Sedation of anxious children undergoing dental treatment

Eastman Dental Institute, Department of Paediatric Dentistry, 256 Gray's Inn Rd, London, UK, WC1X 8LD.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2006; 1(1):CD003877. DOI: 10.1002/14651858.CD003877.pub3
Source: PubMed


Fear of the dentist or behaviour management problems can result in a child's tooth decay going untreated. Behavioural techniques play an important role in managing anxiety, however, some children still find it difficult to tolerate dental treatment and may require sedation. This review examined the effectiveness of drugs that sedate a child whilst keeping them conscious. Due to the poor quality of the research, the review was unable to determine which drugs or methods of sedation are the best for managing a child's anxiety or behaviour.

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    • "Hydroxyzine has been shown to have an analgesic as well as antiemetic and euphoric effects in addition to its sedative potential with fewer hazards.[8] Midazolam, a relatively short-acting benzodiazepine, has received considerable attention as a safe and effective agent mainly beside nitrous oxide.[89101112131415161718] Midazolam has gained high popularity over the recent years based on its margin of safety, half-life, amnestic potential and availability of antagonist. "
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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.
    Full-text · Article · Mar 2013 · Dental research journal
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    ABSTRACT: Very little is known about mothers' beliefs concerning children's refusal of dental treatment. This qualitative study aimed to explore mothers' perceptions of their children's refusal to submit to dental treatment. Semistructured interviews were conducted with 14 mothers of 4-12-yr-old children resistant to dental treatment who were attending two pediatric dentists. Thematic content analysis was used to interpret the data. From this, three categories were developed and labeled origins of child behavior, caregiver attitudes, and the culture of resistance. The origins of the children's behavior were related to the childs' temperament, behavior disorders, lack of affection, level of development, and refusal to submit to health procedures or other situations. Caregiver's attitudes included discipline, protection, incoherence, partnership in dental treatment, and mother-child feeling. The culture of resistance referred to the parents' or guardians' refusal of dental treatment and the mothers' recognition of this. In conclusion, the wide variety of mothers' accounts reinforced the idea that every child is unique, and it is not possible to standardize child behavior models in a dental setting.
    Full-text · Article · Jan 2007 · European Journal Of Oral Sciences
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    ABSTRACT: Sedation can be used to relieve anxiety and manage behaviour in children, 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. DESIGN AND KEY METHODS: Relevant databases and reference lists from articles were searched up to December 2005. 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. Sixty-five studies were included with 3372 subjects in total. Overall quality of studies was found to be disappointing with poor reporting often the main problem. Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children due to issues with the quality and validity of published studies to date.
    Preview · Article · Feb 2007 · Journal of Dentistry
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