Purpose: The objective of this study was to analyze the assessment of pain and distress by the child, dentist, and independent observers during a dental injection and study the relationship between the different assessments.
Methods: The amount of pain experienced by the child during local anesthesia was reported independently by the child to both the dentist and parent on a 4-point scale running from "no pain" to "a lot of pain." The dentist and observers also gave a score for the pain experienced on a 4-point scale. The amount of distress experienced by the child during local anesthesia was assessed by the dentist and observers using a 6-point scale (from "relaxed" to "out of contact").
Results: The dentists' pain assessment was the lowest. A substantial correlation was found between the child's self-reported pain and the pain as assessed by independent observers. There was a moderate correlation between the amount of distress and pain intensity as reported by the child during the anesthesia phase.
Conclusions: Observation of a child in a videotaped procedure is apparently the most reliable method to accurately assess pain behavior and to discriminate pain from distress. A combination of the child's report and video observation is advised to assess pain in young children.