Pediatric Dental Sedation Research Articles

Pharmacological Sedation in Paediatric Dentistry.

This research aims to explore and evaluate various sedation strategies used in paediatric dentistry, focusing on effectively and safely addressing dental anxiety to improve cooperation during dental treatment in paediatric patients. To identify relevant studies for this systematic review, the Scopus, Web of Science and PubMed databases were used, combining the terms "sedation" with "pediatric dentistry" or "pedodontics" through the Boolean operators "AND" and "OR". Only literature published in English within the last ten years was included. The inclusion criteria were clinical studies, case reports and in vivo studies, while systematic reviews, meta-analyses and studies conducted on animals or in vitro were excluded. After eliminating duplicates, 544 articles were identified, of which 501 were excluded for not meeting the inclusion criteria. A further 27 articles were excluded for various reasons, including lack of retrieval, in vitro nature or being reviews. Finally, 16 articles were selected for inclusion in the review. These findings underscore the importance of pharmacological management in paediatric dental care, offering valuable insights into the selection and application of sedation techniques to mitigate dental anxiety and enhance patient outcomes.

Ambulatory Sedation in Pediatric Dentistry “Knowledge and Practice of Dental Graduates of Karachi” A Cross Sectional Study

Ambulatory Sedation in Pediatric Dentistry “Knowledge and Practice of Dental Graduates of Karachi” A Cross Sectional Study

Effectiveness of buccal administration of dexmedetomidine and ketamine combination in paediatric dental sedation: A randomized controlled clinical trial.

Pain and anxiety can be considerable obstacles while treating paediatric dental patients. Moderate sedation is needed to treat uncooperative patients. This study aimed to compare the effectiveness of buccal administration of dexmedetomidine-ketamine combination versus dexmedetomidine. Fifty-six uncooperative children were randomly assigned into two groups: Group I received buccal dexmedetomidine (2 μg/kg) and ketamine (2 mg/kg) (DEX-KET), whereas Group II received buccal dexmedetomidine (4 μg/kg) (DEX). The effects of drugs were evaluated based on changes in vital signs, onset and duration of sedation, sedation level, analgesia, ease of treatment and procedural adverse effects. There were no significant differences in vital signs or sedation onset between the two groups. DEX-KET group showed shorter recovery time than DEX group (p < .0001). There were no statistically significant differences between both groups regarding sedation level at optimum sedation and during operative procedure (p = .064, p = .069 respectively). The ease of treatment was significantly better in DEX-KET group than in DEX group (p = .048). Procedural side effects and analgesic effects of the sedative drugs were comparable between both groups. The combination of dexmedetomidine and ketamine delivered buccally provided a better method of delivering care to uncooperative children with more rapid recovery than dexmedetomidine.

A Comparative Study of Parent and Child Perspectives on Using the Intranasal Mucosal Atomization Device for Behavior Management in Pediatric Dental Sedation.

Background Dental anxiety in children often necessitates sedation for effective treatment. Different methods of sedation have proved to be beneficial. However, intranasalsedation provides a needleless, rapid drug delivery method that bypasses hepatic metabolism. Intranasal sedative drugs can be delivered using a mucosal atomization device (MAD). This study aimed to find the opinions, beliefs, and existing knowledge of parents and children regarding intranasal sedation and the method of drug delivery through MAD. Materials and methods The study comprised 50 parents, aged 20 to 50, who came in with a single child, aged five to nineyears. In separate rooms, parents and kids were each shown a video about the use of the intranasal sedation technique with MAD as a pharmaceutical help during routine dental procedures. After the video presentation, each participant was required to complete a pretested self-made questionnaire with 21 questions and multiple-choice options. The chi-square test was used in the statistical analysis of the completed questionnaires (P < 0.05). Paired t-test was used for behavior assessment of the children before and after intranasal sedation. Results A significant correlation between parental socioeconomic status and acceptance of intranasal sedation was observed. Parents with higher education levels exhibited a greater level of acceptance (P = 0.000). Parents whose children had prior dental experiences were more likely to view intranasal sedation as a safe option (P = 0.038). Additionally, a significant proportion of previously sedated children expressed willingness to undergo treatment using intranasal sedation. Evaluation of children's behavior before and after treatment revealed a notable improvement, indicating the effectiveness of intranasal sedation (P = 0.000). Conclusion The study thoroughly investigated how parents and children view intranasal sedation via MAD. It revealed a positive perception of safety and trust among parents regarding this method for pediatric dental procedures.

