While early enamel lesions are likely to progress to the dentine, this process occurs relatively slowly over a period of at least 2 years. Early diagnosis of such enamel lesions allows timely intervention and helps to stop or reverse the progression of lesions [
1]. Dental radiography is a very important diagnostic tool for the intraoral evaluation of children. In most cases, radiological investigations reveal important additional findings; however, the risks associated with radiography cannot be overlooked. The radiation dose should be kept as low as possible for both the patient and the dentist. Even if the radiation dose is very low, it is important to consider that radiation has the potential to cause biological harm. The younger the individual is, the greater the sensitivity to radiation due to the large number of dividing cells in young children. The motivations in obtaining radiographic images of the teeth and surrounding tissues in children mainly include the diagnosis of 1) decay, 2) traumatic dental injuries, 3) tooth eruption disorders, and 4) pathologies other than decay. Currently, digital radiographic methods are preferred over analog films in most clinics. The image quality achieved with digital radiography is similar to that of analog films but still depends on the digital system used. In terms of patient comfort, it has been reported that pediatric patients may find the abovementioned methods uncomfortable [
2]. Although the use of these methods is quite common in dentistry, only a limited number of studies in the literature have reported the evaluation of patient comfort during such procedures [
3]. There have been even fewer studies evaluating the comfort of pediatric patients during radiographic investigations [
4‐
6]. Radiographic examination is usually considered a difficult, uncomfortable procedure for pediatric patients because the film is not easily positioned in the patients’ small mouths. Moreover, in some cases, the patients are less tolerant, more anxious and not as understanding [
4]. Accordingly, although intraoral periapical radiographic methods are used in clinical practice, the preferred method should be the one associated with the least patient discomfort [
7]. Two different imaging modalities can be used while obtaining X-rays – digital and conventional imaging [
2]. Contrary to conventional imaging systems, digital imaging does not require the use of film bath solutions but instead involves the use of sensors that simultaneously form an image on a computer screen with the aid of computer-based imaging systems [
8]. The image can be seen on a monitor within 0.5–120 s, which is significantly shorter than the time required for the conventional film bath process [
9]. Direct digital imaging involves an X-ray device, an intraoral sensor and a computer [
3,
9]. The sensors can be cabled or wireless. CCDs are the most commonly used image receptors in dental digital imaging and involve a semiconductive layer on a silicon chip that is sensitive to light and X-rays [
8]. A PSPL (photostimulable phosphor luminescence) system is a wireless sensor consisting of a phosphorus-coated plastic plate that is not attached to a computer by a cable and is sensitive to X-rays [
10]. The active area of phosphorus plates are larger than that of a CCD, and manipulating the former in the oral cavity is easier as they are thinner and more similar to periapical films in terms of size [
11]. The outer surface of the sensors is generally rigid; therefore, placing them into the mouth to image the posterior region may be quite challenging, particularly in children. The sensors are fixed within the mouth either by pressure applied by the patient’s finger or by the use of sensor holders, after which the dentist makes necessary adjustments to the angle using a conventional radiographic device and initiates the exposure [
12]. Today, the use of digital radiography systems is quite common, although some clinics still use the conventional method [
2].
After a patient is prepared for an intraoral radiographic scan, the exposure is adjusted, the oral cavity is examined, the film and roentgen tube are positioned, and finally, the radiograph is obtained [
8]. The child’s age, developmental status, cognitive and communication skills, and previously experienced pain should be considered when evaluating pain in pediatric patients. Obtaining accurate and reliable measurements of the level of pain in children is difficult, which has led to the development of several pain measurement methods for use in neonates, infants and children. Healthcare professionals should be able to understand the signs and symptoms of pain in children of different age groups, to identify whether the symptoms are due to pain or other factors in different groups [
13] and to minimize pain and anxiety as much as possible while ensuring patient safety [
12].
Children tend to become more capable of describing increases in pain with age and experience [
14]. While selecting a method for the measurement of pain, factors such as the stage of pain development and the patient’s age and level of understanding should be considered, as well as functional status, abilities and emotional status [
15]. By the time they reach the age of four, the majority of children are usually able to differentiate pain on a scale of 4–5. However, their ability to recognize pain develops as they become able to comprehend the intensity of pain, and this ability is usually developed at around the age of five [
16]. To obtain pain reports in this age group, facial expression scales are generally used, in which children choose the facial expression that best describes the pain they feel or experience [
17]. The scale developed by Wong and Baker is recommended for use in children aged 3 years and older. This scale requires health professionals to describe each face to the child, after which the child is asked to select the face that best reflects their current pain level. The pain score is determined based on the numerical values assigned to the faces, with the lowest and highest scores being 0 and 5, respectively; the high scores indicate lower pain tolerance, and the low scores reflect more tolerable pain [
16]. Upon reaching the age of 7–8 years, children begin to understand the quality of pain. The VAS (visual analog scale) is the most commonly preferred method for use in this age interval [
16].
The present study evaluates perception of pain associated with intraoral radiography in pediatric patients through statistical comparisons of data obtained from the Wong-Baker FACES Pain Raiting Scale (WBFPRS) and VAS scoring.