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Children with pulpitis should have pain assessed with age-appropriate scales and managed primarily with NSAIDs and/or acetaminophen, while antibiotics are reserved only for infectious complications.
Dental pain, often stemming from untreated cavities, remains one of the most prevalent health ailments worldwide. School-aged children and adolescents are particularly at risk, especially when caregivers come from lower socioeconomic backgrounds with limited access to dental care. For very young children, the problem is even more critical—because their pain modulation is still developing. Untreated episodes may leave behind “pain memories” that influence how they respond to pain later in life.
A recent review led by A Mohn et al. set out to examine how dental pain in children with pulpitis should be managed, particularly from a pharmacological standpoint. Using a focused search of PubMed, the authors assessed available evidence on treatment strategies and related complications. According to the findings, pain in pediatric patients must be carefully assessed with age-appropriate tools. First-line treatment should encompass nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen, either used alone or in combination.
Evidence suggests that pairing ibuprofen and acetaminophen at fixed doses may offer enhanced relief, although more high-quality clinical trials are needed before this becomes standard practice. Importantly, antibiotics are not advocated for routine cases of pulpitis. Their use should be reserved only for children with clear local or systemic infection. Likewise, opioids are discouraged owing to safety concerns. Prophylactic antibiotics have a role only in specific situations and must never replace preventive strategies aimed at mitigating dental disease in the first place.
The authors also point to the importance of "Antibiotic Stewardship Programs" in dentistry, which can help curb inappropriate antibiotic prescribing and support global efforts to combat antimicrobial resistance. To sum up, effective management of dental pain in children requires a thoughtful, measured approach: proper assessment, safe pharmacological treatment, strict limits on antibiotic use, and a strong focus on prevention.
European Journal of Paediatric Dentistry
Dental pain in children: pharmacological management
A Mohn et al.
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