Endodontic disease refers to an inflammatory condition of the pulp (pulpitis) or necrosis of the pulp (partial or complete) (Niemiec 2005). Endodontic disease is mainly caused by progressive lesions of dental hard tissue in children, which can produce obvious pain and affect children’s health. After the onset of endodontic disease, severe spontaneous pain will aggravate with oral caloric stimulation. As a special group of patients, children have a low tolerance to pain and poor compliance and even have anxiety and fear in severe cases. In this regard, painless treatment is the core of improving the treatment compliance of children and thereafter ensuring the success of treatment. Therefore, it is of great significance to select safe and effective anesthesia drugs to alleviate pain, improve treatment compliance, and ensure successful completion of surgical treatment.

In this study, lidocaine administrated by children in the control group is usually used as a local anesthetic drug in clinical practice, with strong and durable anesthetic effect and obvious bidirectional excitatory and inhibitory effects on the central nervous system (Hermanns et al. 2019). Lidocaine has anti-inflammatory and opiate-sparing properties, a combination of characteristics which results in an array of effects, including a reduction in postoperative pain and opiate consumption as well as a reduction in the duration of digestive ileus (Beaussier et al. 2018). However, after local anesthesia with lidocaine, the side effects also increase with the increase of dose (Bahar and Yoon 2021). Lidocaine may induce fear or anxiety-related adverse reactions, psychogenic effects, and allergic reactions (Anderson, et al. 1990). Patients in the observation group were anesthetized with articaine. The molecular structure of articaine is featured with both lipophilic and hydrophilic ends connected by a hydrocarbon chain, and the “CO linkage” between the lipophilic aromatic ring and the hydrocarbon chain classifies articaine as an ester local anesthetic, and the link is metabolized by plasma cholinesterase. Next, articaine is rapidly metabolized to its inactive metabolite articaine acid through hydrolysis, which is partially metabolized to articainic acid glucuronide in the kidneys (Vree and Gielen 2005). Articaine has a unique lipophilicity switch in terms of its capability to form an intramolecular hydrogen bond. This intramolecular hydrogen bond is a new and additional solvent-dependent mechanism that can modulate the lipophilicity of articaine, thereby enhancing its diffusion through membranes and connective tissue (Skjevik et al. 2011). The results showed that the total effective rate of anesthesia in the observation group was higher, anesthesia onset time and sensory recovery time were shorter, and duration of anesthesia was longer than those in the control group, revealing that articaine can improve the anesthesia effect and effectively shorten the onset time of anesthesia. Currently, studies have illustrated that local anesthesia with articaine is more effective than lidocaine for dentistry treatment (Nagendrababu et al. 2020; Khan, et al. 2021; Taneja et al. 2020; Martin et al. 2021). It is also noted that for supplementary infiltration after mandibular block anesthesia, articaine has a significant advantage over lidocaine in patients with symptomatic irreversible pulpitis (Kung et al. 2015). Articaine has been revealed to enhance higher anesthesia success and longer duration of anesthesia in comparison to lidocaine for most of the teeth after incisive/mental nerve block (Batista da Silva, et al. 2010). Moreover, articaine is superior to lidocaine for its application in lower third molar surgeries because of the shorter time until the onset of action, higher success rate, and greater control of intraoperative and postoperative pain as well as longer duration of the anesthetic effect (Nogueira et al. 2023).

Moreover, the VAS score was lower and the onset time of anesthesia was shorter than that in the control group, indicating that articaine can reduce pain during surgery. Articaine contains a thiophene group, which increases its liposolubility. Since articaine diffuses better through soft tissues than other anesthetics, a higher concentration of anesthetic is delivered, more longitudinal spread is achieved, and conduction is effectively blocked (Potocnik et al. 2006). It has been reported that articaine is more effective than lidocaine in reducing self-reported pain after dental treatment, although there is no difference between lidocaine and articaine during treatment (Bonifacio 2018; Tong et al. 2018). Measurements of heart rate and blood pressure are used as physiological parameters because they provide indirect measures of anxiety and pain. The body’s response to stressful situations or painful stimuli can be seen as higher heart rate levels and higher SBP values (Rathi et al. 2019). In this trial, after anesthesia, as compared to the control group, the observation group had a lower heart rate and a higher DBP. This shows that articaine effectively relieved negative emotion and pain of children in the treatment. Furthermore, it was recorded that the total incidence of adverse reactions in the observation group was significantly lower than that in the control group, suggesting that while achieving the anesthetic effect, the adverse reactions caused by articaine are less and the clinical safety is higher. Consistently, a comparison study has measured a lower incidence of adverse events in the management of tooth pulp disease after articaine anesthesia than lidocaine anesthesia (Li, et al. 2018).

In summary, the advantages of articaine applied in the painless treatment of dental pulp disease in children are as follows: (1) the anesthetic effect is satisfactory, which can improve the cooperation of children in the treatment process and reduce the difficulty of treatment; (2) the effect is fast, which can effectively alleviate the negative psychology and improve treatment compliance; (3) the incidence of complications can be significantly reduced. However, we did not do the sample size calculations, and more clinical studies are needed to further confirm the authenticity of the results.