الفهرس 
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Abstract
Child management is a primary challenge facing pediatric dentists routinely. Uncooperative
behaviour can significantly affect treatment quality, time, and increase the possibility of child injury
during treatment as mentioned by Ingersoll and Ingersoll.(1) Acknowledgement of various behaviour
management techniques, operating skills, and most importantly providing profound local anaesthesia
are critical to deliver high quality dental service.(2)
Local anaesthetic (LA) forms the backbone of pain control techniques in dentistry. Although
it is considered one of the painful procedures in daily dental practice, especially for children,
however, its obligatory to use LA to eliminate pain during the various dental procedures and maintain
child cooperation during the dental session.
Pain is defined by The International Association for the Study of Pain Subcommittee on
Taxonomy in 1979 as “the unpleasant sensory and emotional experience arising from actual or
potential tissue damage.”(3, 4) Profound LA facilitates successful restorative and surgical treatment.
Exodontia is one of the procedures that demand profound local dental anaesthesia to control high
levels of pain and stress and reduce adverse reactions.(5)
A rapidly acting, potent LA drug is the gold standard. In the late 1940s, a new group of
local anesthetic compounds, the amides, was introduced. The initial amide local anesthetic,
Lidocaine, was used for pain control in dentistry worldwide.(6) Later in the mid-1970s, Articaine,
a more potent Amide-type LA drug was first introduced in Germany by Rusching et al,(7) then
in 2000 by the US Food and Drug Administration (FDA), and later in 2004, it has been approved
by the Therapeutics Goods Administration for clinical use in Australia.(8)
Articaine is 1.5 times more potent than lidocaine;(9) its unique chemical composition
enhances its lipid solubility, which increases its uptake by neurones providing an early onset.(10)
Malamed (2000)(11) stated that Articaine 4% with epinephrine 1:100,000 provides total pain
relief during most dental procedures, as it can effectively penetrate soft and hard tissues and is
highly diffusible compared to other local anesthetics.(8) However, it is only available in high
concentrations. Therefore, it is not recommended for children less than 4 years.(9, 12)
3
A study conducted by Vika and Skaret (2008)(13) reported that LA injections seemed to cause
more anxiety than the treatment process itself, and may even lead to completely avoiding treatment.
Therefore, pediatric dentists are always searching for the least painful LA technique to reduce pain,
anxiety and maintain child cooperation.