Journal of dental anesthesia and pain medicine最新文献

{"title":"Airway management using submental intubation in a patient with multiregional facial fractures from a blast injury: a case report.","authors":"Chiho Moon, Giyoung Yun, Ji-Young Yoon, Cheul-Hong Kim, Eun-Jung Kim","doi":"10.17245/jdapm.2026.26.082","DOIUrl":"10.17245/jdapm.2026.26.082","url":null,"abstract":"<p><p>Airway management in complex maxillofacial trauma is challenging because intraoperative occlusion assessment requires an unobstructed oral cavity, typically favoring nasotracheal intubation (NTI). However, NTI is absolutely contraindicated in patients with a confirmed or suspected basilar skull fracture and is additionally contraindicated when concurrent nasal bone reduction is required. We report the case of a 36-year-old man with multiregional facial fractures caused by a workplace fire-extinguisher blast, in whom an expansile left ethmoid sinus hematoma raised concern for cribriform plate involvement. This finding alone constituted an absolute contraindication to NTI throughout the operative period, irrespective of the planned nasal bone reduction. Tracheostomy was considered disproportionately invasive given that postoperative mechanical ventilation was not required. Submental intubation was performed via a midline submental incision after orotracheal intubation. Mandibular open reduction and internal fixation, closed maxillary and nasal bone reduction, and maxillomandibular fixation were completed without airway interference. The patient was discharged on postoperative day 17 without complications. In this patient, submental intubation served as a safe and effective primary airway strategy when NTI was contraindicated throughout the operative period, providing a less invasive alternative to tracheostomy for patients with complex maxillofacial trauma.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"467-473"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dental Advanced Life Support (DALS) in Korea: development, current practice, and future perspectives.","authors":"Seungoh Kim","doi":"10.17245/jdapm.2026.26.189","DOIUrl":"10.17245/jdapm.2026.26.189","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"475-477"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of anterior middle superior alveolar (AMSA) injection and buccal infiltration as single-injection anesthetic techniques for orthodontic extraction of maxillary first premolars: a randomized split-mouth clinical trial.","authors":"Abdul Ahad, Ali Asger Nakib, Manjula Marandi, Mrinalini, Rajat Sharma","doi":"10.17245/jdapm.2026.26.103","DOIUrl":"10.17245/jdapm.2026.26.103","url":null,"abstract":"<p><strong>Background: </strong>Pain and anxiety regarding local anesthetic injections are common concerns during orthodontic tooth extraction. Single-injection anesthetic techniques may reduce patient discomfort while maintaining adequate pain control by eliminating the need for separate buccal and palatal injections. This study compared the anesthetic efficacy, pain perception, onset and duration of anesthesia, and postoperative analgesia linked to anterior middle superior alveolar (AMSA) injection versus buccal infiltration for maxillary first premolar extraction.</p><p><strong>Methods: </strong>This assessor-blinded randomized split-mouth clinical trial enrolled 42 orthodontic patients (mean age, 18.5 ± 3.12 years; range, 13-24 years) requiring bilateral extraction of maxillary first premolars. The participants received an AMSA injection and buccal infiltration in the contralateral quadrant during two visits, spaced 10 days apart. Both techniques utilized 1.2 mL of 4% articaine with adrenaline (1:100,000) via a 30-gauge needle. The outcomes included anesthetic success, pain during injection and extraction assessed on a visual analog scale (VAS; 0-100 mm), onset and duration of anesthesia, and postoperative analgesia. Anesthetic success was defined as completion of extraction without supplemental anesthesia. Supplemental anesthesia was administered when intraoperative pain exceeded 44 mm on the VAS, and the primary anesthetic technique was classified as unsuccessful. McNemar's test and the paired Student's t-test were used for statistical comparisons.</p><p><strong>Results: </strong>Anesthetic success rates were 85.7% for AMSA injection and 78.6% for buccal infiltration, with no significant difference (P = 0.58; matched OR 1.60, 95% CI 0.52-4.92). AMSA injection produced a significantly faster onset and longer duration of palatal anesthesia, whereas buccal infiltration produced a significantly faster onset and longer duration of buccal anesthesia (P < 0.001). AMSA injection caused greater injection-related pain (P < 0.001; Cohen's dz = 0.68), but lower extraction-related pain (P < 0.001; Cohen's dz = 0.82). Buccal infiltration achieved a longer postoperative analgesia duration (P = 0.006; Cohen's dz = 0.57).</p><p><strong>Conclusions: </strong>Both techniques are effective single-injection options for maxillary first premolar extraction. AMSA provided superior intraoperative comfort and palatal anesthesia, but inflicts greater injection discomfort, while buccal infiltration offered greater injection comfort and longer postoperative analgesia.