Global and regional estimates of dental pain among children and adolescents-systematic review and meta-analysis

Dental pain in Brazilian preschool children: association with the severity of dental caries and impact on oral health-related quality of life

PURPOSE

This study aimed to verify the association between dental pain and severity of dental caries (caries morbidity stages) and the impact on oral health-related quality of life (OHRQoL) in preschool children.

METHODS

A cross-sectional study with 199 children (2-5 years old) enrolled at preschools in Capão do Leão-RS, Brazil. The self-report of mothers of children with a history of dental pain in the last 6 months and perception of their child's OHRQoL (ECOHIS) were obtained through a structured questionnaire. This questionnaire also collected independent variables. Children's oral examination was performed using the CAST instrument to determine caries morbidity stage. Crude and adjusted Poisson regression analysis was performed.

RESULTS

The prevalence of dental pain was 14.57%. The chance of the occurrence of dental pain was higher among children diagnosed in morbidity [Prevalence ratio-PR: 5.29 (95% confidence interval-95% CI 1.91-14.61); p = 0.001] and severe morbidity [RP = 6.12 (95 CI% 2.25-16.64); p < 0.001] stages. Children with dental pain presented higher scores in the total ECOHIS [rate ratio = 7.11 (95% CI 4.55-11.09); p < 0.001] and in all of the domains of this instrument. Furthermore, children with a history of dental trauma [PR = 2.41 (95% CI 1.15-5.04); p < 0.001] and those whose reason for last visit to the dental office was for restorative/endodontic/extraction treatment [PR = 1.29 (95% CI 1.01-6.19); p = 0.049] had a higher prevalence of dental pain.

CONCLUSION

A substantial prevalence of dental pain in the last 6 months and negative impact on children's OHRQoL was identified in this sample. Children diagnosed with carious dentin lesions and abscess and fistula were more likely to have dental pain.

Parental Reports of Children's Dental Pain Experience and Associated Factors among Brazilian Children

Exploring children's dental pain experiences helps to develop healthcare policies for improving oral health and quality of life. A cross-sectional study involved 300 parents/caregivers of four- to seven-year-old children using snowball sampling. Parents/caregivers self-completed an online questionnaire on sociodemographic characteristics, parenting styles, their child's oral hygiene practices, free sugar consumption, and dental history. The questionnaire was created using Google Forms and was disseminated to parents/caregivers via E-mail and/or WhatsApp©. Descriptive and Poisson regression analyses were performed (p < 0.05). Children's dental pain experience was reported by 20.3% of the parents. The authoritative parenting style was predominant. The child's mean age at the first consumption of sugar was 1.38 (±0.64) years, and 40.3% of the children had high-free sugar consumption. The mean age for the first dental appointment was 2.26 (±1.31) years, and 24.3% of the children never went to a dental appointment. The prevalence of dental pain experience was higher in children who attended their first dental appointment later (PR: 1.02; CI 95%: 1.01-1.03) and among those with high-free sugar consumption (PR: 1.90; CI 95%: 1.21-3.00). High sugar consumption and delay in the first dental appointment may increase the likelihood that children will experience dental pain.

The Association between Dental Pain and Psychological Symptoms: Evidence from a Population-Based Study in Indonesia

OBJECTIVES

 This study aimed to determine the prevalence and distribution of dental pain and its association with psychological symptoms: stress and depression.

MATERIALS AND METHODS

 The 2014 Indonesia Family Life Survey data were used for the abovementioned purposes. Records of self-reported dental pain and stress as well as the occurrence of depression based on the 10-item Center for Epidemiologic Studies-Depression scale were analyzed. Multivariable ordinal regression models were fitted to test the hypothesized associations between dental pain and each of the psychological symptoms, controlling for age, sex, education, wealth, and religiosity.

RESULTS

 Dental pain prevalence among Indonesian population was approximately 15%. The adjusted odds ratios (ORs) from the ordinal regression models indicated that dental pain was related to the increase of the stress and depression level (OR: 1.31, 95% confidence interval [CI]: 1.14-1.49 and OR: 1.59, 95% CI: 1.41-1.79, respectively). Higher education, higher wealth, and being male are risk factors for stress. However, higher wealth and being male are protective factors for depression. Furthermore, higher religious level was a protective factor for both stress and depression.