Oral Sedation in Pediatric Dentistry

Anxiety, dental phobia, parental expectations, and challenging patient behavior highlight the need for sedation in paediatric dentistry. Various pharmacological drugs are present within the oral sedation which helps in achieving a calm, relaxed patient who can guard their own airway, sustain their own respiration, and respond to vocal commands. An in-depth overview of oral sedation in pediatric dentistry is what this review’s main goal is to deliver. It will provide knowledge for practitioners who wish to administer oral sedative medications to their pediatric patients. The pharmacodynamics and pharmacology of frequently used oral sedative drugs will be discussed, along with pre-operative concerns, monitoring equipment requirements, and physiological considerations of the paediatric patient.

Sedation in pediatric dentistry: A scoping review

Sedation in pediatric dentistry: A scoping review

Parental preferences for the procedural sedation of children in dentistry: a discrete choice experiment.

The aim of this study was to explore parental preferences for the procedural sedation of children in dentistry through a discrete choice experiment (DCE) to inform clinical decisions and oral health management. Based on literature reviews, interviews with parents of pediatric dental patients, and expert consultation, six attributes, including fasting time, recovery time, sedative administration routes, adverse reactions, sedation depth and procedure cost, were incorporated into the DCE questionnaire. The DCE questionnaire collected data on parental preferences for pediatric dental sedation treatment from June to August 2022. A conditional logit model was used to analyze preference and willingness to pay (WTP) for each attribute and its level. Subgroup analyses assessing the impact of parents' dental anxiety on procedural sedation preferences were also conducted using conditional logit models. A total of 186 valid questionnaires were gathered. Parents' preferences for fewer adverse reactions, a milder sedation depth, lower out-of-pocket cost, shorter fasting and recovery times and administration by inhalation were significantly associated with their choice of sedation model. The conditional logit model showed that parents were most interested in treatments with no adverse reactions (0% vs. 15%) (Coef, 1.033; 95% CI, 0.833-1.233), followed by those providing minimal sedation (vs. deep sedation) (Coef, 0.609; 95% CI, 0.448-0.769). Moreover, the relative importance of adverse reactions and fasting time was higher among anxious than nonanxious parents. The study found a WTP threshold of ¥1,538 for reducing adverse reactions (15% to 0%). The WTP threshold for the best sedation procedure scenario (no fasting requirement, 10 min recovery time, administration by inhalation, 0% adverse reaction incidence and minimal sedation) was ¥3,830. Reducing the adverse reactions and depth of sedation are predominant considerations for parents regarding procedural sedation in pediatric dentistry, followed by lower cost, shorter fasting and recovery times and inhalation sedation. Parents with dental anxiety had a stronger preference for options with a lower incidence of adverse reactions and shorter fasting time than parents without dental anxiety. This discovery is helpful for doctors and can promote collaborative decision-making among parents and doctors.

Procedural sedation in pediatric dentistry: a narrative review.

Procedural sedation and analgesia are now considered standard care for managing pain and anxiety in pediatric dental patients undergoing diagnostic and therapeutic procedures outside of the operating room. Anxiolysis, which combines both pharmacologic and non-pharmacologic approaches, plays a significant role in procedural sedation. Non-pharmacologic interventions such as Behavior Management Technology can help reduce preprocedural agitation, ease the transition to sedation, reduce the required amount of medication for effective sedation, and decrease the occurrence of adverse events. As the introduction of novel sedative regimen and methods in pediatric dentistry, the potential role of mainstay sedatives administered by new routes, for new indications, and with new delivery techniques, should be considered. The purpose of this paper is to examine and discuss the current state of sedation techniques in pediatric dentistry.

