Abstract Objectives: Pain assessment in pediatric dentistry remains challenging because children may have limitations in communication, cognition, and emotional expression. This narrative review examines the validity, reliability, and clinical utility of commonly used and emerging pediatric dental pain assessment scales. Methods: A structured literature search was performed across PubMed, Google Scholar, and EBSCOHost up to June 30, 2025. Six full-text randomized controlled trials evaluating validated pediatric dental pain scales were included. The methodological quality of included studies was assessed with respect to psychometric robustness and clinical usability. Results: Facial expression-based scales, such as the Wong-Baker FACES Pain Scale, were consistently found to be practical and easily understood by most children. Among digital pain assessment tools, the Simplified Pictorial Grading Pain Scale and animated visual face-based scales demonstrated superior reliability and user engagement compared to traditional static facial scales. Behavioral observation tools such as Face, Legs, Activity, Cry, Consolability (FLACC) Scale and Sound-Eye-Motor (SEM) Scale remained valuable for younger or non-verbal children, although their accuracy depended on clinician interpretation skills. Due to heterogeneous outcome reporting and restricted access, quantitative pooling of data was not feasible. Conclusion: Based on the reviewed evidence, emoji-based and animated digital pain scales appear most suitable for cognitively mature, digitally familiar pediatric cohorts, whereas observational tools such as the SEM and FLACC Scales remain more appropriate for younger or non-verbal children. Further high-quality research is required to improve standardization and to expand cultural applicability across diverse populations.
Dalal et al. (Sun,) studied this question.