Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document
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.
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.
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.
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.
KeywordsLocal analgesia Children Adolescents Techniques of administration Adverse events Clinical practice Guideline
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).
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