How much local anaesthetic does a child need when undergoing dental treatment? Dentists’ opinions vary and this has prompted Malmö University researcher Henrik Berlin to suggest guidelines are needed.

As a principle, children can require local anaesthetic for some procedures, and always when teeth are extracted. In addition, headache medications are sometimes given as pain relief before or after treatment.

“As it stands, we lack evidence that pain relief actually has an effect,” says Berlin.

... experiencing pain during dental treatment increases the risk of dental fear.

In an ongoing dissertation, Berlin wants to find out if it has any value or not. In a first sub-study, he asked 100 paediatric dentists and over 400 general dentists how they manage pain during treatment.

“One in five general dentists replied that they do not always use local anaesthesia when repairing primary teeth."This is most unfortunate as experiencing pain during dental treatment increases the risk of dental fear," says Berlin.

There are thus different strategies. Specialists also used painkillers to a much greater extent before or immediately after a procedure than general dentists. The difference indicates an uncertainty about anaesthetising and pain relief, says Berlin.

In a second study, children were asked how they experienced the pain after a tooth extraction; both immediately after and during each day proceeding for seven days. No pain relief was given in addition to local anaesthesia. The study included 30 children who Berlin himself had treated at Malmö University’s School of Dentistry.

The results showed that the children experienced the most pain two hours after treatment, but that it then disappeared and was gone in most cases as soon as four hours after.

“Most children felt mild to moderate pain, but a small group thought it hurt a lot. Why some felt so after the same treatment needs to be mapped,” says Berlin.

Almost all research in the field is about pain relief for adults, almost nothing focusses on children's experiences. Berlin is therefore now conducting in-depth interviews with children about their experiences of pain during treatment, especially tooth extraction, and the following recovery period.

“Their stories and experiences may indicate that we need to continue researching whether drugs can be used in a better way to reduce pain. Clearly, new guidelines are needed to ensure that dental care better prevents and treats pain in children,” says Berlin.

Text: Magnus Jando

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