Acetaminophen and NSAIDs Recommended as First-Line Treatment for Paediatric Dental Pain, Says New Guideline

USA: The American Dental Association Science & Research Institute (ADASRI), in collaboration with the University of Pittsburgh School of Dental Medicine and the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine, has released a clinical practice guideline for the management of short-term dental pain in children under the age of 12. 

This guideline, endorsed by the American Dental Association, provides clear recommendations on pain management, particularly after tooth extractions or during toothaches when immediate dental care is not available.

Acetaminophen and NSAIDs as First-Line Treatments

According to the guideline, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are recommended as the first-line treatments for managing dental pain in children under 12. These treatments, when used as directed, have been found to be effective in providing relief in scenarios such as tooth extractions or toothaches.

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The guideline also evaluates medication doses that may differ from those printed on over-the-counter packages. It emphasises that when administered as directed by a dentist or healthcare provider, the risk of harm to children from acetaminophen or NSAIDs is low. 

This approach aligns with previous guidance from the U.S. Food and Drug Administration (FDA), which in 2017 contraindicated the use of codeine and tramadol in children under 12.

Promoting Safe and Effective Pain Management

Dr. Paul Moore, D.M.D., Ph.D., M.P.H., professor emeritus at the University of Pittsburgh’s School of Dental Medicine and the senior author of the guideline, highlighted that the recommendations provide evidence-based options for both dentists and parents in determining the most appropriate treatment for dental pain. He stressed the safety and effectiveness of widely available medications like acetaminophen and ibuprofen in managing short-term dental pain in children.

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The guideline’s release follows a grant awarded by the FDA to the University of Pittsburgh and ADASRI in 2020, aimed at developing clinical practice guidelines for acute pain management in dentistry across all age groups. Patrizia Cavazzoni, M.D., director of the FDA Center for Drug Evaluation and Research, said that these recommendations not only improve the treatment of dental pain but also help prevent unnecessary prescriptions of medications with abuse potential, including opioids.

Future Guidelines and Access to Recommendations

This guideline represents the first of two sets of recommendations on acute dental pain management. A second set focused on adolescents and adults is currently in development. For access to the new acute pediatric pain management guideline and further information, visit ada.org/painmanagement.

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