الفهرس 
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Abstract
This triple-blinded split mouth design study was conducted to assess the pain experience subjectively and objectively between 8.4 % sodium bicarbonate buffered articaine HCl with epinephrine in a ratio of 1:19 and unbuffered articane HCl with epinephrine during inferior alveolar nerve block injection. It also aimed to compare the onset time of anaesthesia between the two groups.
The study was done in the Department of Pediatric Dentistry and Dental Public Health, Alexandria University. After sample size estimation, a total of 27 patients, with an age range of 5-7 years, presented with at least one mandibular primary molar indicated for vital pulp therapy in both sides of the dental arch which required an IANB anaesthesia, were enrolled in this study. Patients randomly received BAS in one side (test group) and UBAS in the antimere side (control group). Allocation concealment was done by an independent personnel taking the duty of putting BAS and UBAS in two opaque boxes carrying serial numbers and revealing the coding after the results were analyzed. Patients had to be trainable on using the TENS and calculating the CPT value and therefore healthy, positive or definitely positive patients, on Frankl behavior scale, were selected. Patients who gave false responses while using TENS device and those who did not achieve profound numbness and required additional anaesthesia were excluded from the study. The aim of the study was explained to the child’s parent and an informed consent was obtained before initiating the treatment.
Patients were monitored for assessing the pain experience during IANB injection subjectively using FPS and objectively using SEM scale monitored via the recorded video-tapes. The onset time of anaesthesia was also monitored using TENS device by calculating the time starting from the termination of injection till the vanishment of CPT stimulus perception reported prior to injection. CPT tests were executed under the supervision of a physical medicine and rehabilitation consultant. The operator, who was the same for all participants, was trained before starting the study by the same specialist to ensure the intra-examiner reliability through a pilot study of 5 participants.
In the present study; results revealed that 8.4% sodium bicarbonate buffering of 4% articaine HCl with 1:100,000 epinephrine in ratio 1:19, significantly minimized the pain perception during IANB injection either through using FPS or SEM scale (p<0.001, p<0.001 respectively) and significantly hastened the onset time of anaesthesia (p<0.001) by about 40 seconds compared to unbuffered conventional 4% articaine HCl with 1:100,000 epinephrine.
Based on the obtained results, it was concluded that sodium bicarbonate buffered Articaine HCl anaesthetic solutions raises the pH of anaesthetic cartridge resulting in a decreased pain of inferior alveolar nerve block injection as well as a hastened onset time of anaesthesia in 5-7 year old children.