Klingberg G, Ridell K, Brogårdh-Roth S, Vall M, Berlin H
Department of Pediatric Dentistry, Faculty of Odontology, Malmö University, SE 205 06, Malmö, Sweden.
Library Services, Malmö University, Malmö, Sweden.
Eur Arch Paediatr Dent. 2017 Oct;18(5):323-329. doi: 10.1007/s40368-017-0302-z. Epub 2017 Sep 14.
To evaluate the evidence supporting effects and adverse effects of local analgesia using different pharmacological agents and injection techniques during dental treatment in children and adolescents aged 3-19 years.
A systematic literature search of databases including PubMed, Cochrane, and Scopus was conducted in November 2016. The PRISMA-statement was followed. Two review authors independently assessed the selected randomised control trials for risk of bias and quality.
725 scientific papers were identified. 89 papers were identified to be read in full text of which 80 were excluded. Finally, 9 papers were evaluated for quality and risk of bias. Many of the included papers had methodological shortcomings affecting the possibility to draw conclusions. Information about ethical clearance and consent were missing in some of the included papers. No alarming adverse effects were identified. One study was assessed as having low risk of bias. This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of mandibular molars, while no differences were found regarding pharmacological agents.
At present, there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others. There is a need for more rigorous studies which also handle the ethical issues of including children in potentially painful studies.
评估支持在3至19岁儿童及青少年牙科治疗期间使用不同药物和注射技术进行局部镇痛的效果及不良反应的证据。
2016年11月对包括PubMed、Cochrane和Scopus在内的数据库进行了系统的文献检索。遵循PRISMA声明。两位综述作者独立评估所选随机对照试验的偏倚风险和质量。
共识别出725篇科学论文。确定89篇论文需全文阅读，其中80篇被排除。最终，对9篇论文的质量和偏倚风险进行了评估。许多纳入的论文存在方法学缺陷，影响了得出结论的可能性。部分纳入论文缺少伦理审批和知情同意的信息。未发现令人担忧的不良反应。一项研究被评估为偏倚风险较低。该研究报告称，在下颌磨牙的牙科治疗中，下牙槽神经阻滞比颊部浸润更有效，而在药物方面未发现差异。
目前，没有足够的证据支持任何一种药物或注射技术比其他药物或技术更优越。需要进行更严格的研究，同时也要处理将儿童纳入潜在痛苦研究的伦理问题。
