Effectiveness of dental local analgesia among children for dental extractions

INTERVENTION: Comparison of the effectiveness of 4% Articaine with 1:100,000 adrenaline compared with Lignocaine 2% with 1:100,000 adrenaline in achieving local analgesia for dental extractions in the upper jaw among children when delivered as buccal infiltration only adjacent to the tooth to be extracted. Dosage of local anaesthetic limited to 5mg/kg body weight, to a maximum of 2.2ml cartridge of local anaesthetic. Supplementation with Lignocaine 2% permitted for palatal analgesia, dosage not to exceed 5mg/kg body weight. Mode of administration: buccal infiltration injection. Type of anaesthetic used (test or control) for one side of the mouth determined by random allocation. CONDITION: dental local analgesia PRIMARY OUTCOME: Proportion of children with achievement of local analgesia through buccal infiltration alone to allow extraction of upper teeth among study participants. Achievement of analgesia initially tested through tactile probing after maximum of ten minutes wait after analgesia administration. If analgesia is deemed adequate extraction is performed. SECONDARY OUTCOME: Assistant observation of child's reaction to administration of local analgesia and during extraction using the CHEOPS scale Child's report of pain as reported through the faces pain scale Parental report of postoperative pain through completion of parent questionnaire Reports of adverse events pain at injection site, excessive and or prolonged post operative bleeding and soft tissue injuries. INCLUSION CRITERIA: Child registered with Dental Health Services WA. Child requires bilateral maxillary permanent teeth requiring extractions as part of orthodontic treatment as requested by specialist orthodontist