Finding the Best Way to Numb the Pain: How Pediatric Dentists Choose Anaesthesia for Children’s Molars
Why Pain Management Matters in Kids’ Dentistry
For children, a trip to the dentist can be a nerve-wracking experience. Fear of needles and the unfamiliar dental chair often make young patients anxious — and that anxiety can linger for years. That’s why effective local anaesthesia (LA) is vital in pediatric dentistry: it helps control pain, improve cooperation, and shape a child’s lifelong attitude toward oral care.
A new study published in BMC Oral Health (2025) by Pelin Senem Özsunkar and Sacide Duman from Inonu University, Türkiye, explores how pediatric dentists choose local anaesthesia techniques when treating primary molars — specifically, the lower jaw molars that often require pulpotomy or pulpectomy (treatments for infected tooth pulp).
The Study at a Glance
The researchers surveyed 330 pediatric dentists across Türkiye using a 23-question online form. The goal: to understand which anaesthetic methods are preferred in different clinical scenarios and how dentists adapt when the first injection doesn’t work.
Participants were presented with eight “what-would-you-do” scenarios involving 4-year-old and 7-year-old children who needed treatment on their lower molars. Each dentist indicated their primary anaesthesia technique and an alternative method if the first failed.
Different Ages, Different Choices
Results revealed that the child’s age, the tooth’s position, and the treatment type strongly influenced the choice of anaesthesia.
For younger children (4 years old), buccal infiltration (BI) — injecting near the side of the tooth — was the top choice, especially for first molars.
For older children (7 years old), inferior alveolar nerve block (IANB) — numbing the entire lower jaw quadrant — was preferred, particularly for second molars.
When initial anaesthesia failed, intrapulpal (IPA) and intraligamentary (ILA) injections were the most common backup options.
In simple terms, dentists tend to use a lighter, surface-level anaesthesia for younger kids with softer bone structures, and a deeper, more comprehensive block for older children whose jawbones are denser.
Why the Difference Matters
The findings reflect a practical adaptation to anatomy and patient comfort. Infiltration techniques often work well in younger patients because their jawbone is more permeable, allowing the anaesthetic to diffuse effectively. However, as children grow, the bone thickens — making infiltration less effective and nerve block techniques more reliable.
Yet, nerve blocks come with trade-offs: longer numbness, risk of accidental biting, and rare complications like facial paralysis or trismus. Hence, knowing when to switch methods — or add a supplemental one — is key to both safety and success.
Adapting When Numbness Fails
Anaesthetic failure is a common frustration in pediatric practice. When the nerve block doesn’t work, dentists often repeat the same technique — but that doesn’t always help. Studies show repeated injections may only achieve about a 30% success rate.
That’s where supplementary techniques such as intrapulpal (direct injection into the pulp chamber) or intraligamentary (around the tooth socket) anaesthesia come in. These approaches can enhance pain control when standard methods fall short, though they require skill and care to minimize discomfort.
The study also noted growing interest in digital anaesthesia systems, which deliver injections more precisely and with less pain — an emerging option that could help reduce fear and anxiety in young patients.
Training and Technology for the Future
The authors conclude that effective pain management in children isn’t just about choosing the right needle — it’s about clinical judgment, training, and empathy.
They suggest pediatric dental education should include broader training on alternative and computer-assisted anaesthetic techniques, alongside strategies for managing dental anxiety.
Takeaway
This nationwide survey highlights how pediatric dentists tailor their approach to each child’s age, anatomy, and treatment needs. As technology advances and new anaesthetic delivery systems become available, future care may become not only more effective — but also less intimidating for young patients.
Reference:
Özsunkar, P. S., & Duman, S. (2025). Evaluation of local anaesthesia techniques preferred by paediatric dentists in pulpal procedures for mandibular primary molars. BMC Oral Health, 25(1700). https://doi.org/10.1186/s12903-025-07070-3