title: Analgesia for acute gingivostomatitis: a national survey of pediatric emergency physicians.
abstract: OBJECTIVE
  Gingivostomatitis is a common, painful pediatric presentation, and yet, few studies are available to guide management. We aimed to describe pediatric emergency physicians' current practice patterns, with respect to analgesic use in children with acute gingivostomatitis, in order to inform future studies.
  
  
  METHODS
  A national survey was conducted at all 15 national academic pediatric centres. Electronic surveys were distributed to pediatric emergency physicians using a modified Dillman protocol; non-respondents received paper surveys via post. Data were collected regarding demographic characteristics, clinical behaviour, factors that may influence practice, and future directions.
  
  
  RESULTS
  Response rate was 74% (150/202). Most physicians (72%) preferred the combination of acetaminophen and ibuprofen to either agent alone (ibuprofen 19%, acetaminophen 7%). The preferred second-line analgesics were oral morphine (48%, 72/150) and compounded topical formulas (42%, 64/150). The most commonly cited compounded agent was Benadryl plus Maalox (23%, 35/150). Clinical experience with a medication had the greatest influence on practice pattern, with 52% (78/149) strongly agreeing. The most commonly cited barrier to adequate analgesia was difficulty in the administration of topical or oral medication to children.
  
  
  CONCLUSIONS
  As with many other painful conditions, the combination of acetaminophen and ibuprofen was preferred, followed by either agent alone. Oral morphine and topical compounded agents were also frequently prescribed. Regardless of patient age, physicians preferred oral morphine as a second-line agent to treat pain from severe gingivostomatitis. Future research will focus on determining which analgesic and route (oral or topical) is the most effective and best-tolerated choice.
authors.affiliation: *Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Joe
authors.initials: J
authors.lastname: MacLellan
authors.affiliation: *Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Samina
authors.initials: S
authors.lastname: Ali
authors.affiliation: *Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
authors.affiliation: §Department of Pediatrics,University of Calgary,Calgary,AB.
authors.forename: Jason
authors.initials: J
authors.lastname: Baserman
authors.affiliation: *Department of Pediatrics,University of Alberta,Edmonton,AB.
authors.forename: Andrew
authors.initials: A
authors.lastname: Dixon
mesh_terms: D000208:Acute Disease; D000328:Adult; D000416:Alberta; D000698:Analgesia / Q000592:standards* / Q000639:trends; D000700:Analgesics / Q000008:administration & dosage*; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D005891:Gingivitis / Q000175:diagnosis / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D059408:Pain Management; D010147:Pain Measurement; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D013280:Stomatitis / Q000175:diagnosis / Q000188:drug therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
keywords: analgesia; children; emergency; gingivostomatitis; pain