PAIN ASSESSMENT DURING THE REMOVAL OF INFECTED CARIOUS DENTIN USING CERAMIC BURS WITHOUT LOCAL ANESTHESIA IN CHILDREN

Negative dental experiences in childhood can lead to dental phobias in adult patients. The dentist’s role is to lessen dental anxiety by providing a pain-free procedure. This could be achieved by using painless procedures in caries removal such as air abrasion, laser, chemo-mechanical, enzymatic techniques, as well as the use of polymer or ceramic burs. Ceramic burs are rotary cutting instruments made of alumina-yttria stabilized zirconia round burs. They work by selective removal of carious infected dentin consequently avoiding pain which could be more appropriate for very young children.
The aim of this study was to assess the extent of pain perception using ceramic burs during caries removal without local anesthesia in pediatric patients. This was performed on 51 patients between 4-8 years of age with 2 primary molars showing dentinal caries requiring class I restoration. The first visit (group I) caries was removed by ceramic bur on low speed hand-piece without administration of local anesthesia then the second visit (group II) caries was removed by carbide round bur on low speed hand-piece without administration of local anesthesia. During each procedure, objective assessment for pain was performed using FLACC scale. Upon completion, the pain threshold for caries removal was measured subjectively by Wong Baker faces pain rating scale. The various responses were gathered and subjected to statistical analysis. It was concluded that ceramic burs reduce the pain sensation during removal of infected dentin which ensures excellent patient comfort. There could be some advantages in using the ceramic bur: high acceptance by the patient, reduced pain response and sound pulp protection in deep caries lesions.