Reducing the pain of dental treatment for children and adolescents: unclear evidence

intraoperativeIt can be difficult when giving dental treatment to children and young people to do it simply using a local anaesthetic (LA) injection, as they may experience anxiety or need a lot of treatment at once. For example, they may need many teeth taken out at the same time. In these circumstances, a dental practitioner commonly uses a general anaesthetic (GA) and administers the treatment in a hospital. Problems often arise following this treatment and the most common is pain, the experience of which can cause an emotional as well as a physical response. The experience can make it more difficult for the dental practitioner to give the treatment needed, and it can also cause the child or young person to avoid future dental treatment. This research set out to find out whether giving LA injections during dental treatment under GA will result in numbness and therefore pain not being felt for a couple of hours, after which time painkillers can control the pain. The review looked at the benefits of using LA in this way, but also considered the side-effects. These can include discomfort, dribbling, and accidental lip biting. Also, because painkillers are often used as well, the effect of the LA is not clearly defined. Additionally, it is important to clarify the best doses and kind of injections to use to achieve the maximum benefit.

What was the research?

A systematic review of the evidence to find out if injections of local anaesthetic given whilst children and young people (aged 17 years or younger) are having dental treatment under general anaesthetic reduce the amount of pain felt afterwards

Who conducted the research?

The research was conducted by a team led by Susan Parekh from UCL Eastman Dental Institute, on behalf of the Cochrane Oral Health Group. Collette Gardener, Paul F Ashley and Tanya Walsh were also on the team.

What evidence was included in the review?

Data was extracted from 14 randomised controlled trials. A total of 1,152 people under the age of 17 participated in the trials.

What did the evidence say?

Although the 14 studies included addressed the research question, they differed in the way that they delivered the intervention and what they measured. This meant that data could not be combined in the analysis. The results from individual studies for pain, bleeding, and other adverse effects were uncertain. The use of additional different painkillers may have hidden the effect of the LA. Further high-quality trials are needed in order to assess the benefits or harms of LA given to children and young people whilst they are receiving dental treatment under GA. Issues that these trials need to address include local side-effects (e.g., excessive dribbling and accidental lip biting), side-effects on other parts of the body (e.g., the heart), participant and parent satisfaction, dosage, type of anaesthetic, and the effects of extra painkillers (e.g., paracetamol).

How good was the evidence?

The quality of the 14 included studies was variable. We assessed three studies as being at overall risk of high bias, seven at unclear risk of bias, and four at low risk of bias.

What are the implications for dentists and the general public?

It was difficult to reach firm conclusions as to the benefit of using local anaesthetic for dental treatment under general anaesthesia. The evidence was not sufficient to address the objective of the research.

What should researchers look at in the future?

Further randomized controlled trials need to conducted to assess the effect of intraoperative local anaesthetic on the volume and type of anaesthetic used. Consideration should be given to the impact of any changes on the health and wellbeing of the patient. They should be conducted according to CONSORT guidance.

Link

Parekh S, Gardener C, Ashley PF, Walsh T. Intraoperative local anaesthesia for reduction of postoperative pain following general anaesthesia for dental treatment in children and adolescents. Cochrane Database of Systematic Reviews 2014 , Issue 12 . Art. No.: CD009742. DOI: 10.1002/14651858.CD009742.pub2 .

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