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"441-452"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GLP-1 receptor agonists and dental sedation: a potential blind spot in preoperative assessment.","authors":"Toru Yamamoto, Naotaka Kishimoto","doi":"10.17245/jdapm.2026.26.146","DOIUrl":"10.17245/jdapm.2026.26.146","url":null,"abstract":"","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"479-481"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonsteroidal anti-inflammatory drug (NSAID) premedication for pain-free inferior alveolar nerve block: a systematic review and meta-analysis.","authors":"Mohammad A Sabeti, Tara Boroumand, Seyed Mohammadreza Masoumi, Nicka Aghamohammadi, Mohammad Hosein Amirzade-Iranaq","doi":"10.17245/jdapm.2026.26.122","DOIUrl":"10.17245/jdapm.2026.26.122","url":null,"abstract":"<p><p>This systematic review and meta-analysis evaluated whether oral nonsteroidal anti-inflammatory drug (NSAID) premedication increases pain-free inferior alveolar nerve block (IANB) success compared with placebo in adults with mandibular posterior teeth diagnosed with symptomatic irreversible pulpitis (SIP). Randomized controlled trials comparing oral NSAID premedication with placebo before IANB in adults with mandibular posterior teeth and SIP were included. MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception to October 20, 2025. This review was registered in PROSPERO (CRD420251171592). Success required absence of patient-reported intraoperative pain at any recorded procedural step after the initial IANB and no supplemental anesthesia. Risk of bias was assessed using RoB 2, certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation, and pooled effects were assessed using random-effects meta-analysis. Eleven trials involving 737 participants were analyzed. Oral NSAID premedication increased pain-free IANB success compared with placebo (292/452 [64.6%] vs 81/285 [28.4%]; risk ratio, 2.06; 95% confidence interval, 1.48-2.86). Heterogeneity was substantial (I² = 63%), and the prediction interval crossed no effect (0.83-5.10). Sensitivity analyses, excluding high-risk trials and access-only studies, remained significant, with no detected heterogeneity. Diclofenac and ketorolac showed significant and consistent effects, whereas ibuprofen favored benefits but remained imprecise and heterogeneous. Oral NSAID premedication increased pain-free initial IANB success compared with placebo in mandibular posterior teeth with SIP; however, low certainty and between-study variability limit the predictability of this benefit. Oral NSAID premedication may be considered when not contraindicated; however, clinicians should still anticipate supplemental anesthesia because pain-free success after the initial IANB is not predictable.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"373-389"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in stellate ganglion block for orofacial pain: a bibliometric analysis.","authors":"Hidetaka Kuroda, Shota Tsukimoto, Saki Tatsuta, Dairi Iwai, Uno Imaizumi, Yuki Sakamoto, Atsuhiro Kitaura, Kei-Ichiro Miura, Toshiyuki Kishimoto, Toshiyuki Handa, Aiji Sato-Boku, Takuro Sanuki","doi":"10.17245/jdapm.2026.26.109","DOIUrl":"10.17245/jdapm.2026.26.109","url":null,"abstract":"<p><strong>Background: </strong>Stellate ganglion block (SGB) has been applied to a diverse range of orofacial pain conditions, yet no bibliometric analysis has been conducted in this field. In this study, we aimed to characterize the global research trends, geographic distribution, and thematic evolution of the literature on SGB for orofacial pain.</p><p><strong>Methods: </strong>A systematic literature search was conducted using the Scopus database with no restrictions on publication date or language. Publications addressing SGB as the primary intervention for orofacial pain were eligible. Bibliometric indicators included the compound annual growth rate (CAGR), author productivity (Lotka's Law), journal scattering (Bradford's Law), and citation impact (h-index and g-index). Keyword co-occurrence network analysis was performed using the VOSviewer software; a minimum occurrence threshold of five was applied, and overlay visualization was used to map the average publication year of each keyword.</p><p><strong>Results: </strong>Ninety-one publications spanning 55 years (1971-2025) were included. Annual publication output increased 3.7-fold from the initial period (mean 0.9/year, 1971-1999) to the recent period (mean 3.3/year, 2013-2025; overall CAGR: 2.1%). Japan was the leading contributor (n = 31, 34.1%), followed by the United States (n = 18, 19.8%). The corpus received 1,630 citations (h-index: 22; g-index: 38); case reports were the most frequent document type (40.6%). Keyword co-occurrence network analysis identified 54 keywords organized into four clusters, with a temporal gradient from the oldest (herpes zoster and postherpetic neuralgia [PHN]; mean publication year: 2007.8) to the most recent (pharmacotherapy and central sensitization; 2013.4). Within their respective clusters, tooth extraction (2015.2) and orofacial pain (2015.4) showed the most recent average publication years among keywords that directly co-occurred with \"stellate ganglion block\"; tooth extraction was associated with neuropathic pain, allodynia, and central sensitization-related keywords.