Cochrane · intervention · CD008392

Preoperative analgesics for additional pain relief in children and adolescents having dental treatment

Ashley, PF, Parekh, S, Moles, DR, et al. · Cochrane Database of Systematic Reviews · 2016 · Cochrane Library

Oral Health Pain control and patient management3 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

as reported

No studies 6 · 60%Ungraded 2 · 20%Very low 0 · 0%Low 2 · 20%Moderate 0 · 0%High 0 · 0%

Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.

Review question

Element	Planned (methods)	Found (results)
Population	Children and adolescents aged up to 17 years having dental treatment (including orthodontic treatment, fillings, removal of the nerve from a tooth, and extraction of a tooth); excluded children and adolescents having dental treatment under sedation (including nitrous oxide/oxygen) or general anaesthesia	Children aged from 2 to 16 years (each study a different age range); 190 children in total across five trials; four trials in the USA and one in Turkey
Intervention	Analgesics given before dental treatment (both intervention and control groups may include local anaesthetics)	Paracetamol (n=3 studies); Ibuprofen (n=4 studies)
Comparison	Placebo or no analgesics	Placebo, including lactose tablet (n=5 studies)
Outcomes	Primary: Postoperative pain measures (either expressed as intensity of pain or presence or absence of pain). Secondary: Intraoperative pain; Preoperative and postoperative anxiety measures; Patient satisfaction; Parental satisfaction; Cost; Completion of treatment (yes/no); Adverse events	Postoperative pain (n=5; dichotomous presence of pain-related behaviours or continuous severity on VAS); Adverse events (n=2)
Study designs	Randomised controlled clinical trials (RCTs), including cluster-randomised trials and cross-over trials where the order is randomised; quasi-randomised trials excluded	RCT, parallel group (n=5)
Timing	Not specified	Postoperative follow-up 2 hours (severity, ibuprofen); mean 6.5 hours (presence of pain behaviour, paracetamol); other time points 15 min to 7 days

Search date: 2016-01. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE via OVID; EMBASE via OVID; LILACS via BIREME; ISI Web of Science; ClinicalTrials.gov; WHO International Clinical Trials Registry Platform

Questions and results

Current version only

Preoperative analgesics (analgesics given before dental treatment) vs Placebo or no analgesics

Population: Children and adolescents aged up to 17 years having dental treatment (orthodontic treatment, fillings, pulp treatment, or tooth extraction), without sedation or general anaesthesia

CD008392.PUB3 (current) · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Intraoperative pain same question in other reviews	None of the included studies measured intraoperative pain. PUB3: 'The [three/four] studies did not measure intraoperative pain, ... cost or completion of treatment.'	0 studies	No studies
Cost same question in other reviews	None of the included studies reported cost. PUB3: 'The [three/four] studies did not measure ... cost or completion of treatment.'	0 studies	No studies
Preoperative and postoperative anxiety measures same question in other reviews	None of the included studies assessed anxiety or behaviour at baseline, and none recorded baseline anxiety. PUB3: 'The [three/four] studies did not measure ... preoperative and postoperative anxiety measures ...'	0 studies	No studies
Completion of treatment (yes/no) same question in other reviews	None of the included studies measured completion of treatment. PUB3: 'The [three/four] studies did not measure intraoperative pain, preoperative and postoperative anxiety measures, patient satisfaction, parental…	0 studies	No studies
Parental satisfaction same question in other reviews	None of the included studies reported parental satisfaction. PUB3: 'there was no reporting of participant or parent satisfaction in any included study.'	0 studies	No studies
Patient satisfaction same question in other reviews	None of the included studies reported patient satisfaction. PUB3: 'there was no reporting of participant or parent satisfaction in any included study.'	0 studies	No studies

Preoperative paracetamol (acetaminophen) vs Placebo

Population: Children and adolescents having dental treatment under local anaesthetic (restorative and extraction treatments)

