Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

IntroductionThe most frequently used local anesthesia administration techniques for extraction of lower teeth in dentistry are local infiltration and inferior alveolar nerve block. Therapeutic extraction of premolars is the most common procedure done for patients undergoing orthodontic treatment. Inferior alveolar nerve block has been used most commonly for extraction of mandibular posterior teeth; however, it is a technique sensitive procedure and has complications such as facial nerve palsy, trismus, and long duration of anesthesia. Local infiltration is a simple and effective technique for anesthetizing teeth prior to extraction.AimThis study aims to compare the efficacy of local anesthesia administered through inferior alveolar nerve block and local infiltration techniques for extraction of lower premolar teeth for orthodontic purposes.Materials and methodsA prospective comparative study was conducted for a period of six months in which a total of 100 patients who were referred for extraction of lower premolar teeth for orthodontic purposes were included. Among 100 patients, 60 patients were males, and 40 patients were females with a mean age of 16.5 +/- 1.25 years. The patients were equally divided into two groups, in which Group 1 received local infiltration and Group 2 received an inferior alveolar nerve block. The outcome parameters assessed were pain during injection and pain during extraction using the visual analog scale (VAS) score and Wong-Baker Faces Pain Rating Scale score. Statistical analysis was done using an independent sample t-test with SPSS version 23.0 software (IBM Corp., Armonk, NY) at p < 0.05 considered statistically significant.ResultsThe difference in mean pain scores between the two groups during injection as assessed using the Faces Pain Rating Scale (p = 0.001) and VAS (p = 0.001) was statistically significant, with the infiltration group exhibiting less pain than the inferior alveolar nerve block group. The difference in mean pain scores between the two groups during extraction as assessed using the Faces Pain Rating Scale (p = 0.308) and VAS (p = 0.350) was statistically not significant, with the infiltration group not significantly differing from the inferior alveolar nerve block group. Thus, the pain during local infiltration was significantly lesser when compared to the inferior alveolar nerve block during injection, whereas pain perception during extraction was similar in patients with both injection techniques.ConclusionIt can be concluded that local infiltration is less painful for the patient during injection and as efficacious as nerve block for extraction, hence local infiltration can be routinely used for lower premolar orthodontic extractions.