</p><p><strong>Conclusion: </strong>This bibliometric analysis identified a shift in research focus from herpes zoster and PHN toward central sensitization mechanisms and contemporary pharmacotherapy, with post-traumatic trigeminal neuropathic pain (PTTNeuP) emerging as a modern indication for SGB. These findings highlight the need for prospective clinical studies evaluating the efficacy of SGB for PTTNeuP cases.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"429-440"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic accessibility to board-certified dental anesthesiology specialists in Japan: visualizing \"medical deserts\" in dental anesthesia.","authors":"Takuro Sanuki, Yukie Niita, Shota Tsukimoto, Atsuhiro Kitaura, Kei-Ichiro Miura, Yuki Sakamoto, Hidetaka Kuroda, Sotaro Katayama, Aiji Sato-Boku, Kanta Kido","doi":"10.17245/jdapm.2026.26.045","DOIUrl":"10.17245/jdapm.2026.26.045","url":null,"abstract":"<p><strong>Background: </strong>Systemic management by board-certified dental anesthesiology specialists from the Japanese Dental Society of Anesthesiology plays an essential role in ensuring the safety, comfort, and quality of dental care. However, these specialists are most commonly located in urban areas. This study provides a nationwide analysis of geographic accessibility, identifying \"medical deserts\" (operationally defined as travel time ≥ 120 min) in dental anesthesia by calculating actual travel times to facilities with dental anesthesiology specialists across Japan.</p><p><strong>Methods: </strong>Data from 355 dental anesthesiology specialists and 1,878 municipalities were analyzed. Travel times from each municipal office to the nearest facility with a dental anesthesiology specialist were calculated using the Google Maps Directions Application Programming Interface. The Dental Anesthesia Rurality Grade (DARG) was defined as follows: Grade A (accessible, < 60 min), Grade B (intermediate, 60 ≤ 120 min), and Grade C (rural, ≥ 120 min). A Strategic Priority Index (SPI) was developed to identify Strategic Priority Areas (SPAs) where interventions may have greater population-level impacts.</p><p><strong>Results: </strong>Grade A status encompassed 87.9% of the population, but occupied only 48.1% of the land area. Conversely, 11.8% of the municipalities (n = 221) were classified as Grade C, representing 20.1% of the land area. A significant positive correlation was found between travel time and aging rate (r = 0.61, P < 0.001), suggesting a pattern consistent with the Inverse Care Law in dental anesthesia. The SPI suggested candidate SPAs such as those in Matsuyama and Hakodate.</p><p><strong>Conclusions: </strong>There are major differences in the geographic accessibility of facilities with affiliated dental anesthesiology specialists across different regions in Japan. Classification by DARG and detailed analysis using the SPI from this study could serve as a helpful model for evaluating geographic access and guiding future resource planning in areas with geographic limitations and an aging population.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"453-465"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of NSAIDs premedication following third molar extraction: a systematic review with meta-analysis of randomized clinical trials.","authors":"Valentina Delich-Pardo, Matías González-Zeballos, Valentina Veloso Casado, José Ramos-Rojas","doi":"10.17245/jdapm.2026.26.140","DOIUrl":"10.17245/jdapm.2026.26.140","url":null,"abstract":"<p><p>Third molar extraction is one of the most common procedures in oral surgery and is frequently associated with postoperative pain, edema, and trismus. In this context, this systematic review aimed to evaluate the effectiveness of premedication with non-steroidal anti-inflammatory drugs (NSAIDs) on postoperative outcomes following this procedure. A systematic review was conducted in accordance with the Cochrane guidelines and the PRISMA statement, with the protocol registered in PROSPERO (CRD420251048164). Randomized controlled trials including healthy adults undergoing third molar extraction under local anesthesia were included. NSAID premedication was compared with placebo or no premedication, with both groups following standardized postoperative rescue medication protocols. Searches were performed in PubMed, Embase, Web of Science, and EBSCO from inception to April 2025. The risk of bias was assessed using the Cochrane RoB-1 tool, and the certainty of the evidence was evaluated using the GRADE approach. Random-effects meta-analyses were conducted using standardized mean differences (SMD) and risk ratios (RR). Fifteen randomized controlled trials involving 779 participants were included. NSAID premedication significantly reduced postoperative pain within the first 4 h (SMD = -1.20), between 5 and 12 h (SMD = -0.75), at 24 h (SMD = -1.42), and at the longest follow-up periods (SMD = -1.25). It also reduced rescue medication consumption (SMD = -0.63) and the risk of rescue medication use by 39% (RR = 0.61). NSAID premedication reduces postoperative pain and the need for rescue medication after third molar extraction, with a favorable safety profile, supporting its clinical use despite the low certainty of the evidence.