block injections

The purpose of this study was to assess children's reactions to the administration of local anesthetic injection in the mandible and in the maxilla, and to study their sensation of pain after each type of injection.

Twenty-six children between the ages of 4 to 6 (mean age 5.3+/-0.7 years), and 34 children aged between 7 to 10 (mean age 8.1+/-1.1 years,) who were undergoing dental treatment in a pediatric dental clinic, were selected for this study. A random crossover design was used. Each patient was randomly assigned to receive either maxillary infiltration or mandibular block on the first visit, and the remaining local anesthesia on the second visit. During the injection, the modified Behavioral Pain Scale, was used. It comprised the following parameters: a) facial display, b) arm/leg movements, c) torso movements, and d) crying. Immediately after administering the local anesthesia, children were asked to rate their feeling according to the Facial Affective Scale.

The children in each group responded positively to both techniques revealing that there was no difference in either one. Subjective and objective evaluation disclosed no difference when mandibular block was administered during the first or second visit. Regarding the objective evaluation, in all parameters, more children reacted positively during administration of mandibular block than during maxillary infiltration.

a) mandibular block and maxillary infiltration are similarly accepted by children when first administered, and b) children may feel inconvenience or pain and react by crying, yet may report a positive feeling in general.