Pain Management Strategies in Pediatric Dentistry: A Systematic Review of Clinical Approaches and Public Health Implications.

Pain management is a fundamental aspect of pediatric dentistry (PD), as children's dental experiences are closely linked to pain perception, anxiety, and subsequent oral health behaviors. Although numerous pharmacological, behavioral, and technology-assisted strategies have been explored, uncertainty persists regarding their combined effectiveness and wider public health relevance. This systematic review synthesized current evidence on pain management strategies in PD and evaluated clinical outcomes alongside implications for access, equity, and quality of care. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library, covering studies published between 2015 and 2025. Randomized controlled trials and observational comparative studies involving children aged zero to 18 years and reporting pain, anxiety, behavioral, or treatment acceptance outcomes during dental procedures were included following the PRISMA guidelines. After screening and eligibility assessment, 11 studies were included in the final qualitative synthesis. The evidence indicates that pharmacological interventions such as local anesthesia and sedation remain effective for controlling procedural pain, particularly during invasive treatments, while nonpharmacological and technology-assisted approaches reduce anxiety and improve cooperation. Multimodal strategies consistently demonstrated superior outcomes compared with single interventions. These findings highlight implications for patient-centered care, improved treatment acceptance, and reduced fear-related avoidance of dental services, particularly among vulnerable pediatric populations globally.