A systematic review and meta-analysis of analgesia protocols in pediatric dental procedures: current evidence and clinical implications
Authors
Mirko Martelli, Michele Miranda, Stefano Attanasio, Giulia Stelitano, Marco Gargari, Lorenzo Italia, Cristal Isabell Minciarelli, Alessandro D'aurelio, Alessio Rosa
Abstract
Background : Effective pain management is a cornerstone of pediatric dental care, as procedural pain and anxiety can substantially affect both the immediate success of treatment and children’s long-term oral health behaviors. A wide range of pharmacological and non-pharmacological analgesia protocols have been proposed to ensure safe, effective, and patient-centered care in pediatric dentistry. Objectives: This systematic review and meta-analysis aimed to synthesize current evidence on the effectiveness of analgesia protocols used in pediatric dental procedures, with particular attention to both pharmacological and behavioral interventions. Methods: A systematic search of PubMed, Scopus, Web of Science, and EMBASE was conducted in accordance with PRISMA guidelines. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing different analgesia protocols in children (≤18 years) undergoing dental treatment were included. Two independent reviewers assessed study eligibility, extracted data, and evaluated risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. Meta-analyses were performed using a random-effects model, calculating pooled standardized mean differences (SMDs) for pain and anxiety outcomes. Results: Five studies involving a total of 1,260 pediatric patients met the inclusion criteria. Multimodal analgesia protocols, combining pharmacological and behavioral approaches, were associated with a significant reduction in intraoperative pain (SMD = −0.72; 95% CI: −0.95 to −0.50; p < 0.0001), with moderate heterogeneity (I² = 48%). Anxiety scores were also significantly reduced (SMD = −0.68; 95% CI: −0.90 to −0.46; p < 0.0001). Conclusions: The current evidence base is limited, consisting of only five moderately heterogeneous studies. Although multimodal analgesia appears promising, results should be interpreted with caution and do not support prescriptive clinical recommendations. Larger, high-quality trials with standardized outcomes and longer follow-up are required to inform evidence-based guidelines.
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