CONCLUSION

 Dental pain was associated with a higher level of stress and a higher score of depression, even after being adjusted with age, sex, education, wealth, and religiosity.

Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years

Introduction

Local anesthetics are used to alleviate pain, but the prick of the injection delivering anesthesia is known to cause anxiety and pain that affect dental treatment. The most difficult aspect of pediatric dentistry is minimizing discomfort while the intraoral local anesthetic is administered. This pain has been treated using physical, psychological, pharmacological, and combinations of these approaches. Recently, the idea of vibration, which is based on the gates control theory, has gained popularity as a way to reduce discomfort while local anesthesia (LA) is being administered.

Aim

The aim of this trial was to evaluate the efficacy of mucosal vibrators in children aged 6-10 years to alleviate pain associated with LA administration.

Materials and methods

A total of 60 patients aged 6-10 years requiring inferior alveolar nerve block were enrolled for this randomized, single-blind clinical trial. In group I, before and during LA administration, the customized mucosal vibrator was placed at the injection site. In group II, the topical local anesthetic gel was applied to the injection site prior to the administration of LA. Then, the local anesthetic solution was deposited using a disposable syringe needle on both groups. The pain was evaluated using the physiological scale (pulse rate and oxygen saturation), the subjective scale (Wong-Baker scale), and the objective scale [Face, Legs, Activity, Cry, Consolability (FLACC) scale] by an experienced assistant who was unaware of the procedure.

Results

A customized mucosal vibrator along with local anesthetic injections resulted in significantly less pain (p = 0.001*) when compared with the injections with topical anesthetic gel.

Conclusion

The results show that the customized mucosal vibrator is an effective and inexpensive means to reduce pain during LA administration.

How to cite this article

Tatiya N, Singh C, Surana P, et al. Evaluation of the Efficacy of a Customized Mucosal Vibrator in Alleviating Pain Perception Associated with Local Anesthesia Administration in Children Aged 6-10 Years. Int J Clin Pediatr Dent 2024;17(4):404-409.

A novel questionnaire to perform teletriage of dental emergencies in children: A before-and-after study nested within a randomized clinical trial

Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student's t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson's regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.

Provider perspectives on pain management practices and needs in pediatric dentistry

BACKGROUND

Dental pain is common yet understudied and often undertreated in youth. To improve pain management in pediatric dentistry, it is necessary to understand practices and perceptions among providers. The authors assessed pediatric dentists' use of and attitudes toward evidence-based pain management (EBPM) strategies.

METHODS

The authors used a 27-item online survey to assess attitudes about EBPM, pain management and assessment practices, tools for disseminating knowledge about EBPM, and opinions regarding priority areas for improving pain management. Descriptive statistics were used to summarize findings; open-ended items were analyzed thematically.

RESULTS

Participants (N = 625) were pediatric dentists (89.2%) and pediatric dentistry residents (10.8%). Most respondents agreed that pain management is an important aspect of clinical care and thought that improvements in pain management practices are needed. Providers reported spending the most time facilitating pain management during the procedure (compared with before or after), and 73.2% said they feel this is an adequate amount of time. Distraction, tell-show-do techniques, and supportive language were the most used nonpharmacologic pain management strategies, and providers' observational approaches were used most frequently for pain assessment. Top priority areas for improving pain management were reported as developing tools for caregivers and provider resources on nonpharmacologic pain management (ie, continuing education courses).

CONCLUSIONS

Providers reported high use of EBPM strategies, low use of validated pain assessment tools, and a particular interest for professional development opportunities and patient resources focused on nonpharmacologic pain management.

PRACTICAL IMPLICATIONS

Findings from this survey can inform dissemination and implementation of science efforts to improve pain management in pediatric dentistry.

Sex hormones associated with temporomandibular pain on palpation in male adolescents-Results of the epidemiologic LIFE child study

OBJECTIVE

This study aimed to investigate whether the sex steroid precursor hormone dehydroepiandrosterone sulphate (DHEA-S), sex hormone-binding globulin (SHBG) and testosterone (TT) are associated with temporomandibular (TM) pain on palpation in male adolescents.

