Dental procedures in children are relatively common and can range from simple fillings and extractions to more invasive procedures and repairs. Understanding how best to care for your kids and keep them comfortable after a dental procedure will make a big difference in how well they (and you!) do.
Managing your child’s pain after any dental procedure is extremely important, and knowing the pain medications to give, when to give them and which holistic therapies can be used will help you support your child’s recovery, while simultaneously minimizing the potential for adverse side effects.
It is also important to understand the measures you can take to help minimize the chance your child will need to undergo a painful dental procedure. As is often the case in healthcare, preventing a problem before it starts is the best way to keep your child happy, healthy and pain-free.
If your child must undergo a dental procedure, the type of pain management required will ultimately depend on the dental procedure performed. For example, if your child has had a simple tooth extraction, filling or other less complex dental procedure, over-the-counter medications such as acetaminophen or ibuprofen will often suffice.
You should avoid aspirin-containing products due to the risk of Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain.
According to the American Academy of Pediatric Dentistry, because inflammation often contributes to post-procedural pain, ibuprofen and other nonsteriodal anti-inflammatory drugs (NSAIDs) are considered the treatment of choice for mild-to-moderate dental pain in kids.
If your child is not able to take NSAIDs due to a bleeding disorder, kidney problems or other contraindications, acetaminophen is the recommended alternative. Just remember to pay close attention to the frequency with which you give acetaminophen, as there would be at least six hours between each dose. It is no longer recommended to give acetaminophen every four hours due to the concerns about acetaminophen toxicity and liver damage.
If your child has more extensive dental work or requires dental surgery as the result of dental trauma, your dentist or oral surgeon might prescribe opioids.
Opioids provide good pain relief for moderate-to-severe pain, but can also have significant side effects, the most common of which is constipation. If an opioid analgesic is prescribed, it is helpful to encourage lots of fluids, high-fiber foods and occasionally a stool softener to prevent constipation.
Opioids can also have more serious side effects, including sedation and respiratory depression. As a result, they are used with caution in pediatric patients. Rather than using an opioid analgesic alone, it is often recommended to combine it with NSAIDs in order to reduce the amount of opioid doses your child will need. Opioids are also only prescribed for a very short duration (usually for only two to three days) in order to limit side effects and the potential for physical dependence.
It is imperative to give all pain medications at the correct dose and frequency. Giving too low a dose (or giving it inconsistently/too infrequently) will result in inadequate pain relief, and giving too high a dose (or giving the dose too often) can result in toxicity and other adverse side effects.
Therefore, check with your child’s dentist or pharmacist to ensure the dose is safe for your child’s weight and age, and write down when you give each dose so that you can accurately track when the next dose is due.
This is especially important when giving more than one type of pain medication. In addition to ensuring safe medication administration, it also allows for a better understanding of your child’s pain and if the current pain management methods are effective or need adjustment.
Most kids will only need to consistently take pain medications for the first two to three days after a dental procedure, after which they can switch to an as-needed basis. The goal is always to stop the pain medications as soon as they are no longer needed.
However, if you find that your child is requiring more pain medication than seems necessary, suddenly experiences an increase in pain or bleeding, becomes lethargic or hard to arouse or develops any adverse side effects to the medications being administered, stop administration immediately and contact your child’s dentist, oral surgeon or primary care provider.
Persistent pain — or pain that is out of context with what is expected — could be a sign of infection or other complications and always warrants follow-up. If your child develops any signs of respiratory distress or difficulty breathing, seek emergency care or call 911 immediately.
In addition to pain medications, there are some holistic alternatives to the management of pain in kids who have had dental procedures. Distraction often works very well with younger children, especially if it involves playing a game or participating in a quiet activity that requires focus on something other than the pain.
According to the Journal of the American Dental Association and the Canadian Dental Association, applying moistened black or green tea bags to the site of a tooth extraction will not only help stop bleeding, but reduce swelling and pain as well. You can also apply cool compresses, ice packs or even a bag of frozen vegetables to the outer jaw and cheek, as well as give your child cool beverages or ice cream to help temporarily numb the surrounding gum line and tissues.
Just be sure not to apply any alcohol-containing pain-relieving gels or creams to the post-operative site, as these will sting and potentially interfere with healing.
Of course no parent wants to see a child in pain, so preventing the need for painful dental procedures is crucial.
In addition to ensuring that your child brushes at least twice a day, flosses daily and avoids excessive exposure to sweets and carbonated beverages, plan to begin regular dental visits when your child is 12 months of age.
You should also discuss fluoride therapy with your child’s dentist as early as possible. Depending on the amount of fluoride in your child’s drinking water, oral fluoride supplements or topical fluoride application may be recommended.
Fluoride is a great preventative measure because it helps strengthen tooth enamel and alters the activity of bacteria in the mouth to prevent cavities. Dental sealants can also be used as a way to minimize the development of cavities in the crevices of the posterior teeth and molars, but these are not a replacement for fluoride and proper dental care.
So begin dental visits early, try to make tooth brushing fun, encourage flossing and follow your dentist’s fluoride recommendations for your child so that the need for painful dental procedures is minimalized, if not all together avoided!
Sheri Carson, MSN, RN, CPN, CPNP, has worked in pediatrics for more than 18 years and is a clinical instructor of pediatrics at the University of Arizona College of Nursing. She stays clinically active by working as a PNP at a local pediatric clinic, serving as a member of the local Child Abuse Review and Education Committee, and supervising medical students as they administer immunizations and conduct sports physicals at their monthly Tot Shots clinics.