Pain and Discomfort in Young Children After Dental General Anesthesia

Objective: Little is known about post-operative dental pain in young children after comprehensive dental treatment under general anesthesia (GA). Using validated measures, this pilot study explored the occurrence, extent, and severity of dental pain and discomfort in healthy children following GA dental treatment due to dental caries.

Methods: The study sample included children <7 years of age, ASA 1 or 2, who were treated at one of two private surgical facilities in Vancouver, Canada.  Pre-operatively, the Dental Discomfort Questionnaire (DDQ-8) was completed by a parent; the Faces Pain Scale-Revised (FPS-R) was scored by the child. Anesthetic agents (general, local) and dental treatment received were recorded. Observational assessments in recovery included the FLACC scale (Faces, Legs, Activity, Cry, and Consolability), the PAED scale (Pediatric Anesthesia Emergence Delirium) and child's behavior. For the follow-up periods (1-day, 2-days, 7-days, 1-month) DDQ-8, FPS-R, and parent's subjective comments were recorded by telephone or email depending on parental preference. Data was analyzed descriptively.

Results: Preliminary data for 64 children (37 boys/27 girls) age 51.9±15.4 months demonstrated that 36.5% of children had toothache at some time before surgery. Means (range) for FLACC and PAED were 1.7(0-10) and 2.3(0-15). At days 1, 2, 7, and 30, 43.5%, 22.9%, 17.9%, and 11.1%, respectively, reported toothache. Other problems, “sore mouth”, and “tight crowns” were reported by 31.2%, 32.3%, 28.1%, and 16.7% of cases. DDQ-8 and FPS-R, means (range), were:

Measure	Baseline	Day 1 (n=44)	Day 2 (n=47)	Day 7 (n=47)	Day 30 (n=17)
DDQ-8	2.9(0-11)	1.8(0-8)	2.1(0-9)	1.2(0-10)	0.8(0-8)
FPS-R	1.7(0-10)	1.7(0-10)	1.2(0-10)	0.1(0-2)	0

Conclusion: Validated measures demonstrated that pain and discomfort after dental GA occur and bear further study. Parents and their young children can be recruited from private surgical facilities to enable a larger study and, thus, a more definitive investigation of variables influencing post-operative dental pain.

Financial aid: CNPq(National Council for Scientific and Technological Development-Brazil) 200698/2007-9