Moderate sedation helps improve future behavior in pediatric dental patients – a prospective study

Abstract

There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Recommended procedures for the management of early childhood caries lesions – a scoping review by the Children Experiencing Dental Anxiety: Collaboration on Research and Education (CEDACORE)

“…Considering that around 9% of pediatric patients presented dental fear/anxiety or dental behavior management problems [55], a portion of the child population may need the use of pharmacological behavior management techniques to perform the dental treatment, but just six documents considered this possibility [22,23,25,26,28,40]. Sedation and general anesthesia aimed to provide safe and effective dental care [27,56] and had proved to improve the child's behavior in the dental chair along the time [57] and to improve the oral healthrelated quality-of-life [7], respectively.…”

Sedação mínima com midazolam em Odontopediatria: relato de caso de retratamento endodôntico

“…Tal efeito se relaciona também na prevenção de situações de emergência como a lipotimia, a síncope e síndrome de hiperventilação, as quais apresentam uma incidência muito maior em pacientes com ansiedade mal controlada 37 . O medicamento escolhido para a sedação apresentada neste estudo foi o midazolam, ainda pouco utilizado em odontopediatria apesar de altamente seguro quando administrado por via oral [38][39][40][41][42] . Esse fármaco tem rápida absorção, ação e eliminação 4,13,14 .…”

“…Esse fármaco tem rápida absorção, ação e eliminação 4,13,14 . Em virtude da criança ser obesa, optou-se por uma dose bastante segura (0,55mg/kg) de acordo com a literatura [38][39][40][41][42] , sendo administrados 2 comprimidos de midazolam (30mg), além de suprimento de oxigênio durante todo o procedimento de sedação, afim de evitar queda na saturação de oxigênio no sangue, ou complicações médicas como a depressão respiratória.…”

Sedation in Pediatric Patients: Assessment of Pediatric Knowledge

“…Thus, it is required that Pediatric Dentists receive appropriate training to perform sedation. 14 Some countries, such Brazil, the use of sedation in clinical practice by dentists is still not common, mainly due to the deficiency in its formation in relation to these drugs. There is even greater fear in Pediatric Dentistry.…”