Pharmaceutical Approaches to Pain Management in Pediatric Restorative Dentistry A Comprehensive Review
European Journal of Prosthodontics and Restorative Dentistry (2026) 34(2s),159–171
KeywordsPediatric Dentistry; Pain Management; Restorative Dentistry; Local Anesthesia; Analgesics; Sedation
AuthorsAbstractThe goal of pain management in pediatric restorative dentistry is to achieve a successful clinical outcome, patient cooperation and good long term oral health behavior. Dental pain in children is not only associated with biological factors such as caries and pulpal inflammation, operative procedures and administration of local anesthetic, but is also affected by psychological factors such as fear and anxiety, sensory sensitivity and past dental experiences. In this study, the local anesthetic, topical anesthetic, systemic analgesic and sedation-based techniques for the control of pain and anxiety in pediatric restorative dental care are explored in-depth. A literature survey was carried out to identify existing literature on the topic with primary emphasis on literature published between the years 2018. The evidence reviewed supports the following conclusions: Local anesthesia is the cornerstone of procedural pain control; topical anesthetics augment comfort during injection. Opioids should be used sparingly because of their safety concerns, but acetaminophen and nonsteroidal anti-inflammatory drugs can be helpful for pre- and postoperative discomfort. Sedation strategies such as nitrous oxide, oral sedation, intranasal sedation and intravenous sedation can be useful when a child is anxious, very young, or uncooperative, but can only be used with careful selection of patients, accurate weight dosing, monitoring and preparedness. New technologies like needle-free systems, enhanced topical treatments and tailored pain management could further enhance dental care for children. In general, pain management should include pharmacologic interventions and child-friendly behavioral directions that will improve safety, comfort, and treatment outcomes.
1. INTRODUCTION Childhood dental pain is a complicated sensory and emotional experience related to dental caries, pulp involvement, operative treatment, the application of local anesthesia, and restorative treatment. Pain can be pretreatment related to carious lesion, or pre-treatment related to the preparation of the cavity, pulp therapy, the routine of rubber dams, injection, or post-treatment inflammation in pediatric restorative dentistry (Lupu et al., 2024). As children may lack the capacity to explain the severity, location, and nature of the pain, dental pain assessment in children during the clinical process should be carefully observed, with age-related communication and knowledge of behavioral reactions (Morgan, 2021; Ortiz, 2020). Pediatric dental pain is not just a biological experience, but also a psychological experience that is affected by fear, prior dental experience, parental attitude, sensory sensitivity and clinical environment (Stein Duker et al., 2022). The issue of pain during restorative procedures is a significant concern in pediatric dentistry since untreated or inadequately treated pain may impact •••••••••••••••••••••••••••••••• ejprd.org- Published by Riset Publishing Services LLC.
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