New pain management guideline from ADA recommends NSAIDs, acetaminophen for paediatric patients

The new guideline aims to help prevent unnecessary prescribing of medications with abuse potential, including opioids (Image: American Dental Association)

A new clinical practice guideline for dental pain management for paediatric patients has been released by the American Dental Association (ADA), which recommends acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen as first-line treatments for managing short-term dental pain in children under age 12.

A guideline panel determined that, when used as directed, acetaminophen alone, NSAIDs alone or acetaminophen in combination with NSAIDS can effectively manage a child’s pain after a tooth extraction or during a toothache when dental care is not immediately available.

The new guideline which was developed by a group of researchers and methodologists from — the American Dental Association Science & Research Institute (ADASRI), the University of Pittsburgh School of Dental Medicine, the Center for Integrative Global Oral Health at the University of Pennsylvania School of Dental Medicine, McMaster University and the Art of Democracy — has been endorsed by the American Dental Association.

The guideline evaluated doses of acetaminophen and NSAIDs that may differ from the dosing printed on the over-the-counter packages of these medications. When acetaminophen or NSAIDs are administered as directed by a dentist or other health care provider, the risk of harm to children from either medication is low, according to the guideline.

Guideline senior author Dr Paul Moore, DMD, PhD, MPH, said the recommendations align with previous guidance from the US Food and Drug Administration (FDA), which contraindicated the use of codeine and tramadol in children under age 12 in 2017.

“While prescribing opioids to children has become less frequent overall, this guideline ensures that both dentists and parents have evidence-based recommendations to determine the most appropriate treatment for dental pain,” said Dr Moore. “Parents and caregivers can take comfort that widely available medications that have no abuse potential, such as acetaminophen or ibuprofen, are safe and effective for helping their children find relief from short-term dental pain.”

“This clinical prescribing guideline is a critical step in supporting appropriate treatment of paediatric acute dental pain through the use of acetaminophen and NSAIDs,” said Patrizia Cavazzoni, MD, director of the FDA Center for Drug Evaluation and Research. “Not only will this advice allow for better treatment of this kind of pain, but it will help prevent unnecessary prescribing of medications with abuse potential, including opioids.”

In 2020, the FDA awarded the University of Pittsburgh and ADASRI a three-year US$1.5 million grant to develop a clinical practice guideline for the management of acute pain in dentistry in children, adolescents and adults.

The guideline along with other recommendations was published in the September issue of The Journal of the ADA. It is the first of two guidelines on acute dental pain management, where the second set of recommendations for adolescents and adults is in development.