Background
Behavioral management techniques are employed for children who are fearful and uncooperative. Pharmacologic sedation and anesthesia are frequently utilized to manage pain and anxiety in pediatric dental patients.
Aim
To evaluate the intraoperative and postoperative pain levels during dental treatment of children sedated with 1.5 μg/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide.
Materials and methods
In this crossover study, 24 children between the ages of five and seven years were randomly assigned to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhaled nitrous oxide during three different visits. At each visit, a single pulp therapy procedure was conducted after administering the respective sedative agent, and the pain levels were documented. There was a one-week interval between each visit to allow for a washout period. The data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp, Armonk, NY, United States) using the Wilcoxon signed-rank test and Kruskal-Wallis H test (p < 0.05).
Results
All three sedative agents were equally effective in controlling postoperative and intraoperative pain. Although there was no statistically significant difference among the groups, clinically, midazolam showed lower intraoperative pain levels (mean 1.78 ± 1.42).
Conclusion
In pediatric dental patients, intranasal midazolam at a dosage of 0.3 mg/kg and intranasal dexmedetomidine at a dosage of 1.5 μg/kg demonstrate comparable effectiveness to nitrous oxide sedation in pain management. These options serve as effective alternatives for anxious children who may not tolerate nitrous oxide sedation.
Botox has been used in the medical field since 1987 principally for its cosmetic treatment of wrinkles on the face and for its therapeutic uses in the management of strabismus, cervical dystonia, blehpharospasm and juvenile cerebral palsy amongst other disorders. The toxin used is botulinium toxin A (BTX-A), which is a neurotoxin, extracted from the anerobic bacteria -Clostridium botulinium. These BTX-A molecules act by inhibiting the release of acetylcholine from presynaptic vessels at the nerve terminals leading to an inhibition of muscle contraction. A growing number of dental surgeons have now been using this toxin as a part of their armamentarium for the management of various musclerelated dental disorders like bruxism, massetric hypertrophy, myofacial pain, trismus, TMJ disorders and for retraining muscles during orthodontic treatment. This procedure has also been found to be a minimally invasive, safe and reproducible alternative to surgery for perioral esthetic enhancement, which includes treating high lip-line cases, gummy smiles and lip augmentation. Pleasing and promising results have been obtained with this technique showing none or mild and transient side effects.
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