Dental pain is common after dental procedures and can lead to increased fear of dental treatment, avoidance of dental treatment and other associated problems. Reduction of pain is important, particularly in children and adolescents. One way of managing this might be to give painkillers before treatment so that the painkillers can start to work right away. This updated review looked at evidence for using painkillers in children, aged up to 17 years, undergoing treatment without sedation or general anaesthetic, but who may have had a local anaesthetic. The treatments included extracting teeth, restoring teeth and fitting braces.
What was the research?
A systematic review of the evidence to find out whether giving children painkillers such as paracetamol and ibuprofen before dental treatment helps to reduce pain after the treatment.
Who conducted the research?
The research was conducted by a team led by Paul F. Ashley from UCL Eastman Dental Institute, on behalf of Cochrane Oral Health. Susan Parekh, David R Moles, Prabhleen Anand and Laura CI MacDonald were also on the team.
What evidence was included in the review?
Data was extracted from 5 randomised controlled trials. A total of 190 people participated in the trials, Three included studies related to dental treatment (fillings and tooth extractions) and two related to orthodontic treatment (braces). Three of the five included studies compared paracetamol to a placebo (sugar tablet) and four of them compared ibuprofen to a placebo.
What did the evidence say?
From the available evidence, we could not determine whether or not painkillers before treatment are of benefit for children and adolescents having dental procedures under local anaesthetic. There is probably a benefit in giving painkillers before braces are fitted. Only one study reported an adverse event (one participant in each group had a lip or cheek biting injury). More research is needed.
How good was the evidence?
None of the included studies were at low risk of bias. The quality of the evidence is low.
What are the implications for dentists and the general public?
From the available evidence, we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There does seem to be some benefit in use of preoperative analgesics prior to orthodontic separator placement. The quality of the evidence is low.
What should researchers look at in the future?
Further randomised controlled clinical trials (RCTs) are needed to assess the efficacy of preoperative painkillers in children and adolescents having routine dental treatments. Follow-up of participants may be necessary to find out if the effect of preoperative pain relief has reduced postoperative pain and anxiety, and whether this changes children’s perceptions towards dental treatment.
Ashley PF, Parekh S, Moles DR, Anand P, MacDonald LCI. Preoperative analgesics for additional pain relief in children and adolescents having dental treatment. Cochrane Database of Systematic Reviews 2016 , Issue 7 . Art. No.: CD008392. DOI: 10.1002/14651858.CD008392.pub3
This blog post is based on the review’s plain language summary and was compiled at the Cochrane Oral Health Editorial Base by Anne Littlewood