LARAGA – Pharmacological behaviour management in paediatric dentistry in the UK

Abstract

While non-pharmacological behaviour management plays an important role in paediatric dentistry, it is not the solution for all children and a proportion will still require an adjunctive pharmacological approach such as local anaesthetic, relative analgesia or general anaesthetic (LA-RA-GA). Paediatric conscious sedation at Newcastle Dental Hospital (NDH) is distinctive in that RA is provided by both the Child Dental Health (CDH) and Sedation (SED) departments. The primary aim of this study was to evaluate the outcomes of the NDH paediatric sedation service and analyse the effect of various confounding factors involved in treatment. This cross-sectional analysis forms part of a retrospective service evaluation of the inhalation sedation service provided by Newcastle Dental Hospital. Anonymised data were collected on 200 patients attending NDH (100 CDH, 100 SED) between September 2019 and March 2020. Data were cleaned manually and analysed using descriptive statistics, exploratory analysis with chi-squared tests and multivariable analyses (logistic regression) to identify any factors associated with failed RA appointments. Overall success for the NDH paediatric inhalation sedation service was 90.5%; CDH %/n = 89%, SED %/n = 92. There was a significant association between a failed RA appointment and no RA experience, a mother attending as chaperone and patients being under six years old. The odds of failure in an afternoon appointment were 1.6 times higher than a morning appointment, and girls were 1.5 times more likely than boys to have a failed RA appointment. Dental treatment under combined RA and LA is a successful technique for managing mild-to-moderately anxious paediatric patients. Careful patient selection, based on patient cooperation at the initial consultation, alongside an episode of acclimatisation, may help increase treatment success rates. • Careful patient selection, based on patient cooperation at the initial consultation, is important when deciding if conscious sedation is appropriate for a patient. • Acclimatisation, via non-invasive treatment under conscious sedation, may play a crucial role in assessing suitability for more invasive treatment in the future. • Pharmacological behaviour management in paediatric dentistry exists along a spectrum, in which non-pharmacological management plays a pivotal role.