Sedation of children undergoing dental treatment

Ashley, Paul; Chaudhary, Mohsin; Lourenço-Matharu, Liège

doi:10.1002/14651858.cd003877.pub5

Cited by 56 publications

(80 citation statements)

References 82 publications

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“…However, crossover clinical trials in pediatric dental anesthesia and sedation continue to be published (7,8). In a systematic review on pediatric dental sedation, 45 randomized controlled trials (RCT) were excluded from the analysis because they had a crossover design (9). In fact, it is assumed that the level of anxiety/behavior in the first session influences the anxiety/behavior in the second session (9), but that has not been proven in the pediatric dental sedation context.…”

Section: Crossover Studies Of Pediatric Dental Sedation Are Inapproprmentioning

confidence: 99%

Crossover Studies of Pediatric Dental Sedation are Inappropriate

et al. 2019

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Crossover studies continue to be published in spite of warnings about their inherent risks in relation to behavioral outcomes. This study took the opportunity of access to secondary data analysis in order to demonstrate the impact of a crossover design on the outcomes of randomized clinical trials aimed at the behavior of children during dental treatment. We evaluated the effect of the sequence of sedative administration, the sedative and the participant’s age on the behavior of children undergoing two sequential dental visits. Eighteen uncooperative healthy young children were equally randomly assigned to: (G1) 1.0 mg/kg oral midazolam (first session) and oral placebo (second session); (G2) oral placebo (first) and 1.0 mg/kg oral midazolam (second). One trained observer assessed children’s behavior. Data were analyzed by three-way mixed ANOVA. Both midazolam [mean(SD); 71.7%(16.5)] and placebo [48.6%(33.1)] produced more struggling behavior when they were administered in the first session compared to the second one (p=0.001). For the placebo, children aged 2-3 years exhibited more struggling behavior [G1 54.9%(36.2); G2 80.5%(8.3)] than those aged 4-5 years (p=0.04). Also, the reduction of percentage of struggling behavior was higher in G1 for older children (76.2%) and in G2 for younger children (32.9%). There were significant interactions between drug and sequence of administration, and between drug and age. The results of our study confirm the conventional wisdom that crossover study design is inappropriate to evaluate children’s behavior/anxiety related-dental treatment under sedation and the results of crossover studies of dental sedation should be treated with extreme caution.

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Section: Crossover Studies Of Pediatric Dental Sedation Are Inapproprmentioning

confidence: 99%

Crossover Studies of Pediatric Dental Sedation are Inappropriate

et al. 2019

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“…7 Later, the Cochrane collaboration published a protocol aiming to assess the effectiveness of non-pharmacological interventions for DA in children, 8 as well as a 2018 review update reported that oral midazolam is effective for paediatric dental sedation, with a moderate-certainty evidence. 9 That is, the approach of DA/DF/DBMP in paediatric dentistry is a topic that needs studies with better design to allow the development of more evidence-based guidelines and curricula. Besides, clinicians must also consider methods that serve the rights of the child: Non-discrimination (article 2), best interest of the child (article 3), right to life survival and development (article 6), right to be heard (article 12), and right to receive the highest attainable standard of health (article 24), among others (The United Nations Convention on the Rights of the Child).…”

Section: Introductionmentioning

confidence: 99%

A curriculum for behaviour and oral healthcare management for dentally anxious children—Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

Costa

Bendo

Daher

et al. 2020

Int J Paed Dentistry

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Background: Dentists need training in the management of children's anxiety (DA), fear (DF) and behaviour management problems (DBMP) but little is known of their competence on this topic. Aim: To report dentists' opinions and attitudes about protective stabilisation and pharmacological techniques for the management of children with DA/DF/DBMP; to propose a postgraduate curriculum focussing on DA/DF/DBMP. Design: A survey of 301 Brazilian dentists and later a modified Delphi process to outline the curriculum in two phases: (a) face-to-face discussions with 33 early career researchers mentored by six researchers, both from UK and Brazil; (b) online discussions by eight early and senior researchers on the knowledge, experience, and competencies necessary for a specialist in paediatric dentistry in Brazil that should be included in the core curriculum of postgraduate courses. Results: Almost all (99.0%) of the survey respondents provide treatment to children with DA/DF/DBMP, and 91.2% do not systematically diagnose these conditions; 94.3% use protective stabilisation, and 20.0%-30.0% have training in pharmacological | 557 COSTA eT Al.

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“…DA varies from very mild to extreme levels, and interacts with urgency of treatment, therefore different approaches to anxiety reduction may be appropriate given the level of anxiety [10,11]. Although it is possible to employ pharmacological interventions to manage high level of anxiety, such as anesthesia or sedation [12], dentists generally use communicational, behavioral and psychological techniques to manage children's low or moderate level of DA and achieve a high quality of dental care. These include methods such as "Tell-Show-Do" (TSD), voice control, distraction, modelling, restraint, and cognitive restructuring [13,14].…”

Section: Introductionmentioning

confidence: 99%

Experiential learning for children’s dental anxiety: a cluster randomized trial

Zhu

Xie

et al. 2020

BMC Oral Health

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Background: Dental anxiety (DA) has an impact on the quality of dental treatment and may have long-lasting implications for children. A recent study introducing experiential learning (EL) into children's oral health promotion resulted in better oral hygiene. The purpose of the study is to evaluate whether EL can reduce children's DA. Methods: In September 2018, we recruited 988 children aged 7-8 years from 24 classes to participate in a clusterrandomized trial. Classes were randomly assigned to EL (in which children received a lively presentation on oral health and participated in a role play in a simulated dental clinic in the classroom) or the Tell-Show-Do (TSD) group (in which children received a conventional TSD behavior management). The primary outcome was the prevalence of high DA after the procedure of pit and fissure sealant (PFS), assessed by a modified Children's Fear Survey Schedule-Dental Subscale. Secondary outcomes were changes in blood pressures (BP) and pulse rates (PR) before and after the PFS procedure. The intervention effects were estimated by means of mixed effect models, which included covariates of gender and school (and baseline value for BP and PR only), and a random cluster effect. Results: In 396 children of the EL group who received the PFS treatment, the prevalence of high DA (score ≥ 38) was 18.5%, compared with 24.3% in 391 children of the TSD group (OR = 0.65; 95% confidence interval, 0.46-0.93; P = 0.019). The increases in BP and PR after the PFS were also significantly less in the EL group. Conclusion: School-based experiential learning intervention before a dental visit is feasible and effective in reducing children's dental anxiety during PFS.

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Sedation of children undergoing dental treatment

Cited by 56 publications

References 82 publications

Crossover Studies of Pediatric Dental Sedation are Inappropriate

Crossover Studies of Pediatric Dental Sedation are Inappropriate

A curriculum for behaviour and oral healthcare management for dentally anxious children—Recommendations from the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

Experiential learning for children’s dental anxiety: a cluster randomized trial

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