METHODS

Out of the LIFE Child study dataset containing 1022 children and adolescents aged 10-18 years (496 males, 48.5%), we used a subsample of 273 male adolescents (mean age: 13.8 ± 2.3 years) in advanced pubertal development (PD) to analyse the association between hormones and TM pain. The Tanner scale was applied to describe the stage of PD. Pain on palpation of the temporalis and masseter muscles and the TM joints (palpation pain) was assessed using the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Serum levels of sex hormones (DHEA-S, SHBG and TT) were determined using standardised laboratory analyses. Free TT was estimated from the ratio between TT and SHBG (free androgen index[FAI]). We calculated the risk of perceived positive palpation pain for male participants as a function of hormone levels (DHEA-S, FAI) taking into account age and body mass index (BMI).

RESULTS

Among more developed (Tanner stage 4-5) male adolescents, 22.7% (n = 62) reported palpation pain in the TM region. In these participants, FAI levels were approximately half that of individuals without such pain (p < .01). DHEA-S levels were about 30% lower in the pain group (p < .01). In multivariable regression analyses, the odds ratio (OR) for pain on palpation decreased to 0.75 (95% confidence interval [CI]: 0.57-0.98) per 10 units of FAI level compared to those without pain, after controlling for the effects of age and adjusted BMI. We observed the same effect for this subgroup per unit of DHEA-S serum level (OR = 0.71; 95% CI: 0.53-0.94).

CONCLUSION

At subclinical lower levels of serum free TT and DHEA-S, male adolescents are more likely to report pain on standardised palpation of the masticatory muscles and/or TM joints. This finding supports the hypothesis that sex hormones may influence pain reporting.

Prescription patterns of analgesics for oral conditions in india - Analysis of large medical audit data of outpatients in India's private healthcare sector

Background

Analgesic use needs to be regulated due to its adverse effects. This study aimed to analyse the change in prescription rates and patterns of the analgesics prescribed for various oral conditions and to analyse their trends across different age groups and gender to promote rational prescription of drugs and eventually influence regulatory policies.

Methods

Secondary analysis was conducted on medical audit data collected from the private health sector in India. The prescription rate per 1000 persons per year was calculated from May 2013 to April 2016 using the mean projected population (PP) of India. Cross-tabulations were conducted to analyse the prescription rate and their changes across different age groups, gender and oral conditions.

Findings

The mean analgesic prescription rate was highest among the 20-40 age group, and the highest increase was noted in 'non-steroidal anti-inflammatory drug (NSAID) combinations' (3.56 per 1000 persons per year) from May 2013 to April 2016. The 'NSAID combinations' group was also the most prescribed medication across all the oral conditions, with 'diseases of hard tissues' having the highest prescription rate (41.4 and 45.6 per 1000 persons per year, respectively, for 2013-14 and 2015-16).

Interpretation

The results indicate an overall increase in the analgesic prescription rate, especially 'NSAID combinations' for each dental disease and age group, a finding that is hard to explain. Due to the lack of prescription guidelines in India, it is difficult to assess whether these analgesics were prescribed rationally or not.

Effect of COVID-19 on dental care for children during the post-pandemic era in Ghana: A concern for policymaking

The impacts of COVID-19 have been felt globally, especially in the delivery of healthcare services such as dental care, although the incidence in Africa is comparatively low. This review article aims to explore the COVID-19 pandemic lockdown and its impact on dental care for children in Ghana. Some dental facilities in Ghana have been experiencing multiple challenges in service delivery, and the ongoing COVID-19 pandemic has aggravated the situation. The COVID-19 pandemic has interrupted all dental care in many parts of Ghana due to its impact on food insecurity, economic breakdown, depression, shortage of essential instrument supplies, inadequate health workers, and poor infection control practices, which present the main risks to dental care. Furthermore, the shutting of dental departments due to the COVID-19 lockdown has restricted the accessibility and utilization of dental services, especially for children. Hence, to avoid further and future pandemics and their impacts on dental care, there is a need to address the implications identified and prepare for the delivery of suitable dental healthcare in Ghana.

