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Procedural and postoperative pain in paediatric dentistry
Malmö University, Faculty of Odontology (OD).ORCID iD: 0000-0003-3362-3362
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Tooth extraction is one of the most commonly performed dental treatments and there is always a risk of pain during and after this procedure. Pain is a major contributor to the development of dental fear and anxiety(DFA) and dental behaviour management problems (DBMP) in children and adolescents. These, in turn, are two of the most common reasons for referrals to specialist in paediatric dentistry. DFA and DBMP lead to reduced oral health and possibly suffering for the individual, as well as huge costs for society as a whole. It is therefore of uttermost importance that all dental treatments be performed with the aim of avoiding or minimising pain. The aims of this thesis were to (i) investigate how and to what extent Swedish dentists (both general dental practitioners and specialists inpaediatric dentistry) use different pain management strategies when treating children and adolescents, (ii) explain the natural course of pain after uncomplicated bilateral extractions of maxillary premolars in children between the ages of 10 and 15, (iii) systematically evaluate the effect of postoperatively administered over-the-counter oral analgesics as a means to minimise postoperative pain after oral surgery in children between the ages of 0 and 18, and finally (iv) gain greater insight into how children between the ages of 10 and 16 perceive the whole process of tooth extraction (during the procedure and after extraction) as part of orthodontic treatment. In the first study, a postal survey was sent to all active general dental practitioners (GDPs) in Skåne County, and to all specialists in paediatric dentistry (SPDs) in Sweden. The main findings were that pain management strategies differ between the two groups; in addition, GDPs used different strategies depending on whether primary or permanent teeth were being treated. In general, the survey found an underuse of local anaesthesia by general dentists. This calls for guidelines on pain management strategies in paediatric dental care. In the second study, pain intensity was measured at 14 different time points after tooth extraction performed prior to orthodontic treatment, in a sample of 31 children 10 to15 years of age. Pain intensity after extraction of an upper tooth was generally mild to moderate. The natural course of pain intensity followed the same pattern regardless of how the data were analysed. Pain peaked at 2 hours after treatment, then decreasing rapidly until the next measurement that took place 4 hours after treatment. There was no difference between the first and second extraction, indicating that this model is an excellent one for further research on pain management strategies, with no carryover effect. The third study was a systematic review(SR) and health technology assessment (HTA). A systematic review regarding preoperatively administered oral analgesics has been previously published, but it does not present any scientific evidence showing their administration as providing additional pain relief in children after dental treatment. An SR/HTA looked at postoperatively administered oral analgesics with the goal of minimising postoperative pain after oral surgical therapies in children. This SR/HTA yielded an empty review. As of today, there is no scientific evidence for the effectiveness of the administration of oral analgesics postoperatively in order to minimise postoperative pain after oral surgical therapies in children aged 0–18 years. Neither is there any evidence to reject this strategy. This highlights the need for well-designed primary studies on this topic. In the fourth and final study of this thesis, children’s perception of tooth extraction and the postoperative period was investigated in order to better understand the child’s perspective regarding this treatment. A qualitative research approach, using grounded theory, was used. Although the subjects were a bit anxious before the procedure, they all managed to handle the treatment using different types of coping strategies. One central theme that emerged from analysing the interviews was the importance of getting proper information from dental staff, at the right time. Children who received adequate information were able to withstand some pain and discomfort. Having some form of control over the situation also emerged as a coping strategy.

Conclusions

Among Swedish dentists (both GDPs and SPDs), there seems to be uncertainty regarding pain management strategies in children and adolescents in terms of the use of local anaesthetics and oral analgesics. There are differences in pain management strategies between GDPs and SPDs. The majority of the participants perceived pain intensity after tooth extraction due to orthodontic indication to be mild to moderate. These types of extractions can serve as a good model for future pain research. The amount of pain research on paediatric populations in dentistry is scarce. We need more well-designed primary studies before guidelines on pain management strategies for paediatric dental care can be formulated. When given proper and honest information at the right time, children are able to cope with dental treatments, even if they are a bit anxious beforehand and even if they perceive pain or discomfort during and after treatment.

Place, publisher, year, edition, pages
malmö: Malmö universitet, 2020. , p. 124
Series
Doctoral Dissertation in Odontology
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-36856DOI: 10.24834/isbn.9789178771349ISBN: 978-91-7877-133-2 (print)ISBN: 978-91-7877-134-9 (electronic)OAI: oai:DiVA.org:mau-36856DiVA, id: diva2:1501636
Public defence
2020-12-04, Orkanen, hörsal D138 samt digitalt, Nordenskiöldsgatan 10, Malmö, 09:15
Opponent
Note

Paper IV: Children’s perceptions and coping of pain in conjunction with orthodontically indicated tooth extractions: a grounded theory study (manuscript)

Available from: 2020-11-17 Created: 2020-11-17 Last updated: 2022-06-27Bibliographically approved
List of papers
1. Dentists' attitudes towards acute pharmacological pain management in children and adolescents
Open this publication in new window or tab >>Dentists' attitudes towards acute pharmacological pain management in children and adolescents
2018 (English)In: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 28, no 2, p. 152-160Article in journal (Refereed)
Abstract [en]

