Pediatric dental sedation: challenges and opportunities

Abstract

High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

Dental attendance after treatment under dental general analgesia (DGA): a data-based follow-up study

“…Although DGA should be considered as the last alternative in dental care, it has become a daily practice; as many as 0.2% of children are treated under DGA (Savanheimo et al 2012). The reasons for this may include the development of sedative substances and methods, increase of parental knowledge of the option of DGA, as well as professional skills of the practitioners (Vinckier et al 2001;Nelson and Xu 2015).…”

An Introduction to Assessing Dental Fear and Anxiety in Children

“…If the researcher's interest is in children's intrinsic fear of dentistry in general, the instrument chosen should tap into this internal state of anxiety to understand the psychology of dental fear. Where the purpose is to determine children's anxiety response and behaviour to various dental-related stimuli for facilitating treatment planning, dental cues of fear may become the focus of the investigation, and question sets concerning behaviour or behaviour rating scales in a well-defined dental situation should be considered [38], and the chosen scale might tend to be more operator-centred (e.g., how the child's fear and anxiety disrupted the dental procedure) rather than patient-centred (e.g., how the child felt and thought during the dental procedure) [41]. Additionally, open questions regarding the child's past experiences in specific dental procedures might be practically useful for the clinician.…”

Changing Trends in Dental Procedural Sedation

“…Traditionally, oral sedation has been the mainstay of pediatric dental sedation. Because of behavioral constraints, sedation by bolus oral administration is well tolerated and routine; but sedation depth with oral medication is difficult to predict and impossible to titrate the dose [13,68,69] . However, with development of technology and better pharmacologic profile of modern drugs in new ways with high success, newer alternate routes has been proposed and investigated such as transmucosal (intranasal, buccal, sublingual) which has much less discomfort than intravenous route with faster and predictable action than oral sedation [66] .…”

“…It can be safely combined with intranasal fentanyl. Another agent frequently used in pediatric is ketamine which can also be given through various route [69][70][71] . Propofol and dexmedetomidine is also being increasingly used in paediatric procedural sedation.…”