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"391-404"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Articaine versus lidocaine for local anesthesia in pediatric dental procedures: an umbrella review of systematic reviews and meta-analyses.","authors":"Yun-Xi Yao, Shuo Huang, Ke-Xin Liu, Shen-Shen Gao, Yun-Tai Yao","doi":"10.17245/jdapm.2026.26.128","DOIUrl":"10.17245/jdapm.2026.26.128","url":null,"abstract":"<p><p>Articaine has been proposed as an alternative to lidocaine for local anesthesia in pediatric dentistry. Several systematic reviews have compared articaine with lidocaine in children; however, their conclusions vary by procedure, injection technique, outcome scale, and safety definition. We conducted an umbrella review of systematic reviews, with or without meta-analyses, comparing articaine and lidocaine in pediatric dental procedures. PubMed, Embase, and the Cochrane Library were searched without a lower date restriction until June 22, 2026. The study protocol was prospectively registered in PROSPERO (CRD420261430185). Eligible reviews included children or adolescents undergoing dental procedures and directly compared the efficacy and safety outcomes of articaine with those of lidocaine. Methodological quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2, risk of bias with Risk Of Bias In Systematic reviews, certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach, and primary study overlap with the corrected covered area. Twenty records remained after removal of duplicates. Eleven full-text reports were assessed, and eight systematic reviews were included. Six reviews were rated as low and two as critically low confidence using the A MeaSurement Tool to Assess Systematic Reviews 2. Six systematic reviews had a low risk of bias, and two had a high risk of bias. Across eight reviews, 21 unique primary studies generated 55 occurrences, yielding a corrected covered area of 23.1%, indicating very high overlap. Articaine is generally comparable to lidocaine and may provide minor advantages in selected infiltration-based procedures. Safety-focused reviews found no significant difference in overall adverse events between articaine and lidocaine. The outcome-level certainty was low or very low, mainly due to risks of bias, inconsistency, indirectness, imprecision, and concerns about publication bias. Primary study overlap was very high and was considered separately when assessing the independence of the review-level conclusions. Current review-level evidence suggests that articaine is a reasonable alternative to lidocaine for pediatric dental local anesthesia and may offer modest advantages in selected infiltration-based procedures but does not establish universal clinical superiority. The short-term safety appears broadly comparable in available pediatric trials, although rare adverse events and their use in very young children remain insufficiently studied.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"405-415"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and preliminary validation of an artificial intelligence-based facial emotion recognition application for real-time assessment of pediatric dental anxiety.","authors":"Amit Khatri, Rishi Tyagi, Padma Yangdol, Deepak Khandelwal, Urvi Bhatia, Bhavya Bhatia","doi":"10.17245/jdapm.2026.26.097","DOIUrl":"10.17245/jdapm.2026.26.097","url":null,"abstract":"<p><strong>Background: </strong>Dental anxiety is prevalent among children worldwide and represents a barrier to pediatric dental care, contributing to care avoidance, treatment difficulty, and poorer oral health outcomes. Venham Clinical Anxiety Scale (VCAS) and Visual Facial Anxiety Scale (VFAS), are limited by subjectivity and interobserver variability. This study evaluated an artificial intelligence (AI)-based facial emotion recognition (FER) application for assessing dental anxiety across procedural stages in children undergoing tooth extraction.</p><p><strong>Methods: </strong>A total of 186 children aged 7-13 years who were undergoing dental extraction were enrolled. EmoDent, a SwiftUI iOS application using a convolutional neural network (CNN) model, captured facial expressions at four time points: pre-treatment, before local anesthesia, during extraction, and post-treatment. VCAS and VFAS scores were recorded. Spearman's rank correlation and Cohen's kappa were applied (P < 0.05).</p><p><strong>Results: </strong>Emotional responses varied significantly across treatment phases (P < 0.001). Happy (20.4%) and neutral (58.1%) expressions predominated pre-treatment, shifting to anger (49.5%) and sadness (24.7%) during local anesthesia, with partial recovery post-treatment. Concordance with traditional clinical scales was strongest during peak-stress phases. Although extreme trait prevalence mathematically deflated conventional Cohen's kappa (0.146 and -0.010 during local anesthesia), alternative metrics showed high monitoring agreement, with Gwet's AC1 reaching 0.941 versus VCAS and 0.942 versus VFAS.</p><p><strong>Conclusions: </strong>The application demonstrated valid and reliable emotional assessment across all procedural stages and showed strong concordance with conventional scales. It offers a promising non-invasive adjunct, particularly for non-verbal children. Future studies should incorporate multimodal data and clinician feedback.</p>","PeriodicalId":94330,"journal":{"name":"Journal of dental anesthesia and pain medicine","volume":"26 5","pages":"417-428"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}