Pain Management in Infants, Children, Adolescents and Individuals with Special Health Care Needs

Abstract

This statement provides dentists and stakeholders with current best practices for pediatric pain management. Infants, children, adolescents, and individuals with special health care needs may experience pain resulting from dental/orofacial injury, infection, and dental procedures. Dental pain is an inflammatory condition that can be categorized as somatic (i.e., periodontal, alveolar, mucosal) or visceral (i.e., pulpal). Dental professionals should consider pain assessment for all patients. Inadequate pain management may lead to significant physical and psychological consequences for patients. Perioperative pain management approaches include pre-emptive pain management (e.g., anesthetics), use of local anesthesia during general anesthesia for post-operative pain control, non-pharmacological anxiolytic interventions (e.g., providing a calm environment, emotional support), distraction and imagery (e.g., counting, video games), and pharmacological pain control agents including non-opioid analgesics (e.g., nonsteroidal anti-inflammatory drugs, acetaminophen) and opioid analgesics. Acetaminophen and nonsteroidal anti-inflammatory medications are first line pharmacologic therapies for pain management. Use of opioids for pediatric dental patients should be rare, and steps to mitigate opioid misuse are discussed.

This document was developed through a collaborative effort of the American Academy of Pediatric Dentistry Councils on Clinical Affairs and Scientific Affairs to offer updated information and guidance on pain management in infants, children, adolescents, and individuals with special health care needs.

KEYWORDS: FACIAL PAIN, TOOTHACHE, PAIN MANAGEMENT, ACUTE PAIN, CHRONIC PAIN, PAIN, POSTOPERATIVE