| RECOMMENDATIONS |
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| 1. For the management of acute postoperative dental pain in children* undergoing 1 or more simple or surgical tooth extractions,† the guideline panel suggests initiating the pain management scheme using ibuprofen (suspension, tablet) alone,‡ naproxen (> 2 years)§ (suspension, tablet) alone,‡ or either of the 2 in combination with acetaminophen‡ (suspension, tablet, oral disintegrating tablet, caplet, rectal suppository) over the use of acetaminophen alone (conditional, very low certainty). |
| 1.1. If postprocedural (that is, simple or surgical tooth extraction†) pain control using nonsteroidal anti-inflammatory drugs alone is inadequate, the guideline panel suggests the addition of acetaminophen‡ (conditional, very low certainty). |
| 1.2. When nonsteroidal anti-inflammatory drugs are contraindicated,¶ the guideline panel suggests the use of acetaminophen alone (conditional, very low certainty). |
| 2. For the management of acute postoperative dental pain in children* undergoing 1 or more surgical tooth extractions,† the panel will not formulate recommendations for or against corticosteroids owing to a paucity of evidence. |
| GOOD PRACTICE STATEMENTS |
| ● The guideline panel advises clinicians to assess children’s pain using suitable tools for their ages. For example, a Faces scale (≥ 3 years), a numerical rating scale (≥ 8 years), a visual analog scale (≥ 8 years), or a behavioral scale (1-3 years). |
| ● The guideline panel advises clinicians to counsel patients and their caregivers that they should expect some pain and the analgesics should make their pain manageable. The guideline panel also recommends discussing with the patient, parent, guardian, or caregiver their past experiences, preferences, and values regarding managing acute dental pain before prescribing. |
| ● The guideline panel recommends clinicians thoroughly review the patient’s medical and social histories and medications and supplements to avoid overdose and adverse drug-drug interactions. |
| ● According to the FDA, codeine and tramadol are contraindicated¶ in children younger than 12 years. |
The guideline panel defined children as patients younger than 12 years.
Not all extractions in children will require the use of an analgesic. This recommendation applies only when there is unresolved postoperative pain or when conducting multiple extractions.
When defining dosages, weight should be the primary directive as opposed to age.
The recommendation for the use of naproxen in children older than 2 years in this guideline is an off-label use. Naproxen is approved by the US Food and Drug Administration (FDA) for use as young as 12 years. Naproxen is also approved for prescription use only in pediatric patients with polyarticular juvenile idiopathic arthritis as young as age 2 years. Naproxen is not approved by the FDA in children aged 0 through 2 years.
“A drug should be contraindicated only in those clinical situations for which the risk from use clearly outweighs any possible therapeutic benefit. Only known hazards, and not theoretical possibilities, can be the basis for a contraindication.“19