Abstract
Objective. To evaluate the success rate of intra-rectal (IR) midazolam in combination with nitrous oxide/oxygen (N2O) sedation in young uncooperative dental patients when the local anesthesia is delivered by a computerized controlled local anesthetic delivery (C-CLAD).Study Design. This observational study consisted of 219 uncooperative children (age: 4.3 ± 1.69 y) who received IR midazolam (0.4 mg/kg) and N2O to complete their dental treatment. Measured variables included: child’s pain disruptive behavior during delivery of anesthesia by C-CLAD (CHEOP Scale), child behavior during treatment (Houpt scale), dental procedure performed, and side effects that appeared during treatment.Results. There was a high level of cooperation (mean score: 6.69 ± 2.1) during administration of local anesthesia. Good-to-excellent behavior was shown by 87% of the children during treatment. Planned treatment was completed by 184 (92%) patients. No statistically significant changes were noticed in the oxygen saturation levels before and after treatment. Children with side effects included 3 (1.3%) with nistagmus, 5 (2.3%) with diplopia, and 18 (8.2%) with hiccups. Three consecutive sedations decreased the overall behavior score by 5.7% compared to the first appointment (p < .05).Conclusions. IR midazolam-N2O sedation in combination with C-CLAD is very effective for delivery of dental treatment to young uncooperative children.
Highlights
IntroductionA popular sedative agent used in pediatric dental offices, is effective and reliable in reducing anxiety in young children during dental treatment (Lindh-Stromberg, 2001; Jensen, Schroder & Mansson, 1999; Erlandsson et al, 2001; Fuks et al, 1994; Shapira et al, 1996; Lourenco-Matharu & Roberts, 2010; Coventry, Martin & Burke, 1991)
A structured form was designed to collect demographic and dental variables of each child, including age, gender, behavior during administering of sedation, onset of sedation, mode of administered local anesthesia, pain disruptive behavior during administered local anesthesia (McGrath et al, 1985), dental treatment procedure, behavior during operative treatment (Badalaty et al, 1990), completion of planned treatment, use of restraint during treatment, pulse and saturation before sedation and 5 min after delivery of 100% oxygen with termination of the operative treatment, number of operative treatments performed during each appointment, duration of operative treatment, and any side effects that appeared during treatment
The present study showed that midazolam administered intra-rectally in a concentration of 0.4 mg/kg, in combination with controlled local anesthetic delivery (C-CLAD), enabled completion of the planned dental treatment in 92% of the uncooperative or very young children
Summary
A popular sedative agent used in pediatric dental offices, is effective and reliable in reducing anxiety in young children during dental treatment (Lindh-Stromberg, 2001; Jensen, Schroder & Mansson, 1999; Erlandsson et al, 2001; Fuks et al, 1994; Shapira et al, 1996; Lourenco-Matharu & Roberts, 2010; Coventry, Martin & Burke, 1991). Midazolam’s effectiveness as a sedative agent for performing dental treatment has been evaluated in children, aged 16 months to 10.5 years (Lindh-Stromberg, 2001; Jensen, Schroder & Mansson, 1999; Erlandsson et al, 2001; Fuks et al, 1994; Shapira et al, 1996; Lourenco-Matharu & Roberts, 2010; Coventry, Martin & Burke, 1991). Consecutive sedations were associated with decreased cooperation in 30% of the children (Erlandsson et al, 2001; Fuks et al, 1994; Shapira et al, 1996)
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