Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial

Mozafar, Sedigheh; Bargrizan, Majid; Golpayegani, Mojtaba Vahid; Shayeghi, Shahnaz; Ahmadi, Rahim

doi:10.4103/1735-3327.245235

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Regarding the age of the patients, we found that the sedative drugs most frequently used for young patients were nitrous oxide (18.20 ± 8.39 years) and midazolam (21.15 ± 9.96 years). These results are consistent with those of other studies, where nitrous oxide was sometimes combined with midazolam to add its anxiolytic, sedative, amnesic, and hypnotic effects [ 47 48 49 ].…”

Section: Discussionsupporting

confidence: 93%

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study

Cobo Vázquez,

Gasco

2024

J Dent Anesth Pain Med

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Background Excessive fear of dental procedures leads to disruptive behavior during dental examinations and treatments. Dental examinations and treatments of these patients usually require additional techniques, such as sedation. The most commonly used techniques are inhalation of nitrous oxide, infusion of propofol with fentanyl, and premedication and infusion of midazolam. Methods A prospective observational epidemiological study was conducted on patients who required sedoanalgesia techniques for dental exploration and procedures. The reasons for the inability of patients to cooperate (excessive fear or intellectual disability), age, sex, weight, systemic pathology, oral pathology, treatment performed, time of intervention, anesthetic technique performed, and occurrence of complications were recorded. Results In total, 218 patients were studied. Sixty-five patients came for fear of dental treatment and 153 for presenting with a diagnosis of intellectual disability and not collaborating in the treatment with local anesthesia. The average age of all patients was 30.54 ± 17.30 years. The most frequent oral pathologies found in patients with excessive fear were tartar (6.8%) and wisdom teeth (6.4%), followed by missing teeth (5%). In patients with disabilities, a combination of tartar and cavities appeared most frequently (41.3%), followed by cavities (15.6%). The most frequently used sedoanalgesia technique was the infusion of propofol with fentanyl in both groups of patients, followed by nitrous oxide. Conclusion The combination of propofol and fentanyl was the most frequently used alternative in patients who were unable to collaborate because of intellectual disability or carry out longer or more complex treatments. Inhaled nitrous oxide and midazolam were the sedative techniques of choice for simpler oral treatments, such as tartrectomies, shallow obturations, and shorter interventions, or in younger patients.

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Section: Discussionsupporting

confidence: 93%

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study

Cobo Vázquez,

Gasco

2024

J Dent Anesth Pain Med

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“…Therefore, when the proper use of N 2 O-O 2 is effective, the patient shows signs of depressed consciousness (e.g., relaxed, somnolent patient who may appear dissociated and with a feeling of well-being and confidence) [ 3 ] but he/she remains in verbal contact throughout treatment and maintains all vital functions [ 9 ] (e.g., preservation of airway patency and spontaneous ventilation [ 1 ]). However, there is a controversy regarding the efficacy of this technique in scientific literature [ 10 ], as it may not always be successful [ 7 11 ].…”

Section: Introductionmentioning

confidence: 99%

Success rate of nitrous oxide-oxygen procedural sedation in dental patients: systematic review and meta-analysis

Rossit

Gil-Manich

Ribera-Uribe

2021

J Dent Anesth Pain Med

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The aim of this systematic review was to determine the success rate of nitrous oxide-oxygen procedural sedation (NOIS) in dentistry. A systematic digital search was conducted for publications or reports of randomized controlled trials evaluating the clinical performance of NOIS. Abstracts of research papers were screened for suitability, and full-text articles were obtained for those who met the inclusion and exclusion criteria accordingly. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool (RoB 2). A total of 19 articles (eight randomized clinical trials with parallel intervention groups and 11 crossover trials), published between May 1988 and August 2019, were finally selected for this review. The studies followed 1293 patients reporting NOIS success rates, with a cumulative mean value of 94.9% (95% CI: 88.8–98.9%). Thirteen trials were conducted on pediatric populations (1098 patients), and the remaining six were conducted on adults (195 patients), with cumulative efficacy rates of 91.9% (95% CI: 82.5–98.1%) and 99.9% (95% CI: 97.7–100.0%), respectively. The difference was statistically significant (P = 0.002). Completion of treatment and Section IV of the Houpt scale were the most used efficacy criteria. Within the limitations of this systematic review, the present study provides important information on the efficacy rate of NOIS. However, further well-designed and well-documented clinical trials are required and there is a need to develop guidelines for standardization of criteria and definition of success in procedural sedation. Currently, completion of treatment is the most used parameter in clinical practice, though many others also do exist at the same time. To maximize NOIS efficacy, clinicians should strictly consider appropriate indications for the procedure.

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“…As more time passed after the initial treatment, it may be that children were more fearful of undergoing additional dental treatment, either because they experienced more oral health problems or feared they would in the future. With respect to mitigating dental fear, previous studies have examined the effectiveness of nitrous oxide alone [26][27][28] or in conjunction with oral sedatives such as midazolam, 29,30 but none have directly compared outcomes for patients receiving GA versus nitrous oxide. Among children receiving care under nitrous oxide, there were no clear patterns or statistically significant differences found between those with more or fewer restorative procedures or across time periods.…”

Section: Discussionmentioning

confidence: 99%

Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health

Heaton

Wallace

Randall

et al. 2023

Int J Paed Dentistry

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BackgroundDentists often use sedative medications such as nitrous oxide inhaled sedation and general anesthesia (GA) to help decrease patient fear and manage paediatric patients' behavior during treatment.AimThe goal of this study was to examine factors associated with dental fear changes after restorative dental treatment under nitrous oxide or GA in children 4–12 years old.DesignA prospective cohort study of 124 children examined changes in dental fear, number of treatment visits, and parental factors among children receiving restorative dental treatment under nitrous oxide (n = 68) or GA (n = 56) sedation. Data were collected at pretreatment (T1), 16 weeks post‐treatment (T2), and at 29‐month follow‐up (T3).ResultsDental fear increased slightly, but not significantly, under both forms of sedation between T1 and T3. Children's dental fear was associated with parents' poor dental experiences and oral health, but not with number of treatment visits.ConclusionsProgression of children's dental fear seems not dependent solely on the type of sedation used but is likely predicted by factors including pretreatment dental fear and dental needs. Dentists recommending sedation for children's dental care may consider pretreatment dental need, fear levels, and parental factors when determining which type of sedation to use.

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Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial

Cited by 8 publications

References 18 publications

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study

Dental treatments under sedation-analgesia in patients who are unable to collaborate: a prospective observational study

Success rate of nitrous oxide-oxygen procedural sedation in dental patients: systematic review and meta-analysis

Changes in children's dental fear after restorative treatment under different sedation types: Associations with parents' experiences and dental health

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