Morphology of the occlusal surface of primary molars as a risk factor for caries

Aims

Impact of primary molars is a significant problem for children with early caries, as they are the ones that predominate in the structure of damage to primary teeth. The goal of our study was to investigate the peculiarities of the primary molars occlusal surfaces with the study of their types and possibilities of caries occurrence in them.

Methods

To study the odontoglyphics of primary molars, a clinical preventive dental examination of 335 children of preschool institutions in the city of Poltava and Poltava region was conducted with the written consent of their parents. As a part of this examination, the occlusal surface of primary molars was studied according to the classic dental examination method with the examination card of each examined child being filled in. After a detailed study of odontoglyphic patterns of occlusal surfaces, photoprotocoling was carried out. A total of 2484 primary molars were examined: 622 maxillary first molars, 634 maxillary second molars, 608 mandibular first molars, and 620 mandibular second molars.

Results

We found that both maxillary and mandibular primary molars which have a complex relief of the occlusal surface are most often affected by caries.

Conclusions

The obtained data indicate that the primary molars of the upper and lower jaw, which have a complex pattern of the chewing surface, are most often affected. However, there is a need for preventive measures in children with such types of structure of the chewing surface.

Impact of the use of dental services on dental pain according to adolescents' skin colour: a 10-year cohort

OBJECTIVE

Evaluate the association of the interaction between the use of dental services and the skin colour on the occurrence of dental pain over time.

MATERIAL AND METHODS

This study is a cohort with 10 years of follow-up, started in 2010 with a sample of 639 preschool children (1-5 years old). The use of dental services, race and the presence of dental pain were self-reported by the individuals according to predefined criteria. Multilevel logistic regression analysis was performed to assess the interaction between skin colour and use of dental services in the occurrence of dental pain over time.

RESULTS

About 449 and 429 were reassessed in 2017 and 2020, respectively. The occurrence of dental pain across the cohort was 60.7%. Caucasian individuals who used dental services throughout the cohort had a 51% lower chance of having a dental pain than those who used dental services but were non-white (OR 0.49; 95% IC 0.27-0.90).

CONCLUSION

There was a racial inequity in the occurrence of dental pain among individuals who managed to make use of dental services throughout the follow-ups.

CLINICAL RELEVANCE

The differences found should serve as a warning to the way how individuals with different characteristics are treated and must be used to combat this inequity. Individuals should receive resolute and personalized treatments according to their clinical condition and not according to their socioeconomic characteristics.

Fewer Children in Families Associated with Lower Odds of Early Childhood Caries: A Sample from Three Countries

Childhood caries experience is influenced by family characteristics and oral health practices in the context of many social-commercial determinants. The aim of this study was to explore the relationship between families' number of children, oral health practices and child caries experience in a convenience sample of 1374 children aged 6 months through 6 years and their families from Ecuador, Nepal, and Vietnam. Data were collected by mother interviews and child dental exams. Multivariate logistic and Zero-Inflated-Poisson regression analyses assessed associations between number of children, oral health practices and decayed, missing or filled teeth (dmft). Families had a mean of 2.2 children (range 1-12); 72% of children had tooth decay, with mean dmft of 5.4. Adjusting for child age, sex, and urban/rural location, a greater number of children in the family was associated with significantly less likelihood of unhealthy bottle feeding practices, having a toothbrush/toothpaste and parent helping child brush, and being cavity-free; higher number of dmft, and greater likelihood of having a dental visit. Early childhood oral health promotion should include focus on oral hygiene and healthy feeding-particularly breastfeeding and healthy bottle feeding practices-as well as access to family planning services and support for childcare.

Prevalence of toothache and associated factors in children and adolescents: a systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to determine the pooled prevalence of toothache in children and adolescents and to verify its association with sociodemographic characteristics and dental caries experience.

MATERIAL AND METHODS

Six main and three grey literature databases were searched in February 2021. Observational studies that assessed the prevalence of toothache and associated factors were included. The methodological quality of the studies was evaluated following the guidelines by Fowkes and Fulton. Proportion and association meta-analyses were performed in MedCalc and Revman software, respectively. The certainty of the evidence was determined with the GRADE approach.

