Como avaliar a dor sentida por crianças pré-escolares durante os procedimentos odontológicos? revisão de escopo / How to evaluate the pain felt by preschool children during dental procedures? scope review

Introdução: o diagnóstico da dor sentida pela criança é um passo importante para orientar o cirurgião-dentista sobre o uso de técnicas farmacológicas e não farmacológicas que minimizem a sensação desagradável. Objetivo: identificar os instrumentos usados para a avaliação da dor de crianças pré-escolares durante procedimentos odontológicos. Fontes dos dados: busca por artigos foi realizada no PubMed, Scopus, The Cochrane Library e Google Schoolar, em abril/2022. Estudos observacionais e de intervenção que avaliaram a dor de crianças pré- escolares em atendimento odontológico, publicados em português, inglês ou espanhol foram incluídos. Estudos que avaliaram a dor de crianças tratadas sob sedação ou anestesia geral, bem como a dor pós-operatória, foram excluídos. Síntese dos dados: um total de 767 artigos foram identificados; 133 artigos foram lidos integralmente e 62 incluídos. Em 48 estudos, a dor foi avaliada por meio de autorrelato, usando instrumentos como a Wong-Baker FACES Pain Rating Scale e outras escalas de faces como a Faces Pain Scale-Revised e a Faces Pain Scale. Quando a dor foi avaliada a partir do comportamento infantil, foram usadas escalas como a Face, Legs, Activity, Cry, Consolability Scale (FLACC) e a Sound, Eye and Motor scale (SEM). Conclusão: a dor processual das crianças foi avaliada por meio de autorrelato e da observação do seu comportamento. Tanto as escalas de autorrelato quanto as observacionais têm limitações. A combinação dos instrumentos pode ser uma estratégia na avaliação da dor de pré-escolares.

Introduction: the diagnosis of the pain felt by the child is an important step to guide the dentist on the use of pharmacological and non-pharmacological techniques that minimize unpleasant sensation. Objective: to identify the instruments used to assess the pain of preschool children during dental procedures. Sources of Data: search for articles was conducted at PubMed, Scopus, The Cochrane Library and Google Schoolar in April/2022. Observational and interventional studies that evaluated the pain of preschool children in dental care, published in Portuguese, English or Spanish were included. Studies evaluating the pain of children treated under sedation or general anesthesia, as well as postoperative pain, were excluded. Synthesis of data: a total of 767 articles were identified; 133 articles were read in full and 62 included. In 48 studies, pain was evaluated by self-report, using instruments such as the Wong-Baker FACES Pain Rating Scale and other face scales such as the Faces Pain Scale-Revised and the Faces Pain Scale. When pain was evaluated from child behavior, scales such as Face, Legs, Activity, Cry, Consolability Scale (FLACC) and Sound, Eye and Motor scale (SEM) were used. Conclusion: the procedural pain of the children was evaluated by self-report and the observation of their behavior. Both self-report and observational scales have limitations. The combination of the instruments can be a strategy in the evaluation of the pain of preschoolers.

Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial

Abstract Pain due to administration of local anesthetics is the primary reason for patients' fear and anxiety, and various methods are used to minimize it. This study aimed to measure the degree of pain during administration of anesthesia and determine the latency time and duration of pulpal anesthesia using two anesthetic methods in the maxilla. Materials and Methods: A randomized, single-blind, split-mouth clinical trial was conducted with 41 volunteers who required class I restorations in the maxillary first molars. Local anesthesia was administered with a needleless jet injection system (experimental group) or with a carpule syringe (control) using a 30-gauge short needle. The method of anesthesia and laterality of the maxilla were randomized. A pulp electric tester measured the latency time and duration of anesthesia in the second molar. Visual analogue scale (VAS) was used to measure the degree of pain during the anesthetic method. Data were tabulated and then analyzed by a statistician. The t-test was used to analyze the differences between the groups for basal electrical stimulation. Duration of anesthesia and degree of pain were compared using the Mann-Whitney test. A 5% significance level was considered. Results: There was no statistical difference in the basal electrical stimulation threshold (mA) and degree of pain between the two methods of anesthesia (p>0.05). Latency time was 2 minutes for all subjects. The duration of pulpal anesthesia showed no statistical difference (minutes) between the two methods (p<0.001), with a longer duration for the traditional method of anesthesia (median of 40 minutes). Conclusions: The two anesthetics methods did not differ concerning the pain experienced during anesthesia. Latency lasted 2 minutes for all subjects; the traditional infiltration anesthesia resulted in a longer anesthetic duration compared with the needleless jet injection.

Predicting intraoperative pain in emergency endodontic patients: clinical study

Abstract This prospective observational study sought to investigate the incidence of intraoperative pain (IOP) among emergency endodontic patients and to construct an IOP prediction model that includes preoperative pain level (PPL). All patients who underwent emergency endodontic treatment at Gazi University, Ankara, Turkey, during the spring term of 2016 were considered for inclusion in the study. Demographic and clinical variables and PPL were recorded. Local anesthesia was provided to all patients before beginning routine endodontic treatment. IOP was defined as the condition of requiring supplementary anesthesia before the working length was established and exhibiting persistent moderate or severe pain despite supplementary anesthesia. Data from 85% and 15% of 435 patients (178 men, 257 women; mean age: 35 years) were used to develop predictive models by multiple logistic regression analysis and to test external validity of the models, respectively. Two multiple logistic regression models achieved good model fits. Model 1 included age, pulpal diagnosis, and arc (p < 0.05). In addition to these variables, Model 2 included periapical diagnosis and PPL (p < 0.15). Models 1 and 2 showed accuracies of 0.76 and 0.75, sensitivities of 0.74 and 0.77, and specificities of 0.76 and 0.74, respectively for the modeling data (internal validity), and accuracies of 0.82 and 0.80, sensitivities of 0.83 and 0.67, and specificities of 0.81 and 0.81, respectively for the control data (external validity). The IOP incidence was 10.3%. IOP in patients undergoing emergency endodontic treatment can be successfully predicted by using models that account for demographic and clinical variables, including PPL.