Kühnisch J, Daubländer M, Klingberg G, Dougall A, Spyridonos Loizides M, Stratigaki E, Amar J L, Anttonen V, Duggal M, Gizani S
Department of Operative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians University of Munich, Munich, Germany.
Department of Oral Surgery, University Medical Centre Mainz, Mainz, Germany.
Eur Arch Paediatr Dent. 2017 Oct;18(5):313-321. doi: 10.1007/s40368-017-0311-y. Epub 2017 Oct 11.
The European Academy of Paediatric Dentistry (EAPD) proposes this best-practice guidance to help practitioners to decide when and how to use local analgesia to control pain in children, adolescents, and medically compromised individuals during the delivery of oral health care.
A search of different databases was conducted using all terms relevant to the subject. Relevant papers were identified after a review of their titles, abstracts or full papers. Three workshops were held during the corresponding EAPD interim seminar in Torino (Italy) in 2017. Several statements were agreed upon and, furthermore, knowledge gaps were identified.
An important outcome was that when local analgesia administered appropriately-correct choice of agent(s) and dosage, proper route of administration-it is, firstly, clinically effective for pain-control in treating children and, secondly, it carries a very low risk of morbidity including adverse or side-effects. Furthermore, several gaps in knowledge were identified during the workshop which indicates future research needs. Most importantly it remains unsatisfactory that in several European countries the most frequently used injectable local analgesic agent, articaine, is not approved for usage in children below the age of 4 years.
When considering the dental demand to treat vulnerable (medically compromised) children and adolescents in a safe, painless, less-invasive and effective way, there seems to be an urgent need to close these gaps in knowledge.
欧洲儿童牙科学会（EAPD）提出本最佳实践指南，以帮助从业者决定在为儿童、青少年及身体状况不佳者提供口腔保健服务时，何时以及如何使用局部镇痛来控制疼痛。
使用与该主题相关的所有术语对不同数据库进行检索。在对论文标题、摘要或全文进行审查后确定相关论文。在2017年于意大利都灵举行的相应EAPD中期研讨会上举办了三场研讨会。就若干声明达成了一致意见，此外，还确定了知识空白。
一个重要成果是，当局部镇痛给药恰当（正确选择药物和剂量、正确给药途径）时，首先，在治疗儿童疼痛方面临床有效，其次，其发病风险极低，包括不良或副作用。此外，研讨会上还确定了若干知识空白，这表明了未来的研究需求。最重要的是，在几个欧洲国家，最常用的注射用局部麻醉剂阿替卡因未被批准用于4岁以下儿童，这一点仍不尽人意。
在考虑以安全、无痛、微创且有效的方式治疗脆弱（身体状况不佳）儿童和青少年的牙科需求时，似乎迫切需要填补这些知识空白。
