Anesthetic Effectiveness of Articaine and Lidocaine in Pediatric Patients During Dental Procedures: A Systematic Review and Meta-Analysis.

Purpose: Pain on needle insertion and deposition of local anesthetic agents are a cause of anxiety in pediatric patients. Articaine is a potential anesthetic agent whose superior properties reduce the need for multiple insertions, yet it is not commonly used. The purpose of this study was to compare the effectiveness of articaine with lidocaine in pediatric dental anesthesia. Methods: An exhaustive search of the literature was conducted using the electronic databases (Medline, Google Scholar, and Cochrane). Randomized controlled clinical trials evaluating anesthetic effectiveness of articaine and lidocaine in children up to 14 years old by Facial Pain Scale (FPS) and Visual Analog Scale (VAS) were included in the review. Qualitative analysis and risk of bias assessment were done. Values obtained using FPS and VAS were analyzed using a random-effects model. Results: Out of the 25,447 studies obtained from various databases, 11 were considered eligible for inclusion. Assessment of effectiveness using both scales revealed articaine to be significantly better (mean difference [MD] equals -0.46; 95 percent confidence interval [95% CI] equals -0.81 to -0.12; P=0.008; I 2 equals 58 percent; VAS - mean difference equals -0.20, 95% CI equals -0.29 to-0.10, P=0.0001, I 2 equals zero percent). Conclusion: Effectiveness of articaine as a local anesthetic in pediatric dentistry was better than the gold standard lidocaine but the rating difference was small based on the FPS.