Pain Management and Parafunctional Activity Secondary to Local Anesthesia in Children 4–12 Years Old—A Retrospective Study

<b>Objective</b>: Successful local anesthesia reduces patient pain and anxiety, facilitates the procedure, and enhances overall comfort; however, in children, it may also increase the risk of parafunctional activities in anesthetized areas. This retrospective study aimed to evaluate the factors influencing the risk of self-inflicted injuries. <b>Methods</b>: A study was conducted from January to December 2023 using the records of 4285 pediatric patients aged 4-12 years who underwent dental treatment under local anesthesia. Among 1161 cases at Poznan University (Poland), 73 (6.3%) of self-inflicted injuries were reported. At Rome University (Italy), 823 cases were reviewed, with 522 involving local anesthesia and 23 cases (4.4%) of trauma. <b>Results</b>: The overall prevalence of trauma following local anesthesia was 5.9%, indicating significant clinical concern. The lips were the most commonly affected (69.9%), followed by the cheeks (15.1%) and tongue (15.1%). The study confirmed a positive correlation between younger age and higher trauma incidence, with no significant differences in sex or ethnicity. Longer anesthesia duration and higher anesthetic doses were associated with increased lesion severity. The type of anesthetic also played a role, with articaine showing a higher risk compared to lidocaine. Furthermore, the type of injection influenced trauma incidence, due to the distribution of numbness and exploratory behaviors. <b>Conclusions</b>: Local anesthesia remains an indispensable tool in pain management in pediatric dentistry. However, the risk of self-inflicted injuries is not limited to the youngest patient. Proper education on post-anesthetic care is essential for minimizing complications and ensuring safe and effective dental treatment.