Pain during Removal of Carious Lesions in Children: A Randomized Controlled Clinical Trial

The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the traditional method (low-speed bur) in pediatric patients. A randomized, controlled, clinical trial with a “split-mouth” design was carried out involving 20 children (10 girls and 10 boys) aged four to seven years. Forty primary teeth (two per child) were randomly allocated to either Group 1 (G1: chemomechanical caries removal with Papacarie gel) or Group 2 (G2: removal of carious dentin with low-speed bur). A face scale was used to classify the sensation of pain during the procedure (1: absence of pain; 2: mild pain; 3: moderate pain; 4: moderately intense pain; 5: intense pain; and 6: extremely intense pain). Statistical analysis of the data was performed using the Wilcoxon-Mann-Whitney ( ) test. Pain scores were higher in G2, with statistically significant differences in comparison to G1 ( ; ; ). Chemomechanical caries removal with Papacarie provides a lesser degree of pain in comparison to conventional caries removal and does not require the use of local anesthesia. The clinical trial registration number is NCT01811420. 1. Introduction The aim of minimally invasive restorative treatment in dentistry is the selective removal of carious tissue and the preservation of the maximum amount of sound dental tissue [1–5]. Chemomechanical caries removal (CMCR) is in line with this philosophy and consists of the application of a proteolytic substance to soften carious dentin and facilitate the removal of the affected tissue with the use of blunt instruments [3, 6–8]. Papacarie gel is a product designed for CMCR. This gel unites the cleaning and healing (antibacterial and anti-inflammatory) properties of papain with the disinfecting properties of chloramine [9]. Studies have demonstrated the efficacy of this product [6, 7, 10, 11] and emphasize its use on children [6, 12, 13], adolescents [7], and individuals with disabilities [14]. The removal of carious lesions using a low-speed bur (conventional method) involves physical and mechanical stimuli that cause pain [3]. In young patients, anxiety regarding dental treatment due to the possibility of experiencing pain hampers this type of procedure [15]. Moreover, studies have reported that noninvasive methods cause less discomfort to patients [12, 16, 17]. The aim of the present study was to assess pain and the need for anesthesia during chemomechanical caries removal with Papacarie gel and the conventional method (low-speed bur) in pediatric patients. 2. Material and Methods