An interesting article titled “Provider perspectives on pain management practices and needs in pediatric dentistry,” written by Melissa Pielech and Caroline Sawicki appears in the Journal of the American Dental Association (published October 25, 2023). The article sought to assess the pediatric dentists use of and attitudes toward evidence-based pain management strategies.
To better understand dental pain management in children, the authors surveyed 625 pediatric dentists and residents. The dentists and residents were sent a 27-item online survey to assess attitudes about evidence-based pain management, tools, and practices and opinions regarding areas for improving pain management. Among the respondents, 89% were dentists and 11% were residents.
The majority of respondents thought that pain management is an important aspect of clinical care in pediatric dentistry and believe it is necessary to improve pain management practices. Dentists and residents said that they spend most of the time facilitating pain management during procedures and 73.2% said they feel this is an adequate amount of time. About 74% of repondents said that pain management is extremely important in pediatric dentistry while 23% said it was very important. Nearly 63% of respondents rated managing pain as a big (20%) or moderate (43%) problem in their practices. In addition, 88% of respondents rated dental anxiety or fear as a big (46%) or moderate (42%) problem.
Dentists and residents reported using a variety of nonpharmacologic strategies — including tell-show-do techniques, desensitization to the dental setting, and pharmacologic pain management strategies. About 89% of respondents used topical and local anesthesia most to manage pain. About 92% of clinicians said they did not not use any opioids. The top areas for improving pain management were developing tools for caregivers and provider resources on nonpharmacologic pain management.
Image by Jenny Friedrichs from Pixabay
Some limitations of the study included some several respondents wrote laughing gas in the survey and thus may not have remembered or considered nitrous oxide as a basic behavior guidance technique. In the future observational and randomized controlled studies should be conducted to determine the effectiveness of pharmacologic and nonpharmacologic pain management and any underlying patient and provider differences or impacts.