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

Abstract

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.

A Comparative Study of Parent and Child Perspectives on Using the Intranasal Mucosal Atomization Device for Behavior Management in Pediatric Dental Sedation

“…Due to its rapid onset of effect and relatively straightforward administration approach, the intranasal route is becoming more and more popular [6]. Nitrous oxide-oxygen sedation, also known as "laughing gas," is supported by the Council of European Dentists as the recommended standard sedation technique [7,8]. It offers rapid onset and recovery, dosage flexibility, and less harm to the body's systems [7].…”

“…Nitrous oxide-oxygen sedation, also known as "laughing gas," is supported by the Council of European Dentists as the recommended standard sedation technique [7,8]. It offers rapid onset and recovery, dosage flexibility, and less harm to the body's systems [7]. Intranasal sedative drugs, when delivered through a mucosal atomization device (MAD, BVM Meditech Pvt Ltd, New Delhi), offer rapid absorption into the systemic circulation via the nasal mucosa.…”