Analyzing facial action units in children to differentiate genuine and fake pain during inferior alveolar nerve block: a cross-sectional study

Abstract

This study aimed to investigate the association between facial action units and pain levels in Syrian children, focusing on both genuine and fake pain expressions. A total of 300 Syrian children aged 6–9 years participated in the study. Pain levels were assessed using the validated Face, Legs, Activity, Cry, Consolability scale, and facial expressions were analyzed using the Facial Action Coding System. The children were asked to mimic their feelings after receiving a dental injection to elicit fake pain expressions. Statistical analysis, including multinomial logistic regression and chi-square tests, was conducted to determine the Action Units (AUs) associated with each pain level and to compare the differences between real and fake pain expressions. The results revealed significant associations between specific AUs and pain levels. For real pain expressions, the most activated AUs across different pain levels with positive coefficient values of correlation (P-value < 0.01) were analyzed. In contrast, for fake pain expressions, AU12 and AU38 were consistently observed to be the most activated. These findings suggest that certain AUs are uniquely associated with fake pain expressions, distinct from those observed in real pain expressions. Furthermore, there were no significant differences between boys and girls in terms of their genuine and fake pain expressions, indicating a similar pattern of AU activation (P-value > 0.05). It was concluded that AUs 4, 6, 41, and 46 were associated with mild pain, and AUs 4, 6, 41, 46, and 11 were associated with moderate pain cases. In severe pain, AUs 4, 6, 7, 9, 11, and 43 were associated. In fake pain feelings, AU43, AU38, and AU12 were the most activated with no difference between boys and girls.

Exploring the Role of Artificial Intelligence in Gauging Pain Severity caused by Local Dental Anesthetic Injections in Children: a cross-sectional study

“…CFCS is a valid and reliable system that is used to assess the intensity of children pain [31,32]. As facial expressions related to pain can vary between different races, we used the results concluded by the study of Alkhouli et al, [9] which was performed on Syrian children to determine the AUs associated with each level of pain. FLACC scale is a valid and reliable scale that is used commonly in the eld of pediatric dentistry in assessing pain level.…”

“…Those photos were taken from the children treated in the pediatric dentistry clinics at Damascus University while they were receiving an inferior alveolar nerve block. The dataset was carefully curated by two trained researchers in the Child Facial Coding System (CFCS) (M.A and Z.A) to classify the photos into the different grades of pain depending on the results found by our previous work [9].…”

“…It was also revealed that AU4 (brow lowered), AU6 (cheek raiser), AU41 (lid drop), AU46 (wink), and AU11 (nasolabial deepener) were the most activated AUs in moderate pain (pain level 2). However, in severe pain (pain level 3), AU4 (brow lowered), AU6 (cheek raiser), AU7 (lid tightener), AU9 (nose wrinkle), AU11 (nasolabial deepener), and AU43 (eyes closed) were the most relevant AUs [9].…”