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A systematic review of the use of local analgesia in medically compromised children and adolescents

  • Systematic Review
  • Published:
European Archives of Paediatric Dentistry Aims and scope Submit manuscript

Abstract

Aim

To determine if the use of routine techniques and agents for topical and injectable dental local analgesia (LA) are safe for use in medically compromised children and adolescents.

Method

Medline, Embase and Cochrane Oral Health Group’s trials register, were searched electronically, supplemented by hand searching of relevant journals.

Selection criteria

RCTs, cohort studies, case-control studies, observational studies, case series, case reports, evidence based guidelines reporting on children and adolescents aged 18 years or younger with one/more pre-designated medical condition, being administered topical and/or injectable local analgesic for dental procedures using standard techniques of delivery. Outcomes were presence of adverse events which were attributable directly or indirectly to the underlying medical condition.

Results

N = 71 studies were retrieved but only three observational studies, one case series, two case reports and four evidence based guidelines met the criteria for inclusion. A disparate set of medical conditions were reported upon and sparse guidance given in these areas. Thirty-nine review articles and consensus documents provided little or no clinical data to support their recommendations.

Conclusions

There are insufficient high quality data reporting on the use of topical and local analgesia to medically compromised children and adolescents. Apart from a known allergy to local analgesia or one of the agents, there appears to be very few absolute or relative contra-indications to the use of local analgesia in children and adolescents based on medical history. There is an urgent need for high quality studies wherever possible and appropriate, in order to improve and inform the evidence-base in this cohort.

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Author information

Authors and Affiliations

  1. Department of Child and Public Dental Health, School of Dental Science, Trinity College, Dublin, Ireland

    A. Dougall & B. Daly

  2. Dublin Dental University Hospital, Lincoln Place, Dublin, Republic of Ireland

    A. Dougall, M. Hayes & B. Daly

Authors
  1. A. Dougall
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  2. M. Hayes
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  3. B. Daly
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Contributions

AD conceived the ideas; MH performed the literature search; AD/MH/BD analysed the data. AD led the writing; and all authors participated in finalizing the manuscript.

Corresponding author

Correspondence to A. Dougall.

Ethics declarations

The study was funded in part by European Association of Paediatric Dentistry as part of their guideline development process.

Informed consent

This article does not contain any studies with human participants and therefore did not require informed consent or ethical approval.

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

This research did not involving human participants and/or animals.

Appendices

Appendix (1) Example of Medline search terms and table of results summary

Search terms

  1. 1.

    Local anesth* [tiab] AND dent* [tiab] AND (child* OR pediatr* OR adolesc*)

  2. 2.

    Diseases NOT ‘animal diseases’ (MeSH term)

  3. 3.

    ‘Drug related side effects and adverse reactions’ OR ‘safety’ OR ‘risk’ OR ‘side effect’ OR ‘adverse effect’ (MeSH term)

  4. 4.

    Child* OR Infant OR adolescen* OR pediatric* (MeSH term)

  5. 5.

    Porphyria OR ‘congenital heart disease’ OR ‘liver disease’ OR ‘hepatic disease’ OR ‘renal disease’ OR ‘kidney disease’ OR ‘bleeding disorder’ OR ‘platelet disorder’ OR ‘coagulopathy’ OR ‘bleeding diathesis’ OR haemophilia OR asthma OR hypertension OR pregnancy OR ‘Inborn error of metabolism’ OR ‘diabetes mellitus’ OR ‘card* disease’ OR angioedema OR ‘Fibrodysplasia ossificans progressiva’ OR ‘Addiction’ OR ‘Substance Abuse’ OR ‘Heaemaglobinopathies’ OR ‘Immunological disease’ OR ‘Arrythmias’ OR ‘Thyroid disease’ OR ‘Epilepsy’ OR “Haemaglobinopathies” OR “Haematological Disease”

  6. 6.

    #1 AND #2

  7. 7.

    #1 AND #2 AND #3

  8. 8.

    #1 AND #2 AND #3 AND #4

  9. 9.

    #1 AND #2 AND #3 AND #4 AND #5

Search terms

Number of search results

10. Local anesth* [tiab] AND dent* [tiab] AND (child* OR pediatr* OR adolesc*)

188

11. Diseases NOT ‘animal diseases’ (MeSH term)

386

12. ‘Drug related side effects and adverse reactions’ OR ‘safety’ OR ‘risk’ OR ‘side effect’ OR ‘adverse effect’

710

13. Child* OR Infant OR adolescen* OR pediatric* (MeSH term)

3,875,849

14. Porphyria OR ‘congenital heart disease’ OR ‘liver disease’ OR ‘hepatic disease’ OR ‘renal disease’ OR ‘kidney disease’ OR ‘bleeding disorder’ OR ‘platelet disorder’ OR ‘coagulopathy’ OR ‘bleeding diathesis’ OR haemophilia OR asthma OR hypertension OR pregnancy OR ‘Inborn error of metabolism’ OR ‘diabetes mellitus’ OR ‘cardio* disease’ OR ‘heart disease’ OR angioedema OR ‘Fibrodysplasia ossificans progressiva’ OR ‘Eating disorder’ OR ‘Mental Health’ OR ‘Addiction’ OR ‘Substance Abuse’ OR ‘Hemoglobinopathies’ OR ‘Immunological disease’ OR ‘Arrythmias’ OR ‘Thyroid disease’ OR ‘Epilepsy’

