Is pain during pediatric dental sedation associated with children’s pre-operative characteristics? An exploratory study
Dor durante sedação em odontopediatria associa-se a características pré-operatórias da criança? Estudo exploratório
Mendonça, Jordanna Guedes Amorim; Daher, Anelise; Corrêa-Faria, Patrícia; Costa, Luciane Rezende
Abstract
Introduction: Little is known about the factors associated with the pain of children in dental treatment under conscious sedation. Objective: To investigate the association between preoperative characteristics and pain during pediatric dental treatment under sedation. Material and method: This exploratory study was conducted with 27 children in restorative treatment under sedation. Information on age, sex and experience of the children with previous dental treatment was obtained through interviews with parents. Oral health status, determined from the presence of dental caries, was verified using the dmf-t index. Pain was assessed by analyzing videos of the dental treatments by two previously calibrated examiners, using the items “legs”, “activity” and “crying” of the observational scale “face, legs, activity, consolability and crying” (FLACC). Data were analyzed using bivariate tests. Result: Most of the children (n=14, 51.8%) had no pain during dental treatment under sedation. Among the other children, lower or moderate pain scores (median 1.1; minimum 0 to 3.8) were observed. The FLACC scores did not vary according to sex (P=0.38), previous experience with dental treatment (P=0.32) and history with local anesthesia (P=0.96). The FLACC scores did not correlate significantly with age (Spearman rho= -0.08, P=0.67) and dmf-t (Spearman rho= -0.04, P=0.84). Conclusion: In this group of children, pain during dental treatment under sedation was of low frequency and intensity and did not associate with age, sex, oral condition and previous dental experience.
Keywords
Resumo
Introdução: Pouco se sabe sobre os fatores associados à dor das crianças no tratamento odontológico sob sedação consciente. Objetivo: Verificar a associação entre as características pré-operatórias e a dor durante o tratamento odontopediátrico sob sedação. Material e método: Este estudo exploratório foi realizado com 27 crianças submetidas a tratamento restaurador sob sedação. As informações sobre idade, sexo e experiência de tratamento odontológico prévio da criança foram obtidas por meio de entrevista aos pais. A condição bucal, determinada a partir da presença de cárie dentária, foi verificada por meio do índice ceo-d. A dor foi avaliada por análise dos vídeos dos tratamentos, por dois examinadores previamente calibrados, utilizando-se os itens “pernas”, “atividade” e “choro” da escala observacional “Face, pernas, atividade, consolabilidade e choro” (FLACC). Os dados foram analisados por meio de testes bivariados. Resultado: A maioria das crianças (n=14; 51,8%) não teve dor durante o tratamento odontológico sob sedação. Entre as demais crianças, observaram-se escores de dor baixos ou moderados (mediana 1,1; mínimo 0-3,8). Os escores FLACC não diferiram conforme sexo (P=0,38), experiência prévia de tratamento odontológico (P=0,32) e história de anestesia local (P=0,96). Os escores FLACC não se correlacionaram significativamente com idade (Spearman rho= -0,08; P=0,67) e ceo-d (Spearman rho= -0,04, P=0,84). Conclusão: Neste grupo de crianças, a dor durante tratamento odontológico sob sedação foi pouco observada, de baixa intensidade e não se associou a idade, sexo, condição bucal e experiência odontológica anterior.
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References
1. Versloot J, Craig KD. The communication of pain in paediatric dentistry. Eur Arch Paediatr Dent. 2009 Jun;10(2):61-6. http://dx.doi.org/10.1007/BF03321601. PMid:19627668.
2. Chang J, Versloot J, Fashler SR, McCrystal KN, Craig KD. Pain assessment in children: validity of facial expression items in observational pain scales. Clin J Pain. 2015 Mar;31(3):189-97. http://dx.doi.org/10.1097/AJP.0000000000000103. PMid:24810648.
3. Stanford EA, Chambers CT, Craig KD. A normative analysis of the development of pain-related vocabulary in children. Pain. 2005 Mar;114(1-2):278-84. http://dx.doi.org/10.1016/j.pain.2004.12.029. PMid:15733654.
4. Hesselgard K, Larsson S, Romner B, Strömblad LG, Reinstrup P. Validity and reliability of the behavioural observational pain scale for postoperative pain measurement in children 1-7 years of age. Pediatr Crit Care Med. 2007 Mar;8(2):102-8. http://dx.doi.org/10.1097/01.PCC.0000257098.32268.AA. PMid:17273124.