Comparing the Efficacy of 3 and 5 mg/kg Intramuscular Ketamine with the Addition of Oral Midazolam and Atropine in Pediatric Dental Sedation

Statement of the Problem: One of the main obstacles in dealing with pediatric patients is patients’ lack of cooperation when undergoing dental treatment. Providing a safe yet effective method to tackle such a problem is a priority of today’s pediatric dentistry. Purpose: The aim of this study was to compare the sedative effect of 3 and 5 mg/kg intramuscular (IM) ketamine with oral atropine and midazolam. Settings and Design: This clinical trial was performed on 25 uncooperative children aged 3–5 years. Each patient acted as self-control. Patients were randomly divided into two groups. Materials and Methods: In this experimental study, one group received 5 mg/kg ketamine (Daroupakhsh, Iran) IM at first and 3 mg/kg ketamine IM at the second visit, while the other received the same doses in the opposite order. All patients received oral midazolam (0.5 mg/kg) (Dales Pharmaceutical, England) with 0.02 mg/kg atropine (Caspian Co, Rasht, Iran) half an hour before the main IM ketamine injection. Statistical Analysis Used: Collected data were analyzed using ANOVA and Wilcoxon signed-rank test. Results: There was no significant difference between sedative effects of the two administered doses of ketamine (P &lt; 0.1). In the 5 and 3 mg/kg ketamine groups, there were 80% and 76% success rates, respectively. For complications, two cases of emergence reaction and one case of visual disorders were reported in both sessions. Parents were more satisfied with child’s reactions after the 3 mg/kg ketamine dose session. Conclusion: No difference was found in effectiveness between the 3 and 5 mg/kg IM ketamine with the addition of oral midazolam and atropine in the sedation of very young children.

Sedative Agents in Minor Paediatric Oral Surgical ProceduresA Narrative Review

Sedation in pediatric dentistry reduces anxiety during surgical procedures and also helps cope with very stressful events encountered during dental treatment. Various sedative agents like Nitrous oxide, diazepam, midazolam, Ketamine, propofol, fentanyl, and dexmedetomidine have been administered through several sedation routes including oral, nasal, inhalation, intramuscular, and sub-mucosal to attain active sedation. However, it is evident that the sesedative drugs also have the prospective to causelethal complications. Aim: The present review was carried out to brief the clinical aspects of various sedative agents currently available in pediatric practices based on the existing literature with special emphasis on their role in minor pediatric oral surgical procedures. Discussion: Nitrous oxide is frequently used in combination with complextime-consuming procedures and dental extractions, particularly for young and anxious patients undergoing orthodontic extractions. Fentanyl decreases pain and anxiety but causes respiratory distress. Oral ketamine is a potent dissociative drug often combined with midazolam produces excellent analgesic and sedative effects. None the less, the most common combinations include sedatives with ketamine/opioids or dexmedetomidine to maintain the airway reflexes if given in small doses with precautions. Sometimes a combination of inhaled gases especially short-acting sevoflurane along with Diazepam is favored. Conclusion: Within the limitation, it is evident that a clear understanding of the proper selection of sedative agents, awareness of the intended level of sedation or route of drug administration, and knowledge of adverse responses during and after sedation are essential to achieve appropriate sedation levels during minor oral surgical procedures.

Managing Anxiety In Children: The Role Of Oral Sedation In Pediatric Dentistry

Managing Anxiety In Children: The Role Of Oral Sedation In Pediatric Dentistry

Nitrous Oxide Inhalation Sedation in Pediatric Dentistry: An overview of the available guidelines

Children with behavioral issues are usually inadequately treated using non-pharmacological behavior management techniques, making dental treatment a real clinical challenge for the practitioner. This leads to the indispensable need for advanced pharmacological techniques, such as inhalation sedation (IS). In pediatric dentistry, nitrous oxide sedation is considered the safest tool for a dental practitioner to use on uncooperative children, thus reducing the need for dental treatment under general anesthesia. To date, several sets of high-ranking evidence-based inhalation sedation guidelines are available,developed in the United States, United Kingdom, Europe, Australia, and New Zealand. This review summarizes the indications, contraindications, advantages, and disadvantages of using nitrous oxide sedation in children, and compares these in terms of inhalation sedation procedure and documentation. This review will assist the dental practitioner in developing appropriate practice regulations for safe and effective practice.

A double-blind randomized controlled trial to compare the safety and efficacy of dexmedetomidine alone and in combination with ketamine in uncooperative and anxious paediatric dental patients requiring pulpectomy.

