Evidence lacking to determine whether preoperative analgesic use reduces post dental treatment pain for children

Abstract

The Cochrane Oral Health Group Trials Register, CENTRAL, Medline, Embase, LILACS and the ISI Web of Knowledge and relevant dental journals were searched with no restrictions. Randomised controlled trials (RCTs) of analgesics given before dental treatment versus placebo or no analgesics in children and adolescents ≤ 17 were included. Those having treatment under sedation or general anaesthesia were excluded. Two reviewers independently assessed eligibility and undertook data extraction and assessment of risk of bias. Meta-analysis was undertaken where appropriate. Five trials (190 participants) were included, three involved dental treatment, two orthodontic treatment, none of the trials was at low risk of bias. Three compared paracetamol with placebo, only two provided data for analysis, this showed a non significant risk ratio (RR) for postoperative pain-related behaviours of 0.81 (95% confidence interval (CI) 0.53 to 1.22; P = 0.31), ie, no evidence of benefit in taking paracetamol preoperatively (52% reporting pain in placebo versus 42% in test group). Four trials compared ibuprofen with placebo. Three trials provided useable data. One reported no statistical difference in post-operative pain experienced by the ibuprofen group and the control group for children undergoing dental treatment. Data from two trials, in patients having orthodontic separator replacement, were pooled. There was a statistically significant benefit, with regard to severity of postoperative pain, for giving ibuprofen preoperatively, with mean difference -19.12 (95% CI -29.36 to -8.87; P = 0.0003; moderate quality evidence) on a visual analogue scale (0 to 100) indicating a probable benefit for preoperative ibuprofen before this orthodontic procedure. However, both these trials were at high risk of bias. From the available evidence we cannot determine whether or not preoperative analgesics are of benefit in paediatric dentistry for procedures under local anaesthetic. There is probably a benefit in prescribing preoperative analgesics prior to orthodontic separator placement.