Comparative Evaluation of Alveolar Nerve Block with 2% Lidocaine–Epinephrine and 4% Articaine–Epinephrine Buccal Infiltration in Mandibular Premolar and Molar Region in Children: A Double-Blind, Randomized Trial

<b>Background/Objectives</b>: Effective pain control in pediatric dentistry combines behavior management, local anesthesia, and follow-up care. This study compared the efficacy of inferior alveolar nerve block (IANB) with 2% lidocaine and epinephrine versus buccal infiltration (BI) with 4% articaine and epinephrine in treating primary molars, permanent premolars, and molars in children. <b>Methods</b>: Sixty children aged 5-18 years were randomly assigned to two groups in a double-blind study. One group received 1.7 mL BI with 4% articaine, and the other 1.8 mL IANB with 2% lidocaine for dental treatment. Pain was assessed using the self-reported Visual Analog Scale (VAS) and Wong-Baker Faces Pain Rating Scale (W-BFRS), while anesthesia effectiveness and behavior were evaluated using the Frankl Behavior Rating Scale (FBRS) and vitality tests. <b>Results</b>: The articaine group reported significantly lower pain scores on all scales (VAS: 1.23 ± 2.01; FBRS: 0.47 ± 0.57; W-BFRS: 1.33 ± 2.04) than the lidocaine group (VAS: 3.17 ± 1.64; FBRS: 1.26 ± 0.45; W-BFRS: 3.17 ± 1.64). Articaine also outperformed lidocaine in secondary measures, with higher positive responses on the questionnaires (articaine: 8.37 ± 1.61 vs. lidocaine: 5.27 ± 1.41, <i>p</i> < 0.001). <b>Conclusions</b>: Buccal infiltration with 4% articaine is more effective than 2% lidocaine administered via IANB for invasive dental procedures in children, providing superior pain control and positive patient responses.