5. Versloot J, Hall-Scullin E, Veerkamp JS, Freeman R. Dental Discomfort questionnaire: its use with children with a learning disability. Spec Care Dentist. 2008 Jul-Aug;28(4):140-4. http://dx.doi.org/10.1111/j.1754-4505.2008.00032.x. PMid:18647374.
6. Gall O, Champigneulle B, Schweitzer B, Deram T, Maupain O, Montmayeur Verchere J, et al. Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index. Br J Anaesth. 2015 Dec;115(6):890-5. http://dx.doi.org/10.1093/bja/aev361. PMid:26582849.
7. Stevens B. Development and testing of a pediatric pain management sheet. Pediatr Nurs. 1990 Nov-Dec;16(6):543-8. PMid:2082269.
8. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: A behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997 May-Jun;23(3):293-7. PMid:9220806.
9. Çalış AS, Cagiran E, Efeoglu C, Ak AT, Koca H. Lidocaine versus mepivacaine in sedated pediatric dental patients: randomized, prospective clinical study. J Clin Pediatr Dent. 2014;39(1):74-8. http://dx.doi.org/10.17796/jcpd.39.1.g12782873611827u. PMid:25631731.
10. Elbay M, Şermet Elbay Ü, Yıldırım S, Uğurluel C, Kaya C, Baydemir C. Comparison of injection pain caused by the DentalVibe Injection System versus a traditional syringe for inferior alveolar nerve block anaesthesia in paediatric patients. Eur J Paediatr Dent. 2015 Jun;16(2):123-8. PMid:26147818.
11. Bohari MR, Chunawalla YK, Ahmed BM. Clinical evaluation of caries removal in primary teeth using conventional, chemomechanical and laser technique: an in vivo study. J Contemp Dent Pract. 2012 Jan;13(1):40-7. http://dx.doi.org/10.5005/jp-journals-10024-1093. PMid:22430692.
12. Pala SP, Nuvvula S, Kamatham R. Expression of pain and distress in children during dental extractions through drawings as a projective measure: a clinical study. World J Clin Pediatr. 2016 Feb 8;5(1):102-11. http://dx.doi.org/10.5409/wjcp.v5.i1.102. PMid: 26862509.
13. von Baeyer CL, Marche TA, Rocha EM, Salmon K. Children’s memory for pain: overview and implications for practice. J Pain. 2004 Jun;5(5):241-9. http://dx.doi.org/10.1016/j.jpain.2004.05.001. PMid:15219255.
14. Chen E, Zeltzer LK, Craske MG, Katz ER. Children’s memories for painful cancer treatment procedures: implications for distress. Child Dev. 2000 Jul-Aug;71(4):933-47. http://dx.doi.org/10.1111/1467-8624.00200. PMid:11016557.
15. Lourenço-Matharu L, Ashley PF, Furness S. Sedation of children undergoing dental treatment. Cochrane Database Syst Rev. 2012 Mar;(3):CD003877. http://dx.doi.org/10.1002/14651858.CD003877.pub4. PMid:22419289.
16. Zahid MF. Methods of reducing pain during bone marrow biopsy: a narrative review. Ann Palliat Med. 2015 Oct;4(4):184-93. http://dx.doi.org/10.3978/j.issn.2224-5820.2015.09.02. PMid:26541397.
17. American Academy of Pediatric Dentistry – AAPD. Clinical Affairs Committee-Behavior Management Subcommittee. American Academy of Pediatric Dentistry. Guideline on behavior guidance for the pediatric dental patient. 2015 Sep-Oct;37(5):57-70. PMid: 26531077.
18. Silva FC, Thuler LCS. Cross-cultural adaptation and translation of two pain assessment tools in children and adolescents. J Pediatr. 2008 Jul-Aug;84(4):344-9. http://dx.doi.org/10.1590/S0021-75572008000400010.
19. Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth. 2006 Mar;16(3):258-65. http://dx.doi.org/10.1111/j.1460-9592.2005.01773.x. PMid:16490089.
20. Crosta QR, Ward TM, Walker AJ, Peters LM. A review of pain measures for hospitalized children with cognitive impairment. J Spec Pediatr Nurs. 2014 Apr;19(2):109-18. http://dx.doi.org/10.1111/jspn.12069. PMid:24612473.
21. Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009 May;10(5):447-85. http://dx.doi.org/10.1016/j.jpain.2008.12.001. PMid:19411059.
22. Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013 Jul;111(1):52-8. http://dx.doi.org/10.1093/bja/aet127. PMid:23794645.
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