AIM: This study aimed to investigate Swedish dentists' attitudes regarding pain management strategies for treating children and adolescents. It assessed recommendations for pre- and postoperative analgesics, and use of local anaesthesia, and whether application of these strategies differs between general dental practitioners (GDPs) and specialists in paediatric dentistry (SPDs). DESIGN: We invited all GDPs (n = 807) in southern Sweden (Region Skåne), and all registered SPDs (n = 122) working in Sweden (929 actively practising dentists under age 65 years) to participate in a postal survey on pain management in paediatric dental care. RESULTS: The SPDs reported using all types of pain-reducing strategies more frequently than GDPs except local anaesthesia when extracting a permanent premolar, which SPDs and GDPs used equally often. Preoperative analgesic use was greater among SPDs than GDPs. GDPs used local anaesthesia less frequently for filling therapy in primary teeth than in permanent teeth. CONCLUSIONS: SPDs recommend preoperative analgesics more often than GDPs do. GDPs seem to underuse local anaesthetics when treating children and adolescents. SPDs also use pain management strategies more frequently than GDPs. Among GDPs, pain management is less frequent when treating primary teeth than permanent teeth.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
dentistry, child, adolescent, pain, dental pain, pain management
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15364 (URN)10.1111/ipd.12316 (DOI)000424920200005 ()28691744 (PubMedID)2-s2.0-85023186249 (Scopus ID)23327 (Local ID)23327 (Archive number)23327 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved
2. Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars
Open this publication in new window or tab >>Postoperative pain profile in 10-15-year-olds after bilateral extraction of maxillary premolars
Show others...
2019 (English)In: European Archives of Paediatric Dentistry, ISSN 1818-6300, E-ISSN 1996-9805, Vol. 20, no 6, p. 545-555Article in journal (Refereed)
Abstract [en]

PURPOSE: To study pain perception in 10-15-year-olds, during and after uncomplicated extractions of bilateral maxillary premolars. The study investigated pain's natural course and made comparisons between the first and second extractions. METHODS: 31 Swedish children in need of orthodontic treatment were identified and consecutively enrolled. Tooth extractions followed a standardised protocol and the two teeth were extracted with at least 10 days between. The participants rated pain intensity using visual analogue scale (VAS) at 14 different time points from treatment and 7 days forward. RESULTS: The pain intensity profile followed the same pattern for all patients. Pain intensity peaked 2 h after extractions (mean VASPI 27.3, SD 20.8; median 23.0) when moderate pain intensity (VASPI >/= 40) was registered for 16 (28%) of 57 cases. After that, there was a rapid decrease in pain intensity notable already at 4 h after extractions. There were no statistically significant differences in any VASPI measurements between the first and second extractions, sexes, or different age groups. CONCLUSIONS: The majority of the participants who undergo uncomplicated bilateral extraction of maxillary premolars experience mild to moderate levels of postoperative pain during a short period of time, with no differences between the first and second extractions. Bilateral tooth extractions is a suitable model for further studies on pain management.

Place, publisher, year, edition, pages
Springer, 2019
Keywords
Pain, Child, Adolescent, Visual analogue scale, Self-assessment, Tooth extraction, Postoperative
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-6824 (URN)10.1007/s40368-019-00425-9 (DOI)000501308000006 ()30963511 (PubMedID)2-s2.0-85064526234 (Scopus ID)30169 (Local ID)30169 (Archive number)30169 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-02-05Bibliographically approved
3. Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review
Open this publication in new window or tab >>Effects and cost-effectiveness of postoperative oral analgesics for additional postoperative pain relief in children and adolescents undergoing dental treatment: Health technology assessment including a systematic review
Show others...
2019 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 14, no 12, article id e0227027Article, review/survey (Refereed) Published
Abstract [en]

Background There is an uncertainty regarding how to optimally prevent and/or reduce pain after dental treatment on children and adolescents. Aim To conduct a systematic review (SR) and health technology assessment (HTA) of oral analgesics administered after dental treatment to prevent postoperative pain in children and adolescents aged 3-19 years. Design A PICO-protocol was constructed and registered in PROSPERO (CRD42017075589). Searches were conducted in PubMed, Cochrane, Scopus, Cinahl, and EMBASE, November 2018. The researchers (reading in pairs) assessed identified studies independently, according to the defined inclusion and exclusion criteria, following the PRISMA-statement. Results 3,963 scientific papers were identified, whereof 216 read in full text. None met the inclusion criteria, leading to an empty SR. Ethical issues were identified related to the recognized knowledge gap in terms of challenges to conduct studies that are well-designed from methodological as well as ethical perspectives. Conclusions There is no scientific support for the use or rejection of oral analgesics administered after dental treatment in order to prevent or reduce postoperative pain in children and adolescents. Thus, no guidelines can be formulated on this issue based solely on scientific evidence. Well-designed studies on how to prevent pain from developing after dental treatment in children and adolescents is urgently needed.

Place, publisher, year, edition, pages
Public Library of Science, 2019
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-17235 (URN)10.1371/journal.pone.0227027 (DOI)000515096600052 ()31891621 (PubMedID)2-s2.0-85077390425 (Scopus ID)
Available from: 2020-05-13 Created: 2020-05-13 Last updated: 2024-02-05Bibliographically approved

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