CD008392.PUB3 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Postoperative pain (dichotomous measure: parent report of presence of pain-related behaviours) Mean 6.5 hours same question in other reviews	RR 0.81 [0.53, 1.22] 520 per 1000 vs 421 per 1000	2 studies · 100 participants	Low Downgraded: risk of bias, imprecision
Adverse events same question in other reviews	No adverse events were recorded in Primosch 1995. The other two studies did not mention adverse events.	1 study	Ungraded

Preoperative ibuprofen vs Placebo

Population: Children and adolescents having orthodontic separator placement (without local anaesthetic)

CD008392.PUB3 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Postoperative pain (continuous measure: self report using visual analogue scale) 2 hours same question in other reviews	MD -13.44 [-23.01, -3.88]	2 studies · 85 participants	Low Downgraded: risk of bias, imprecision
Adverse events same question in other reviews	One participant from the ibuprofen group and one from the placebo group reported a lip or cheek biting injury (Bernhardt 2001). No other adverse events were recorded for Bernhardt 2001 and Law 2000.	2 studies	Ungraded

Preoperative analgesics (analgesics given before dental treatment) vs Placebo or no analgesics

Population: Children and adolescents aged up to 17 years having dental treatment (orthodontic treatment, fillings, pulp treatment, or tooth extraction), without sedation or general anaesthesia

CD008392.PUB2 · 6 questions

Outcome	Effect	Evidence	Status / GRADE
Patient satisfaction	Planned secondary outcome; no included study reported patient satisfaction.	0 studies	No studies
Intraoperative pain	Planned secondary outcome; no included study reported intraoperative pain data.	0 studies	No studies
Parental satisfaction	Planned secondary outcome; no included study reported parental satisfaction.	0 studies	No studies
Cost	Planned secondary outcome; no included study reported cost.	0 studies	No studies
Preoperative and postoperative anxiety measures	Planned secondary outcome; no assessment of anxiety or behaviour was made at baseline by any included study.	0 studies	No studies
Completion of treatment (yes/no)	Planned secondary outcome; no included study reported completion-of-treatment data.	0 studies	No studies

Preoperative paracetamol (acetaminophen) vs Placebo

Population: Children and adolescents having dental treatment under local anaesthetic (restorative and extraction treatments)

CD008392.PUB2 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse events	No adverse events were recorded in Primosch 1995. The other two studies did not mention adverse events.	1 study	Ungraded
Postoperative pain (presence of postoperative pain-related behaviour, parent-reported) Mean 6.5 hours	RR 0.81 [0.53, 1.22] 520 per 1000 vs 421 per 1000	2 studies · 100 participants	Moderate Downgraded: risk of bias

Preoperative ibuprofen vs Placebo

Population: Children and adolescents having orthodontic separator placement (without local anaesthetic)

CD008392.PUB2 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Adverse events	One patient from the ibuprofen group and one from the placebo group reported a lip or cheek biting injury (Bernhardt 2001). No other adverse events were recorded for Bernhardt 2001 and Law 2000.	2 studies	Ungraded
Postoperative pain (severity, self-reported on 0 to 100 visual analogue scale) Mean 2 hours	MD -19.12 [-29.36, -8.87]	2 studies · 71 participants	Moderate Downgraded: risk of bias

Preoperative analgesics (analgesics given before dental treatment) vs Placebo or no analgesics

Population: Children and adolescents aged up to 17 years having dental treatment (orthodontic treatment, fillings, pulp treatment, or tooth extraction), without sedation or general anaesthesia

CD008392 · 7 questions

Outcome	Effect	Evidence	Status / GRADE
Cost	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Postoperative pain measures	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Preoperative and postoperative anxiety measures	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Completion of treatment (yes/no)	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Patient satisfaction	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Intraoperative pain	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies
Parental satisfaction	Protocol (2010): planned outcome; no results reported and no studies included yet.	NR	No studies