Pain management is a fundamental component of pediatric dental care. Pharmacology in pediatric dentistry requires precise drug selection, accurate dosing, and a clear understanding of safety profiles.
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✅ Principles of Analgesic Use in Pediatric Dentistry
Safe analgesic prescription in children should follow these principles:
▪️ Weight-based dosing
▪️ Use of the lowest effective dose
▪️ Shortest duration necessary
▪️ Avoidance of drugs with unfavorable risk–benefit profiles
Paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) are the cornerstone of pediatric dental analgesia.
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Paracetamol is considered the first-line analgesic in pediatric dentistry due to its favorable safety profile.
▪️ Indicated for mild to moderate dental pain
▪️ Antipyretic effect
▪️ Minimal gastrointestinal irritation
▪️ Safe when used within therapeutic doses
⚠️ Hepatotoxicity is associated with overdose, emphasizing the importance of caregiver education.
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NSAIDs provide both analgesic and anti-inflammatory effects, making them particularly useful after invasive dental procedures.
➤ Ibuprofen
Ibuprofen is the most widely recommended NSAID in pediatric dentistry.
▪️ Effective for postoperative pain
▪️ Good safety profile when properly dosed
▪️ Superior anti-inflammatory action compared to paracetamol
Contraindications
▪️ Dehydration
▪️ Renal disease
▪️ History of gastrointestinal disorders
▪️ Asthma sensitive to NSAIDs
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▪️ Aspirin: Contraindicated due to the risk of Reye’s syndrome
▪️ Opioids: Not routinely recommended; associated with respiratory depression and dependence
▪️ Metamizole (dipyrone): Use remains controversial due to rare but serious adverse effects
✅ Clinical Relevance in Pediatric Dentistry
Effective analgesia:
▪️ Improves child cooperation
▪️ Reduces dental anxiety
▪️ Enhances postoperative recovery
▪️ Promotes positive dental experiences
▪️ Evidence supports non-opioid analgesics as the first-line therapy for pediatric dental pain.
📊 Comparative Table: Common Analgesics in Pediatric Dentistry
| Aspect | Advantages | Limitations |
|---|---|---|
| Paracetamol | High safety profile and well tolerated | Limited anti-inflammatory effect |
| Ibuprofen | Effective analgesic and anti-inflammatory action | Contraindicated in renal or gastrointestinal conditions |
| Opioids | Strong analgesic effect | High risk of adverse effects; not first-line |
Recent evidence highlights a global shift toward minimizing opioid use in pediatric pain management, including dentistry. Studies consistently show that paracetamol and ibuprofen provide adequate analgesia for most dental procedures when used correctly. The key challenge remains educating caregivers on correct dosing and avoiding self-medication errors.
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▪️ Use paracetamol as first-line therapy for mild dental pain
▪️ Ibuprofen is preferred when inflammation is present
▪️ Avoid aspirin and routine opioid prescriptions
▪️ Always prescribe based on child’s weight and age
▪️ Provide clear written instructions to caregivers
✍️ Conclusion
Safe analgesic use in pediatric dentistry relies on evidence-based pharmacology, appropriate dosing, and careful patient assessment. Paracetamol and ibuprofen remain the most reliable and safest options for managing dental pain in children. Adhering to current guidelines ensures effective pain control while minimizing adverse drug reactions.
📚 References
✔ American Academy of Pediatric Dentistry. (2023). Guideline on Use of Analgesics for Pediatric Dental Patients. Pediatric Dentistry, 45(6), 292–298.
✔ Malamed, S. F. (2020). Handbook of Local Anesthesia (7th ed.). Elsevier.
✔ World Health Organization. (2012). WHO guidelines on the pharmacological treatment of persisting pain in children. WHO Press.
✔ Moore, P. A., & Hersh, E. V. (2013). Combining ibuprofen and acetaminophen for acute pain management. Journal of the American Dental Association, 144(8), 898–908. https://doi.org/10.14219/jada.archive.2013.0207
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