Conscious Sedation in Dentistry for the Management of Pediatric Patients with Autism: A Narrative Review of the Literature

Abstract

(1) Background: the variety of autism spectrum disorder makes the definition of guidelines for dental care a challenging task. The aim of this review was to evaluate the literature concerning the use of conscious sedation for dental treatments in pediatric autistic patients. (2) Methods: we searched MEDLINE/PubMed, EMBASE, Cochrane databases in order to identify pertinent studies. The search strategy was based on these areas of interest: autistic spectrum disorder, pediatric patients, dentistry, tranquilizing agents, and conscious sedation. (3) Results: the search yielded 177 non-duplicated articles, of which 24 articles were retrieved for full text review, and 2 were found to address our review aim. The first paper was a retrospective study that included 83 autistic patients sedated either with an oral premedication combined with nitrous oxide/oxygen inhalation or with nitrous oxide/oxygen inhalation alone; the second article was a prospective trial on the effectiveness of 0.3 mg/kg of oral diazepam with 0.5 mg/kg of oral midazolam in 13 sedated uncooperative autistic patients. (4) Conclusions: this review highlights the insufficiency of studies that can provide concrete indications for the dental treatment in conscious sedation of pediatric patients with autism. New studies are needed to better define the appropriate drugs, dosages, sedation level and evaluate patient cooperation.

Autism spectrum disorder and the risk of supernumerary teeth: A multi-centre cohort study

“…According to reports from the American Academy of Paediatrics [48], screening for ASD has been emphasized to assist in treating ASDassociated medical conditions and potentially prevent complications in the context, SNT should also be taken into consideration using a multi-disciplinary approach by establishing referrals to oral and maxillofacial surgeons, dentists, behavioural therapists, and parent training interventions [49]. Speci cally, those approaches may involve desensitization that is essential for children with ASD to undergo panoramic radiography to identify SNT and receive tell-show-do, visual pedagogy and social stories [50,51], behavioural management techniques [52] and pharmacological management [11]. To achieve this, access to healthcare providers with experience in working with children with ASD is essential; challenges would include the need for longer appointments for familiarization and the fact that some required procedures may not be covered by insurance [53].…”

Assessment of Pain During Pediatric Dental Treatment Using Different Sedative Agents: A Crossover Trial

“…Midazolam, when administered orally, has limitations such as its bitter taste and variable sedative effects due to insufficient drug ingestion [ 8 ]. Therefore, the intranasal route of administration was chosen for this study.…”

Protocolos de premedicación y sedación odontológica para personas con discapacidad. Revisión Sistemática

“…En base a una búsqueda sistemática de literatura, se encontraron 9 estudios que cumplieron con los criterios de inclusión para analizar los protocolos de premedicación y sedación en pacientes con discapacidad (14,23,15,24,25,26,27,28,29). Se aplicaron diferentes factores, como el uso de descriptores o la revisión de textos completos para la inclusión de artículos.…”