To compare the sedation regimen Dexmedetomidine alone and its combination with low dose Ketamine through intravenous route in terms of safety, efficacy and recovery profile in uncooperative paediatric dental patients requiring pulpectomy. Thirty anxious and uncooperative 2-6-year-old children requiring pulpectomy in at least one primary molar were enrolled. Propofol was used as an induction agent. Drugs were administered through the intravenous route as per group assignment, i.e., Dexmedetomidine (1µg/kg) with ketamine (0.5mg/kg) administered over 10min followed by a maintenance dose of Dexmedetomidine (0.2-0.8µg/kg/h) in group A and Dexmedetomidine (1µg/kg) administered over 10min followed by a maintenance dose in group B. The sedation was titrated to achieve Houpt's overall behavior score of 4/5. The primary outcome measure was the successful completion of treatment. Secondary outcome measures were vital signs, quality of sedation, time need for the procedure, recovery time, intra-operative and post-operative adverse sequelae. Results showed that both of the regimens were similar in efficacy, safety and recovery profile. Also, the required dose of dexmedetomidine and the need for rescue boluses was similar in both of the study groups. Dexmedetomidine either alone or in combination with ketamine proved to be a safe and efficacious agent for paediatric dental sedation. No beneficial evidence of adding ketamine was observed.

Sedation in pediatric dentistry, an overview and current update

Introduction: Conscious sedation is a technique of administering sedatives or dissociative agents with or without analgesics to induce a state that allows the patient to tolerate unpleasant procedures. Objective: To analyze the literature on the types of sedation and the different drugs that can be used such as midazolam, dexmedetomidine, propofol, and nitrous oxide. Methodology: A comprehensive search was performed in PubMed, SCOPUS and Google Scholar using keywords such as sedation, pediatric dentistry, midazolam, dexmedetomidine, propofol, nitrous oxide. Results: The types of sedation are minimal, moderate, and general anesthesia, these are important in order to provide the best option according to the patient's age, condition and level of anxiety. Oral midazolam is usually used as a premedication causing good behavior, patient cooperation and decreased anxiety. Dexmedetomidine has anxiolytic, analgesic effects and little postoperative agitation. Propofol has a fast effect, short duration and fast elimination helping dentists to carry out dental treatments; as well as nitrous oxide, these two are preferred by parents. Conclusion: The best drug for sedation in pediatric dentistry is nitrous oxide because it is preferred by parents for being safe, effective, with minimal side effects and gives a good working time, it can be used in patients with special needs, with excessive anxiety or behavioral disorders making it a good alternative for sedation.

Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial.

BackgroundManagement of children has always been a challenging task in the dental office, as many children exhibit extreme fear, apprehension, and anxiety toward dental procedures. Pharmacological means of behavior management such as sedation are now at the forefront. Midazolam and nitrous oxide are the commonly employed pharmacological agents for sedation in pediatric dentistry. Though each route has its advantages and disadvantages, we compared the effect of atomized intranasal midazolam (dosage 0.3 mg/kg body weight) and nitrous oxide oxygen sedation in evaluating the behavior of child, pain experienced during local anesthesia administration, sedation level, and patient's acceptance.Materials and methodsA total of 35 (n = 35) anxious pediatric patients aged 4-7 years with negative and definitely negative behavioral rating were randomized to receive intranasal midazolam and inhalational nitrous oxide through mask. The overall behavior, alertness, and cry were recorded using Houpt rating scale while pain and sedation were assessed by face, legs, activity, cry, and consolability (FLACC) and Ellis sedation scores, respectively.ResultsThe children who received intranasal midazolam sedation were calm, had less adverse effects, and had better acceptance of the drug. Both the techniques of sedation were found to be equally effective in terms overall behavior rating.ConclusionIntranasal midazolam was found to be as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. It can also be an effective alternative for anxious patients who are unable to maintain the nitrous oxide mask throughout the dental procedure.How to cite this articleSrinivasan NK, Karunagaran P, Panchal V, et al. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021;14(S-2):S111-S116.

Comparison of efficacy and recovery time of sevoflurane inhalation deep sedation with propofol deep sedation in pediatric dentistry

Comparison of efficacy and recovery time of sevoflurane inhalation deep sedation with propofol deep sedation in pediatric dentistry

