Analgesic regimens for acute dental pain in children

For factors that affect the choice of analgesic regimen, see here. Do not use aspirin in people younger than 16 years because of the risk of Reye syndrome. Do not use opioids for acute dental pain in children outside the specialist setting.

For acute dental pain in children 3 months or older, use ibuprofen or paracetamol; ibuprofen and paracetamol can be combined for enhanced pain management. Give doses regularly, rather than as required, to achieve continuous pain relief. Use:

1 ibuprofen 5 to 10 mg/kg (use the lowest effective dose) up to 400 mg orally, 3 times daily, at 6- to 8-hour intervals. See #dtg3-c34-s7__tdtg3-c34-tbl4 for calculated doses. Continue treatment for the shortest duration possible and no more than 3 days without review dental pain (children) ibuprofen

OR

2 paracetamol 15 mg/kg up to 1000 mg orally, 4 times daily, at 4- to 6-hour intervals. See #dtg3-c34-s7__tdtg3-c34-tbl6 for calculated doses. Continue treatment for the shortest duration possible. dental pain (children) paracetamol

Particular care is required for dose selection in children at extremes of weight or height:

  • For children who are not obese, calculate the dose of analgesic using the child’s actual body weight, even if they are significantly underweight. If the child’s weight cannot be determined, use the age-based dose in #dtg3-c34-s7__tdtg3-c34-tbl4 for ibuprofen or #dtg3-c34-s7__tdtg3-c34-tbl6 for paracetamol; however, age-based dosing is imprecise for children at extremes of weight or height.
  • For children who are obese, calculate the dose using ideal body weight; because of changes in drug pharmacokinetics in obesity, using the child’s actual body weight will result in an excessive dose. If the child’s height is known, estimate their ideal body weight using the corresponding weight for the height percentile on the growth chart (eg the Centers for Disease Control and Prevention (CDC) growth charts). If the child’s height cannot be determined, use the age-based dose in #dtg3-c34-s7__tdtg3-c34-tbl4 for ibuprofen or #dtg3-c34-s7__tdtg3-c34-tbl6 for paracetamol; however, age-based dosing is imprecise for obese children at extremes of height.