Self‐ratings by phobic patients during dental treatment: Greater improvement with nitrous oxide than midazolam

Abstract

The efficacy of intravenous midazolam and nitrous oxide inhalation at reducing self-rated mood and bodily symptoms was compared in patients referred to a dental sedation unit because their dental fears precluded treatment undrugged. Fifty-eight per cent of our patients could be randomly allocated to drug treatment, the others were assigned on clinical grounds. When they arrived for their first treatment, the clinically allocated patients (n = 40) were significantly more anxious, tense and restless than those randomly allocated (n = 61). Both drugs reduced ratings of anxious, tense, discontented and restlessness, but the improvements were greater with nitrous oxide. Nitrous oxide reduced ratings of irritable and depressed, but patients treated with midazolam only showed reductions when dental treatment was finished. The scores for 70 patients were analysed over two treatment days; their pre-sedation scores of tense, depressed and discontented were lower on day 2 than on day I, with the randomly allocated group showing greater reduction. Nitrous oxide remained superior on day 2. Thirty-eight patients completed 3 days of treatment; there were no further reductions in baseline ratings and the superiority of nitrous oxide was maintained.

Predictors of dental anxiety and effects of treatment with nitrous oxide and midazolam in dentally phobic patients

“…We are therefore unable to separate out the contributions of each drug from the effect of having successfully received dental treatment. This contrasts with our previous finding of a clear superiority of nitrous oxide over midazolam in reducing the patient's seif-ratings of anxiety, when this was assessed during the gctsal treatment (Goodall et al, 1994). Whether the reductions in dental anxiety are of sufficient magnitude, and sufficiently long-lasting, to convey benefit for future dental treatment remains unknown.…”

Dental anxiety reduction and dental attendance after treatment in a dental fear clinic: a follow‐up study

“…For example, in a study that compared a BM approach with GA, it was found that BM was superior to GA in terms of reduction in dental anxiety scores (both self-reported and as rated by dentist) and led to less late cancellations and broken appointments (29). Another study, comparing NOS with IVS, found that reduction of distress during treatment was less for IVS patients than for NOS patients (30). Patients treated with concentrations of nitrous oxide gas utilized in dental fear clinics experience dental treatment fully conscious and are able to influence their own depth of sedation.…”

¿Por qué se le tiene miedo al dentista?: Estudio descriptivo de la posición de los pacientes de la Sanidad Pública en relación a diferentes factores subyacentes a los miedos dentales

“…Entre las disciplinas que se dedican a la prevención y tratamiento del miedo dental está la odontología conductual que aplica los principios teóricos, metodológicos y tecnológicos de la psicología conductual al ámbito extenso de la salud dental, pero principalmente a la prevención y tratamiento de la ansiedad dental y de los miedos dentales mediante la aplicación de múltiples técnicas orientadas al cambio conductual 3* . La utilización de las benzodiacepinas por diferentes vías de administración (oral, rectal, intranasal, intravenosa) es frecuente y sobradamente conocida en la prevención de estos problemas [14][15][16][17] . Otra alternativa es el uso de óxido nitroso que también se muestra eficiente en la prevención de estos sucesos 16,18 .…”

“…La utilización de las benzodiacepinas por diferentes vías de administración (oral, rectal, intranasal, intravenosa) es frecuente y sobradamente conocida en la prevención de estos problemas [14][15][16][17] . Otra alternativa es el uso de óxido nitroso que también se muestra eficiente en la prevención de estos sucesos 16,18 . Otros profesionales obtienen una reducción sustancial de la ansiedad y el miedo dental a través de sencillas sesiones de reestructuración cognitiva, modificando las ideas negativas que los sujetos tienen, perdurando en el tiempo la reducción del miedo conseguida 17,[19][20][21][22] .…”