Ibuprofen Linked to Lower Pain Following Tooth Extraction in Pediatric Patients

Nabih Raslan

Although poor pain management in pediatric dentistry is considered one of the main hinderances of 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 the pain of injection, extraction, and postoperative pain, in children undergoing primary tooth extraction.

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

Study

Investigators conducted a randomized, placebo-controlled, triple blinded clinical trial of children who needed primary molar extraction by local anesthesia.

In the study, 66 children aged 6 – 8 years were included. Patients were treated at the Department of Pediatric Dentistry between April – June 2019.

Inclusion criteria included cooperative child, positive according to Frankl behavioral rating scale, and healthy child according to American Society of Anesthesiologists with no contraindication to either two analgesics.

The team noted molars selection criteria included unfit for restoration or with abscess exceeding 1/3 of inter radicular area.

Exclusions included non-cooperative children, acute pain, patients taking analgesic within 5 hours of extraction, and those with history of prolonged bleeding, hypersensitivity, or allergic reaction to analgesics. Further, molars with advanced physiological resorption were excluded.

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

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

Investigators assessed pain level using the Wong-Baker faces pain rating scale after injection, extraction, and postoperatively.

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

Results

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

Data show patients who received preemptive analgesics reported significantly less pain compared to the placebo group, after injection, immediately after extraction, and up to 5 hours following extraction.

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

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

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

Further, no differences in median pain scores were found in number and site of teeth extraction, or mean pain scores according to gender. No patients reported any side effects following analgesic treatment.

Conclusion

Following the study, investigator concluded ibuprofen resulted in significantly lower pain scores, immediately after extraction and at 5 hours after extraction, compared to both acetaminophen and placebo.

“The present study showed that preemptive analgesic administration may be considered a routine and rational pain management strategy in primary tooth extraction procedures in children,” investigators wrote.

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