Diagnosis and management of traumatic injuries in pediatric patients secondary to dental local anesthesia: A systematic review.

This study examines soft tissue injuries secondary to the prevalence of local anesthesia, differential diagnosis and therapeutic approaches. In October 2024, a comprehensive search was performed in PubMed, Web of Science and Scopus along with gray literature sources, adhering to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, using the following keywords: "bite", "traumatic injuries", "soft tissue injuries", "self-inflicted injuries", "topical anesthesia", "local anesthesia", "pediatric", or "children". The search was limited to English-language publications. Additional manual screening of reference lists was performed. The risk of bias was assessed using the checklist developed by the Joanna Briggs Institute (JBI). Out of 574 identified studies, 21 were included in the qualitative analysis (9 randomized controlled trials (RCTs), 6 case reports and 6 cohort studies), mainly focusing on children aged 6-12. Anesthesia methods included traditional techniques (12 studies) and computer-controlled injection (5 studies). The role of articaine (9) and lidocaine (10) was analyzed. Suggested interventions to mitigate injury risks and improve recovery included the use of phentolamine mesylate (2 studies) and non-pharmacological strategies: intraoral appliances (2 studies) and photobiomodulation (2 studies). The included studies varied in design, sample size and duration, limiting direct comparisons. Effect sizes and confidence intervals were inconsistently reported, and the risk of bias assessment using the Cohen's kappa test highlighted methodological heterogeneity and potential reporting bias. Soft tissue injuries from local anesthesia in children can cause significant pain and cooperation issues. Effective strategies include early intervention with pharmacological and non-pharmacological approaches. Increased awareness and patient-specific management are essential for reducing risks and improving outcomes.