European Archives of Paediatric Dentistry

, Volume 18, Issue 5, pp 331–343 | Cite as

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

  • A. DougallEmail author
  • M. Hayes
  • B. Daly
Systematic Review



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.


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.


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.


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.


Local anaesthesia Local analgesia Dental Systematic review Medically compromised Child Adolescent 


Authors contribution

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.

Compliance with ethical standards

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.


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Copyright information

© European Academy of Paediatric Dentistry 2017

Authors and Affiliations

  1. 1.Department of Child and Public Dental Health, School of Dental ScienceTrinity CollegeDublinIreland
  2. 2.Dublin Dental University HospitalDublinRepublic of Ireland

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