Aims and background: Local anesthetics play a crucial role in pain management in pediatric dentistry, where anxiety and fear are common among young patients. This study aimed to compare the anesthetic efficacy of 2% lignocaine with a 20-gauge needle in an inferior alveolar nerve block (IANB) and 4% articaine with a 24-gauge needle in a buccal nerve block (BNB) during the extraction of dentoalveolar abscesses in children aged 5–11 years. Materials and methods: A 12-month randomized controlled trial involving 100 healthy children was conducted following ethical standards. Patients were assigned to receive either lignocaine or articaine anesthesia. Pain assessments were conducted using the Wong–Baker Faces Pain Rating Scale (W–BFRS) and visual analog scale (VAS). Postoperative follow-ups were performed to evaluate pain, biting incidents, and numbness duration. Results: The study demonstrated a strong positive correlation between W–BFRS and VAS ratings, indicating effective pain assessment. While both techniques showed efficacy, the BNB + local infiltration (LI) technique exhibited lower rates of reanesthesia and discomfort compared to IANB + LI. Follow-up assessments revealed shorter numbness duration and reduced biting incidents with the BNB + LI technique. Conclusion: This study underscores the importance of considering patient comfort and experience when selecting anesthesia techniques in pediatric dentistry. Articaine emerges as a favorable option, offering improved pain management and patient satisfaction compared to lignocaine. Both the IANB + LI and BNB + LI techniques are viable options, with the choice influenced by adverse events and patient preferences. This research contributes valuable insights into optimizing pain management for pediatric dental procedures, particularly in cases of dentoalveolar abscesses.