Dental Sedasyon ile İlgili YouTubeTM Videolarının Analizi: Kesitsel Çalışma

Objective: YouTubeTM is an online platform that parents usually prefer to seek information on health issues, including pediatric dental sedation. The study aimed to assess the quality, reliability, and content of the YouTubeTM videos on pediatric dental sedation. Material and Methods: The searching term was detected as 'sedation in pediatric dentistry' (Google Trends Application). The first 149 videos on YouTubeTM were listed, and the Uniform Resource Locator was copied. A five-point scale [Global Quality Scale (GQS)], reliability scores, and content analyses were performed on the videos remained which are suitable with the including criteria (n=55). The Shapiro-Wilk and the Mann-Whitney U tests were used for statistical evaluations. Results: The recent study results showed that the videos analyzed were classified as 'poor' considering the content analyses. The mean and median reliability score and GQS of the videos were generally moderate quality. The median GQS values of the rich content videos seemed to be significantly higher than the poor ones (p0.05). Conclusion: YouTubeTM videos on pediatric dental sedation seemed to be insufficient considering the study headings. Dental professionals and anesthesiologists should put more effort into improving the quality and reliability of the videos regarding pediatric dental sedation.

KNOWLEDGE, ATTITUDE AND PRACTICES OF DENTAL STUDENTS AND PRACTITIONERS TOWARDS CONSCIOUS SEDATION - A CROSS-SECTIONAL STUDY

BACKGROUND: Dental professionals work effectively and efficiently to impart a positive behavioral attitude towards dental treatment in children with oral health care needs. The main objective of sedation in pediatric dentistry is to reduce fear, minimize physical discomfort and control behavior for dental procedures. The present study was carried out to evaluate the knowledge, attitude and practices of dental students and practitioners towards conscious sedation. METHODS: A descriptive cross-sectional survey was conducted among 384 dental professionals that included undergraduate, postgraduate dental students and dental practitioners across Tamil Nadu, India. The data was collected through self-constructed questionnaires consisting of 28 questions in English and circulated via online platform on account of COVID-19 pandemic. Every respondent was informed of the purpose of the study and participation was purely voluntary. RESULTS: The mean age of the study participants was found to be 25.99 ± 12.34 years (mean ± S.D) comprising of 184 (48%) males and 200 (52%) females. Majority of the study participants acquired knowledge about conscious sedation through dental curriculum only. About 46.1% considered conscious sedation over general anesthesia for all dental procedures like restoration, scaling, minor bone fractures and minor surgeries, 40.1% preferred midazolam and 78.4% recommend Nitrous oxide sedation as effective technique. Most of the study participants believed oral sedation was easier to administer, required less expertise and skill with minimal or no complication. CONCLUSION: This study reveals lacunae in adequate knowledge and understanding among the practitioners. The result of this study thus provides an insight on need for strategies like incorporating guidelines in dental curriculum, organizing continuing dental education programs and workshops to provide knowledge and incorporate positive attitude among the dental professionals to offer effective conscious sedation in children necessitating oral health care. KEYWORDS: Dental anxiety, Midazolam, Pediatric dentistry, general

Comparative Evaluation of Effect of White Noise, Nursery Rhymes and Movie Songs as Distraction Methods On Behaviour Of Children During Induction Of Nitrous Oxide Sedation In Pediatric Dentistry

Comparative Evaluation of Effect of White Noise, Nursery Rhymes and Movie Songs as Distraction Methods On Behaviour Of Children During Induction Of Nitrous Oxide Sedation In Pediatric Dentistry

Intranasal versus sublingual route of dexmedetomidine sedation in paediatric dentistry: A randomized controlled clinical trial.

Many children experience dental anxiety during dental treatment. Conscious sedation is used to alleviate anxiety and enhance a child's cooperation. This study aimed to compare the efficacy of intranasal versus sublingual dexmedetomidine. Forty-two healthy, uncooperative children participated in the study. They were divided randomly into two groups: In the first visit, Group I received intranasal dexmedetomidine and group II received sublingual dexmedetomidine, whereas at the second visit, the alternate route was implemented in a crossover design. The child's acceptance of drug administration method was assessed using a 4-point rating scale. Time until optimum sedation was measured. Anxiety during local anesthesia administration was scored using Venham's rating scale. Postoperative response was recorded through Vernon et al's questionnaire. The sublingual dexmedetomidine route was better accepted than the intranasal route (P=0.01), while the latter acted faster (P>0.001). No significant difference in anxiety scores was found between groups at baseline (P=0.84) or during local anesthetic administration (P=0.44). No negative effect was recorded by the parents who answered the Modified Vernon et al questionnaire 24 hour after the dental visit compared to before the dental visit (P=1.00). Both routes prevented the increase in anxiety scores equally during local anesthesia and do not have negative effect on postoperative behavior of children. However, the sublingual route showed better acceptance with longer onset time of action than the intranasal route.