Evidence-based clinical practice guideline for the pharmacologic management of acute dental pain in children: A report from the American Dental Association Science and Research Institute, the University of Pittsburgh School of Dental Medicine, and the Center for Integrative Global Oral Health at the University of Pennsylvania

Abstract

Background: A guideline panel convened by the American Dental Association Council on Scientific Affairs, American Dental Association Science and Research Institute, University of Pittsburgh School of Dental Medicine, and Center for Integrative Global Oral Health at the University of Pennsylvania conducted a systematic review and meta-analyses and formulated evidence-based recommendations for the pharmacologic management of acute dental pain after 1 or more simple and surgical tooth extractions and the temporary management of toothache (that is, when definitive dental treatment not immediately available) associated with pulp and furcation or periapical diseases in children (< 12 years).

Types of studies reviewed: The authors conducted a systematic review to determine the effect of analgesics and corticosteroids in managing acute dental pain. They used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the certainty of the evidence and the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework to formulate recommendations.

Results: The panel formulated 7 recommendations and 5 good practice statements across conditions. There is a small beneficial net balance favoring the use of nonsteroidal anti-inflammatory drugs alone or in combination with acetaminophen compared with not providing analgesic therapy. There is no available evidence regarding the effect of corticosteroids on acute pain after surgical tooth extractions in children.

Conclusions and practical implications: Nonopioid medications, specifically nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen alone or in combination with acetaminophen, are recommended for managing acute dental pain after 1 or more tooth extractions (that is, simple and surgical) and the temporary management of toothache in children (conditional recommendation, very low certainty). According to the US Food and Drug Administration, the use of codeine and tramadol in children for managing acute pain is contraindicated.

Keywords: Clinical practice guideline; acute dental pain; analgesics; corticosteroids; opioids; pediatric dentistry; tooth extractions; toothache.

Figure 1.

Clinical pathway for the pharmacologic management of acute dental pain: postoperative pain after surgical and simple tooth extractions in children. Naproxen is approved by the US Food and Drug Administration for prescription use only in pediatric patients older than 2 years with polyarticular juvenile idiopathic arthritis. The recommendation for the use of naproxen in children older than 2 years in this guideline is an off-label use. NSAID: Nonsteroidal anti-inflammatory drug.

Figure 2.

Clinical pathway for the temporary pharmacologic management of toothache with no immediate access to definitive dental treatment in children. Naproxen is approved by the US Food and Drug Administration for prescription use only in pediatric patients older than 2 years with polyarticular juvenile idiopathic arthritis. The recommendation for the use of naproxen in children older than 2 years in this guideline is an off-label use. NSAID: Nonsteroidal anti-inflammatory drug.