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European Archives of Paediatric Dentistry

, Volume 18, Issue 5, pp 313–321 | Cite as

Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document

  • J. KühnischEmail author
  • M. Daubländer
  • G. Klingberg
  • A. Dougall
  • M. Spyridonos Loizides
  • E. Stratigaki
  • J. L. Amar
  • V. Anttonen
  • M. Duggal
  • S. Gizani
Original Scientific Article

Abstract

Background

The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care.

Methods

A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified.

Results

An important outcome was that when local analgesia administered appropriately—correct choice of agent(s) and dosage, proper route of administration—it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years.

Conclusion

When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.

Keywords

Local analgesia Children Adolescents Techniques of administration Adverse events Clinical practice Guideline 

Notes

Acknowledgements

The European Academy of Paediatric Dentistry thanks the Italian Society of Paediatric Dentistry for organising the 11th Interim Seminar and Workshop in Torino, Italy from April 21-22, 2017, on “Local Analgesia in Paediatric Dentistry”. Special thanks are attributed to the head of the organising committee, Prof. P Defabianis (University of Torino) who made this meeting successful. Furthermore, the EAPD wishes to thank all participants of the workshops from the member countries for their valuable contributions. Workshop 1/Pharmacology, toxicology, agents and vasoconstrictors: M. Daubländer (Germany), G. Ahbab (Belgium), H. Yli-Urpo (Finland), K. Kavvadia (Greece), A. Ni Chaollai (Ireland), E. Hembrecht-van Geer (The Netherlands), A. Skaare (Norway), E. Gazda (Poland), A.C. Coelho Canta (Portugal), V. Zivojinovic Toumba (Serbia), A. Pavlic (Slovenia), H. Van Waes (Switzerland), J. Monteiro (UK), Mariya Dolhova (Ukraine), M. Spyridonos Loizidou (Cyprus, moderator), E. Stratigaki (Switzerland, moderator). Workshop 2/Local analgesia in daily practice: Application techniques, indications,contraindications, opportunities and limitations: G. Klingberg (Sweden), D. Finucane (Ireland), N. Kokkinos (Cyprus), C. Oulis (Greece), A.M. Vierrou (Greece), M. Ivanovic (Serbia), P. Hess (Denmark), M. Blomqvist (Sweden), M. Muller-Bolla, C. Tardieu (France), S. Theys (Belgium), M. Elfrink (The Netherlands), M. Sobczak (Poland), S. Barry (UK), I.J. Brusevold (Norway), S. Burnik Bobic (Slovenia), N. van Gelder, L. Rodica (Romania), M. Ashkenazi (Israel), Va Merglova (Czech), V. Rozman (Ukraine), L. Neveu (Switzerland), J. Leonhardt Amar (Switzerland, moderator), V. Anttonen (Finland, moderator). Workshop 3/Local analgesia in medically compromised children and adolescents: A. Dougall (Ireland), J. Mandic (Serbia), B. Kargul (Turkey), Y. Myts (Ukraine), R. Koberova (Czech), K. Kavvadia (Greece), M. Tanase (Romania), M. Jonker, J. Krikken (The Netherlands), H. Alapulli (Finland), K. Bücher (Germany), C. Onisiforou (Cyprus), T. Tomazevic (Slovenia), K. Emerich (Poland), J. Vandenbulcke (Belgium), A.E. Jacobsen (Norway), T. Kandiah (UK), M.C. Maniere (France), S. Gizani (Greece, moderator), J. Kühnisch (Germany, moderator).

References

  1. American Academy of Pediatric Dentistry (AAPD). Guideline on use of local anesthesia for pediatric dental patients. Revised 2015. http://www.aapd.org/media/policies_guidelines/g_localanesthesia.pdf. Accessed 30 July 2017.
  2. Arrow P. A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J. 2012;57:325–33.CrossRefPubMedGoogle Scholar
  3. Dougall AJ, Hayes M, Daly B. A systematic review of the use of local analgesia in medically compromised children and adolescents. Eur Arch Paediatr Dent. 2017. doi: 10.1007/s40368-017-0304-x
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  6. General Assembly of the United Nations: The Universal Declaration of Human Rights. UN article 25. http://www.claiminghumanrights.org/udhr_article_25.html. Accessed July 30 2017.
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Copyright information

© European Academy of Paediatric Dentistry 2017

Authors and Affiliations

  • J. Kühnisch
    • 1
    Email author
  • M. Daubländer
    • 2
  • G. Klingberg
    • 3
  • A. Dougall
    • 4
    • 5
  • M. Spyridonos Loizides
    • 6
  • E. Stratigaki
    • 7
  • J. L. Amar
    • 8
  • V. Anttonen
    • 9
    • 10
  • M. Duggal
    • 11
  • S. Gizani
    • 12
  1. 1.Department of Operative Dentistry and Periodontology, University HospitalLudwig-Maximilians University of MunichMunichGermany
  2. 2.Department of Oral SurgeryUniversity Medical Centre MainzMainzGermany
  3. 3.Department of Pediatric Dentistry, Faculty of OdontologyMalmö UniversityMalmöSweden
  4. 4.Department of Child and Public Dental HealthTrinity CollegeDublinRepublic of Ireland
  5. 5.Dublin Dental University HospitalDublinRepublic of Ireland
  6. 6.Private Practice for Paediatric DentistryNicosiaCyprus
  7. 7.Department of Orthodontics and Paediatric DentistryUniversity of BaselBaselSwitzerland
  8. 8.Private Practice for Paediatric DentistryGenevaSwitzerland
  9. 9.Research Unit of Oral Health Sciences, Department of Cariology, Endodontology and Paediatric DentistryUniversity of OuluOuluFinland
  10. 10.MRC of Oulu University and University HospitalOuluFinland
  11. 11.Faculty of DentistryNational University of SingaporeSingaporeSingapore
  12. 12.Department of Paediatric Dentistry, Dental SchoolNational and Kapodistrian University of AthensAthensGreece

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