Dental emergencies in pediatric patients require prompt attention due to the rapid progression of symptoms and the limited cooperation of young children.
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1. Introduction
Pediatric dental emergencies are critical conditions that demand immediate intervention to relieve pain, manage infections, and prevent systemic complications. Pharmacological therapy is a key component in addressing these emergencies, serving as a complement to clinical procedures. In children, treatment must be tailored to the patient’s age, weight, medical history, and severity of the condition.
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2.1. Acute Dentoalveolar Abscess
➤ Clinical Signs: Swelling, pain, dental mobility, fever, malaise.
➤ Pharmacologic Management:
° Amoxicillin: 40–50 mg/kg/day every 8 hours for 5–7 days.
° For penicillin allergy: Clindamycin 10–20 mg/kg/day in 3 divided doses.
° Pain control:
- Acetaminophen: 10–15 mg/kg every 6 hours.
- Ibuprofen: 5–10 mg/kg every 6–8 hours.
2.2. Facial Cellulitis of Odontogenic Origin
➤ Clinical Signs: Diffuse swelling, fever, facial erythema, systemic symptoms.
Pharmacologic Management:
° Amoxicillin-Clavulanate: 45 mg/kg/day in 2 divided doses.
° For penicillin allergy: Clindamycin or azithromycin.
° Hospitalization: Required in cases of airway compromise or systemic spread.
2.3. Pericoronitis in Erupting Molars
➤ Clinical Signs: Red, painful gingiva around partially erupted molars.
➤ Pharmacologic Management:
° Amoxicillin: 40 mg/kg/day every 8 hours.
° Pain control: Ibuprofen or acetaminophen depending on child’s weight and age.
2.4. Acute Irreversible Pulpitis
➤ Clinical Signs: Persistent spontaneous pain, especially at night.
➤ Pharmacologic Management:
° Antibiotics not indicated unless systemic infection is present.
° Pain relief: Acetaminophen or ibuprofen, alone or alternated.
2.5. Dental Trauma (e.g., Luxation, Avulsion)
➤ Clinical Signs: Displacement or avulsion of teeth, soft tissue injury.
➤ Pharmacologic Management:
° Prophylactic Antibiotics:
- Amoxicillin 40–50 mg/kg/day for exposed pulp or avulsed teeth.
- Consider adding metronidazole in complex injuries.
° Pain management: Based on severity; ibuprofen preferred for inflammation.
2.6. Alveolar Osteitis (Dry Socket) in Adolescents
➤ Clinical Signs: Severe post-extraction pain with empty socket and no infection.
➤ Pharmacologic Management:
° No antibiotics needed.
° Analgesics: Strong pain relievers such as ibuprofen + acetaminophen combination.
° Local irrigation: With 0.12% chlorhexidine rinse.
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Pharmacological intervention in pediatric dental emergencies must be carefully justified. Antibiotics should not be prescribed solely for pain or localized swelling without signs of systemic infection. Overprescription contributes significantly to antibiotic resistance, a rising concern in pediatric healthcare (Rosa-Garcia et al., 2023).
Pain management should be tailored based on the child’s age and weight. Acetaminophen and ibuprofen remain the mainstays of dental analgesia in children, with alternating doses safe and effective in cases of moderate to severe pain.
Crucially, medications must complement — not replace — definitive treatment, such as extraction, drainage, or pulpectomy, depending on the source of the dental emergency.
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Effective management of pediatric dental emergencies involves timely diagnosis, proper clinical treatment, and judicious use of pharmacologic agents. Dentists should rely on evidence-based protocols when prescribing antibiotics or analgesics, ensuring safety and reducing the risk of antibiotic resistance. Continuing education and adherence to pediatric dental guidelines are essential for optimal patient outcomes.
References
✔ Rosa-Garcia, M., López-Ramos, R., & Martín-Ramos, E. (2023). Rational use of antibiotics in pediatric dental infections: A review. Pediatric Dentistry Today, 41(2), 89–95. https://doi.org/10.1016/j.peddent.2023.04.002
✔ American Academy of Pediatric Dentistry. (2023). Guideline on Use of Antibiotic Therapy for Pediatric Dental Patients. Retrieved from https://www.aapd.org/research/oral-health-policies--recommendations/antibiotic-therapy
✔ Balmer, R., et al. (2021). Pain management and antibiotic use in pediatric dental emergencies. British Dental Journal, 231(6), 325–331. https://doi.org/10.1038/s41415-021-3321-0
✔ Pichichero, M. E. (2020). Understanding antibiotic dosing in children. Pediatric Clinics of North America, 67(6), 1067–1081. https://doi.org/10.1016/j.pcl.2020.08.003
✔ European Academy of Paediatric Dentistry (EAPD). (2022). Antimicrobial stewardship in pediatric dentistry: Policy document. https://www.eapd.eu
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