Ibuprofen Linked to Lower Pain Following Tooth Extraction in Pediatric Patients

While poor pain management in pediatric dentistry is considered one of the major barriers to dental treatment, it is often assumed that children do not experience significant pain.

As a result, a new study evaluated the efficacy of ibuprofen or acetaminophen administration on pain from injection, extraction and postoperative pain in children undergoing primary tooth extraction.

A team of researchers led by Nabih Raslan, Department of Pediatric Dentistry at Tishreen University, found that the preventive use of pain medications, including ibuprofen, showed lower pain scores compared to placebo in children undergoing primary tooth extraction.

Study

Researchers conducted a randomized, placebo-controlled, triple-blinded clinical trial in children who required primary molar extraction by local anesthesia.

The study included 66 children aged 6-8 years. Patients were treated in the Pediatric Dentistry Department between April and June 2019.

Inclusion criteria included a cooperative child, positive according to Frankl’s Behavioral Rating Scale, and a healthy child according to the American Society of Anesthesiologists with no contraindication to either pain medication.

The team noted that the selection criteria for molars were unsuitable for restoration or with an abscess greater than 1/3 of the interradicular area.

Exclusions included uncooperative children, acute pain, patients taking analgesics within 5 hours of extraction, and patients with a history of prolonged bleeding, hypersensitivity, or allergic reaction to analgesics. Furthermore, molars with advanced physiological resorption were excluded.

Patients were randomized into 3 groups to receive either ibuprofen suspension (100 mg/5 ml), paracetamol syrup (160 mg/5 ml), or strawberry flavored placebo solution. Each solution was given the same color and smell, as well as identical bottles.

The team noted that each solution was given 30 minutes before administration of a local anesthetic.

Researchers assessed pain level using the Wong-Baker facial rating scale for pain after injection, extraction, and postoperatively.

They also used the Kruskal-Wallis and Mann-Whitney U tests to evaluate pain scores between groups with a 95% confidence interval.

Results

Researchers identified 37 boys and 29 girls with a mean age of 7.37 ± 0.66 years, with 30 maxillary and 49 mandibular primary molars.

Data show that patients receiving preventive analgesics reported significantly less pain compared to the placebo group, after injection, immediately after extraction, and up to 5 hours after extraction.

The Kruskal-Wallis test also showed that the reduction in pain score was significant at the same time points.

In addition, analysis using the Mann-Whitney U test showed that pain scores were significantly lower in the ibuprofen group compared to acetaminophen (P < .05).

They noted that ibuprofen alone significantly reduced pain scores compared to placebo immediately after injection (P = .001), immediately after extraction (P = .0001) and 5 hours after extraction (P = .002).

Furthermore, no differences were found in median pain scores in number and location of tooth extraction, or mean pain scores by gender. No patient reported side effects after analgesic treatment.

Conclusion

After the study, the researcher concluded that ibuprofen resulted in significantly lower pain scores immediately after extraction and 5 hours after extraction, compared to both acetaminophen and placebo.

“The present study showed that preventive administration of analgesics can be considered a routine and rational pain management strategy in primary tooth extraction procedures in children,” the researchers wrote.

The study, “Comparison of prophylactic administration of ibuprofen, acetaminophen and placebo in reducing peri- and postoperative pain with primary tooth extraction: a randomized clinical trial,” was published online in Clinical and Experimental Dental Research.

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