Sedation of anxious children undergoing dental treatment
ABSTRACT Anxiety about dental treatment or behaviour management problems can be a barrier to its uptake in children. Sedation can be used to relieve anxiety and manage behaviour, unfortunately it is difficult to determine from published research which agents, dosages and techniques are effective.
To evaluate the relative efficacy of the various conscious sedation techniques and dosages for behaviour management in paediatric dentistry.
Computerised: MEDLINE, PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references up to December 2004. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched.
Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age.
Information regarding methods, participants, interventions and outcome measures and results were independently extracted, in duplicate, by two authors. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed.
Sixty-one studies were included with 3246 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. Data reported could not be easily aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, then the differing outcome measures used made their meta-analysis impossible.
Review authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.
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ABSTRACT: To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry. A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps. Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low. There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.PLoS ONE 02/2015; 10(2):e0117537. DOI:10.1371/journal.pone.0117537 · 3.53 Impact Factor
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ABSTRACT: THE GOAL OF THIS INVESTIGATION WAS TO COMPARE THE BEHAVIORAL AND PHYSIOLOGICAL EFFECTS OF THREE SEDATIVE DRUG REGIMENS: oral meperidine (OM), submucosal meperidine (SM) and oral midazolam (M) in healthy pediatric patients. This study sample consisted of thirty children aged 24-72 months (mean = 41.1) exhibiting definitely negative behavior. Three sedative regimens including: Oral meperidine/hydroxyzine, oral midazolam/hydroxyzine and submucosal meperidine/oral hydroxyzine were administered randomly during three consecutive appointments with a crossover design. Houpt behavioral scale was employed for evaluating the sedation effect of each regimen by a calibrated independent Pediatric dentist. Physiologic parameters were also recorded including blood oxygen saturation and pulse rate. Data was analyzed using Wilcoxon-signed ranked test, Mc-Nemar, GEE Logistic regression, Friedman, Fisher exact and Cochran tests for significance. Overall success rates were 50%, 46.7% and 26.7% for submucosal meperidine, oral meperidine and oral midazolam, respectively (P = 0.03). The probability of achieving a success in behavior control was more in 48-72 month olds. Child's age and drug type were the two main predictors of altered behavior. Evaluating the differences between the effects of three tested regimens on recorded physiological parameters showed no significant differences. All three regimens were proved safe within the limits of the current study. Meperidine sedation in both routes was considered to be more effective. Although there was less sleep and more head/oral resistance in midazolam group, the difference between groups was not significant.Dental research journal 03/2013; 10(2):173-9. DOI:10.4103/1735-3327.113335
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ABSTRACT: To investigate the influence of factors such as age, gender and pre-operative behavior rating on the outcome of sedation using oral trimeprazine during dental treatment of children. Records of children who received dental treatment under sedation with oral trimeprazine between 2000 and 2007 were reviewed and the following data were obtained: age and weight of patient at the time of treatment, gender, behavior classification prior to sedation, dose of medication used, efficacy of sedation and treatment accomplished. Descriptive statistics, cross-tabulations and χ (2) analysis were done. Forty-eight sedation sessions met the inclusive criteria for children whose mean age was 4.92 (SD 1.65, range 3.0-8.0) years and mean weight was 18.23 (SD 4.82, range: 12.0-31.0) kg. Overall, 54.2% (26/48) of the sedations were rated successful, 20.8% (10/48) were partially successful and 25.0% (12/48) not successful. Younger children 3-5 years, and those with only negative pre-operative behavior rating had more successful sedation sessions than older, 6-8 years or children with definitely negative pre-operative behavior rating (X (2) = 8.165, p = .017) and (X (2) = 17.258, p = .001), respectively. Variables such as patient's age and pre-operative behavior but not gender and type of treatment could predict outcome of dental sedation using trimeprazine in children.Saudi Dental Journal 04/2011; 23(2):87-90. DOI:10.1016/j.sdentj.2011.01.004