Pedodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine and Pharmacy Science and Technology, 540139 Tirgu-Mures, Romania.
Orthodontics Department, Faculty of Dental Medicine, George Emil Palade University of Medicine and Pharmacy Science and Technology, 540139 Tirgu-Mures, Romania.
J Clin Pediatr Dent. 2024 Nov;48(6):123-132. doi: 10.22514/jocpd.2024.096. Epub 2024 Nov 3.
Preemptive analgesia is an important strategy used in pediatric dentistry to intercept pain signals in neural pathways early, thus mitigating the perception of pain and enhancing overall patient comfort. Pedodontists often encounter challenges in conducting the therapy and managing uncooperative patients, when addressing enamel defects of the Molar-incisor hypomineralization (MIH) type. The aim of this study is to demonstrate the impact of preemptive analgesia on optimizing behavioral management and restorative treatment strategies for immature permanent molars exhibiting severe MIH and Treatment need index 4 (TNI), through the effective control of pain. This study comprised 27 cases with MIH level 3 Posteruptive breakdown (PEB), indicating post-eruptive enamel breakdown, with initial hypersensitivity scores exceeding 4 on the Wong-Baker Scale, was conducted over 12 months, between January 2023-January 2024. Data on pediatric patients aged between 5 years and 4 months and 7 years and 1 month with varying degrees of sensitivity in their permanent first molars before the completion of the eruption process were collected. Pain intensity was systematically evaluated at six specific time points: before and after the administration of analgesic medication as well as during restorative treatment using the Wong-Baker scale and data from the Face, Legs, Activity, Cry, Consolability index (FLACC). Statistical analysis for Wong-Baker scores and FLACC index indicated statistical significance ( < 0.05) for Mann-Whitney and Wilcoxon tests, respectively -test. The comparison of mean scores recorded before and after preemptive analgesia during rotary instrumentation moments for the Wong-Baker index (4 > 0.29) and for the FLACC index (8.47 > 1.71) indicates the positive influence of administering ibuprofen. In conclusion, preemptive analgesia, alongside standardized anesthesia, significantly improved intraoperative pain management and behavioral outcomes.
超前镇痛是儿科牙科中使用的一种重要策略，旨在早期阻断神经通路中的疼痛信号，从而减轻疼痛感知，提高患者整体舒适度。当处理磨牙-切牙低矿化（MIH）型釉质缺陷时，儿童牙医在进行治疗和管理不合作患者方面常常会遇到挑战。本研究旨在通过有效控制疼痛，展示超前镇痛对优化行为管理和修复治疗策略的影响，以治疗严重 MIH 和治疗需求指数 4（TNI）的未成熟恒牙。这项研究共纳入 27 例 MIH 3 级萌出后崩解（PEB）病例，即萌出后釉质崩解，初始敏感到 Wong-Baker 量表评分超过 4 分，于 2023 年 1 月至 2024 年 1 月进行，历时 12 个月。研究对象为 5 岁 4 个月至 7 岁 1 个月之间的儿童患者，其恒第一磨牙萌出过程尚未完成，且敏感度不同。使用 Wong-Baker 量表和面部、腿部、活动、哭泣、安慰指数（FLACC）在 6 个特定时间点系统评估疼痛强度：镇痛药物给药前后以及修复治疗期间。Wong-Baker 评分和 FLACC 指数的统计分析表明，Mann-Whitney 和 Wilcoxon 检验分别具有统计学意义（<0.05）。在旋转器械时刻进行 Wong-Baker 指数（4 > 0.29）和 FLACC 指数（8.47 > 1.71）的超前镇痛前后平均评分比较，表明布洛芬给药的积极影响。总之，标准麻醉联合超前镇痛可显著改善术中疼痛管理和行为结果。
