Analgesics for the management of acute dental pain in the pediatric population

• Published in: The Journal of the American Dental Association (1939) Vol. 154; no. 5; pp. 403 - 416.e14
• Main Authors: Miroshnychenko, Anna, Azab, Maria, Ibrahim, Sara, Roldan, Yetiani, Diaz Martinez, Juan Pablo, Tamilselvan, Divyalakshmi, He, Leon, Urquhart, Olivia, Tampi, Malavika, Polk, Deborah E., Moore, Paul A., Hersh, Elliot V., Carrasco-Labra, Alonso, Brignardello-Petersen, Romina
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2023
• Subjects: acetaminophen; Acute dental pain; dental extraction; irreversible pulpitis; nonsteroidal antiinflammatory; systematic review; toothache; irreversible pulpitis; dental extraction; acetaminophen; FDA; RCT; toothache; NSAID; nonsteroidal antiinflammatory; GRADE; systematic review; Acute dental pain; SR
• ISSN: 0002-8177; 1943-4723
• DOI: 10.1016/j.adaj.2023.02.013

The authors assessed the clinical effectiveness of analgesics to manage acute pain after dental extractions and pain associated with irreversible pulpitis in children. The authors searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and US Clinical Trials registry from inception through November 2020. They included randomized controlled trials comparing any pharmacologic interventions with each other and a placebo in pediatric participants undergoing dental extractions or experiencing irreversible pulpitis. After duplicate screening and data abstraction, the authors conducted random-effects meta-analyses. They assessed risk of bias using the Cochrane Risk of Bias 2.0 tool and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors included 6 randomized controlled trials reporting 8 comparisons. Ibuprofen may reduce pain intensity compared with acetaminophen (mean difference [MD], 0.27 points; 95% CI, −0.13 to 0.68; low certainty) and a placebo (MD, −0.19 points; 95% CI, −0.58 to 0.21; low certainty). Acetaminophen may reduce pain intensity compared with a placebo (MD, −0.13 points; 95% CI, −0.52 to 0.26; low certainty). Acetaminophen and ibuprofen combined probably reduce pain intensity compared with acetaminophen alone (MD, −0.75 points; 95% CI, −1.22 to −0.27; moderate certainty) and ibuprofen alone (MD, −0.01 points; 95% CI, −0.53 to 0.51; moderate certainty). There was very low certainty evidence regarding adverse effects. Several pharmacologic interventions alone or in combination may provide a beneficial effect when managing acute dental pain in children. There is a paucity of evidence regarding the use of analgesics to manage irreversible pulpitis.