Abstract
Background and aims. There are several known sedative drugs, with midazolam and ketamine being the most commonly used drugs in children. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety.Materials and methods.A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3-6 (negative or definitely negative by Frankel scale), who required at least two similar dental treatment visits. Cases were randomly given ketamine (10 mg/kg) and midazolam (0.5 mg/kg) through oral or intranasal routes in each visit. The sedative efficacy of the agents was assessed by an overall success rate judged by two independent pediatric dentists based on Houpt’s scale for sedation. Data analysis was carried out using Wilcoxon test and paired t-test.Results. Intranasal administration was more effective in reduction of crying and movement during dental procedures compared to oral sedation (P<0.05). Overall behavior control was scored higher in nasal compared to oral routes at the time of LA injection and after 15 minutes (P<0.05). The difference was found to be statistically significant at the start and during treatment. However, the difference was no longer significant after 30 minutes, with the vital signs remaining within physiological limits. Recovery time was longer in the intranasal group (P<0.001) with a more sleepy face (P=0.004).Conclusion.. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children.
Highlights
One of the most common challenges faced by pediatric dentists in daily practice is child behavior management
The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety
A crossover double-blind clinical trial was conducted on 23 uncooperative children aged 3‒6, who required at least two similar dental treatment visits
Summary
One of the most common challenges faced by pediatric dentists in daily practice is child behavior management. Any impression from a dental experience will be reflected through individual’s future dental attendance by creation of positive or negative memories.[1] Various approaches have been identified to enable the operator to overcome behavioral problems in children In those with absolute negative behavior, help is necessary to achieve a successful procedure. Even an experienced pediatric dentist may find it difficult to render treatments to certain children when using conventional techniques. In these circumstances the use of conscious sedation and general anesthesia (GA) is considered as helpful alternatives.[2]. The aim of this study was to compare the effect of intranasal and oral midazolam plus ketamine in children with high levels of dental anxiety. Intranasal midazolam/ketamine combination was more satisfactory and effective than the oral route when sedating uncooperative children.
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