RESULTS

Seventy-one studies met the inclusion criteria. Thirty-two presented high methodological quality and a low risk of bias. The overall pooled prevalence of toothache in children and adolescents was 36.2% (95%CI: 33.0-39.42; I²: 99.72%; P < 0.001). Females (OR: 1.17; 95%CI: 1.08-1.26; I²: 91%; P < 0.001) and children and adolescents whose caregivers had ≤ 8 years of schooling (OR: 1.42; 95%CI: 1.30-1.56; I²: 77%; P < 0.001) presented the higher chance of reporting toothache. Dental caries experience increased the chance of reporting toothache in 3.49 times (95%CI: 2.70-4.51; I²: 92%; P < 0.001). The certainty of the evidence was very low.

CONCLUSIONS

The overall pooled prevalence of toothache was considered high. Sociodemographic characteristics (sex and caregivers' educational level) and previous dental caries experience were significantly associated with toothache reports.

CLINICAL RELEVANCE

Toothache is still a recurrent issue in many countries. Thus, it is essential to understand its possible associated factors to reduce the occurrence of new episodes.

Local Dental Emergencies and Mitigation Strategies Adopted by Private Dental Practitioners of South India during COVID-19 Shelter in Place Warning - Multi-Centric Online Survey

Objective:

To evaluate the common dental emergencies reported to dental practitioners and to compare the mitigation strategies implemented during the Shelter-In-Place (SIP) warning with dental practitioners’ age and sex.

Methods:

We conducted a cross-sectional online survey among the dental practitioners of south India during the period of COVID-19 SIP warning. An initial pool of items was prepared to capture the mitigation strategies in managing local dental emergencies. A structured questionnaire was then prepared in English based on the inputs of four expert dentist panel. Age and sex of the practitioners were also recorded.

Results:

The mean age of the dental practitioners was 37.11(range: 23 - 63) years.Of 159 dental practitioners that responded to survey, 90 were male. Most dental practitioners responded that they were contacted through a phone call (n=140) and WhatsApp messaging (n=108). The common dental emergencies reported were tooth pain (100%), swelling (91.7%), a decayed tooth (81.3%), and gum pain (78.6%). A higher number of male than female dental practitioners had “scheduled the treatment immediately” (OR=3.45; P=0.002) after adjusting for age.

Conclusion:

The most common dental emergencies during COVID-19 SIP were tooth pain, swelling, decayed teeth, and gum pain. Males and older dental practitioners scheduled appointments immediately.

Prevalence of toothache in Chinese adults aged 65 years and above

OBJECTIVES

To investigate the prevalence of toothache and its risk indicators in the older Chinese population.

METHODS

National cross-sectional survey data on 25 048 Chinese people ≥65 years in 2011, 2014 and 2018 survey year were analysed and then pooled. Chi-square test was used to examine the differences in prevalence among specific subgroups. Multivariate modified Poisson regression analyses with robust error variances were used to detect related factors and prevalence ratios (PR) were calculated.

RESULTS

The prevalence of toothache was 16.3% (95% CI: 15.5%-17.1%), 12.8% (95% CI: 12.0%-13.7%) and 16.0% (95% CI: 15.3%-16.7%) in years 2011, 2014 and 2018. In the pooled multivariate Poisson regression model, factors associated with toothache were female (PR: 1.27, 95% CI: 1.18-1.37), younger age (PR: 1.84, 95% CI: 1.63-2.09), currently married and living with spouse (PR: 1.08, 95% CI: 1.01-1.15), current living in urban area (PR:1.12, 95% CI: 1.06-1.20), enough financial support (PR: 0.69, 95% CI: 0.65-0.74), having chronic disease (PR: 1.46, 95% CI: 1.35, 1.57), higher sugar intake (PR: 1.10, 95% CI: 1.03-1.17), salty flavour (PR:1.15, 95% CI: 1.07-1.23), smoking (PR: 1.14, 95% CI:1.06-1.23) or drinking (PR: 1.17, 95% CI: 1.09-1.25), with denture (PR: 1.15, 95% CI: 1.08-1.22) and higher toothbrushing frequency (PR: 1.25-1.50).

CONCLUSIONS

More than one in ten older Chinese population had toothache, and it was related to age, gender, socioeconomic status, behaviour and oral health status. Lifestyle interventions should be taken to avoid the occurrence of the toothache.