18

6. #1 AND #2

11

7. #1 AND #2 AND #3 AND #4

1

Appendix (2) List of 61 studies excluded from meta-analysis and narrative review

Reference #

Author, year of publication

Reason for exclusion

1

Anderson et al. (2013)

Review article; not specific to paediatric/adolescent population

7

Arhakis et al. (2012)

Not medically compromised children

15

Bahl et al. (2004)

Review article; adult population

10

Bayat et al. (2011)

Case report not medically compromised

37

Boynes et al. (2013)

Not medically compromised patients

40

Bracco et al. (1990)

Review article

67

Brewer et al. (2005)

Review article (adults only)

5

Brown and Welbury (2002)

Review article

14

Caceres et al. (2008)

Review article; not specific to paediatric/adolescent population

54

Carroll et al. (1981)

Review article

43

Cuestas et al. (1989)

Review article

69

Chen et al. (1998)

Review article

15

Chicka et al. (2012)

Not specific to medically compromised population

71

Chin KL et al. (2003)

Healthy patients; prospepctive RCT

17

Chiu CY et al. (2004)

Case report not medically compromied

18

De Morais et al. (2012)

Adult patients

47

Di Jeso et al. (1987)

Healthy patients; review article

58

Del Papa TA et al. (1947)

Review article; not medically compromised population

52

Ferro A et al. (1984)

Review article; not medically compromised patients;.

38

Frabetti et al. (1992)

Adult population

33

Frankenmolen et al. (1996)

Review article

70

Friedlander AH et al. (1993)

Review article

4

Gutenberg LL et al. (2013)

Not medically compromised population

23

Haas DA et al. (2002)

Review article; not specific to medically compromised population

58

Hayden J et al. (1965)

Review article; not specific to medically compromised

35

Hersh EV et al. (2002)

Review article; not specific to medically compromised patients

57

Hewson et al. (2011b)

Review article not sspecific to paediatric populations

49

Hirota Y et al. (1986)

Adult population; uncontrolled trial

36

Hodgson TA et al. (1993)

Non-randomised prospective trial; not medically compromised patients

42

Jacquelin LF (1986)

Review article; not specific for medically compromised patients

32

Jurevic, R., 1998

Healthy subjects

64

James and Hift 2000

Review

24

Kaufman et al. (2000)

Healthy subjects

16

Kohase et al. (2004)

Case report, adult

51

Kuster et al. (1984)

Healthy subjects

60

Lampshire et al. (1947)

Review article; not specific for medically compromised subjects

12

Laragnoit et al. (2009)

Adult patients

29

Leyman et al. (1999)

Review article; adult patients

28

Lustig et al. (1999)

Uncontrolled trial; adult subjects

26

Malamed (2000)

Healthy subjects

25

Malamed (2001)

Healthy subjects

27

Malamed (2000)

Adult patients

50

Milam (1984)

Adult patients; review article

39

Montebugnoli et al. (1990)

Review article

45

Moore et al. (1988)

Review; not specific to medically compromised patients

3

Olufunke (2013)

Case report

56

Peedikayil et al. (2013)

Review article; not specific for medically compromised patients

18

Rosenburg et al. (2004)

Review article; not medically compromised patients

48

Rosa et al. (1986)

Review article

19

Sapir et al. (2003)

Review article

20

Shapira et al. (1987)

Case report; not medically compromised patients

68

Shapira et al. (2003)

Review article

22

Shojaei et al. (2002)

Review article; Adult patients

2

Scarparo et al. (2014)

Adult patients

56

Tarsitano et al. (1965)

Review article

55

Tartaro (1977)

Adult patients

1

Von Arx (2014)

Review article; adult patients

11

Wahl (2010)

Review article; not medically compromised patients

53

West et al. (1983)

Not medically compromised patients

41

Wright (1989)

Not medically compromised patients

31

Yan (1998)

Case report not medically compromised

Appendix (3) List of studies included in narrative view

List of 10 studies included in narrative review

Reference #

Author, year of publication

13

AAPD, Council on Clinical Affairs 2015 (guidance)

61

Brewer et al. 2003 (guidance)

30

Deybach et al. 2010 (guidance)

46

Hewson et al. 2011 (a) (observational study)

66

Inada et al. 2005 (case report)

34

Luchetti et al. 1996 (observational)

63

McGovern et al. 2007 (case series)

44

Minasian, A, et al. 1998 (observational)

65

Noguchi et al. 2006 (case report)

21

Srivastava et al. 2013 (guideline)

Reference list of 71 full text publications searched

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Dougall, A., Hayes, M. & Daly, B. A systematic review of the use of local analgesia in medically compromised children and adolescents. Eur Arch Paediatr Dent 18, 331–343 (2017). https://doi.org/10.1007/s40368-017-0304-x

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