Pediatric Sedation in Dutch Dental Clinics: The Influence of Guideline Modifications on Adverse Events.

Background: Dental fear and uncooperative behavior can hinder dental treatment quality. Pediatric Procedural Sedation and Analgesia (PPSA) is used to facilitate treatment when the coping capacity is exceeded. Out-of-hospital PPSA has been associated with more adverse outcomes compared to when it is used in hospital-based settings. The updated Dutch PPSA guidelines have increased costs and raised concerns about the accessibility of specialized high-quality dental care for children in the Netherlands. This study aimed to investigate the impact of the updated 2017 guidelines on the occurrence rate of adverse events during PPSA in twelve Dutch dental clinics. Methods: The data of 25,872 children who were treated at twelve dental clinics between 1997 and 2019 were analyzed. A logistic two-level mixed-effects model was used to estimate the updated guidelines' impacts on adverse events. Results: The OR of the occurrence rate of an adverse event adjusted for age, weight, and duration of treatment was 0.75 (95% CI 0.64-0.89) after the implementation of the updated guidelines. This outcome was significant with p = 0.001, indicating a protective effect. Conclusions: Our findings demonstrate that there was a significant reduction in adverse events after the implementation of the updated guideline and highlight the importance of adhering to evidence-based practices in out-of-hospital dental clinics.

Hypnosis and Sedation for Anxious Children Undergoing Dental Treatment: A Retrospective Practice-Based Longitudinal Study.

To assess whether the treatment of children with oral midazolam and pediatric hypnosis techniques can improve the compliance in consecutive sessions, a retrospective longitudinal practice-based observational study was designed and carried out. A total of 311 children between 3 and 12 years of age were treated under hypnosis and sedation with midazolam (0.40 mg/kg body weight). Treatments were performed in one to a maximum of three sessions. A total of 183 children received one, 103 received two and 25 children received three treatment sessions. The behavior of the children during the sessions was examined by means of the Venham score. The self-evaluation of the children was based on the Wong−Baker Scale. Child behavior using midazolam and hypnosis techniques showed little difference and good compliance between the sessions. Venham scores did not increase significantly regarding total treatment from the first (0.99 ± 1.41) to the second (1.17 ± 1.39) and to the third session (1.27 ± 1.20) (p > 0.05). However, considering the highest Venham scores that occurred in each case, the behavior of the children worsened significantly (p < 0.01) during the three treatment sessions, from 1.37 ± 1.31 (first) to 1.87 ± 1.74 (second) to 2.32 ± 1.33 (third). In 6.11% of the children, treatment was discontinued in the first session (n = 19), 0.96% in the second (n = 3) and 0% in the third. Treatment with low-dose midazolam, combined with hypnosis techniques, showed to be an effective option for dental treatment in children. Within the limitations of the current study, and with consideration of highest possible compliance, no more than two treatment sessions for pediatric dental treatment should be performed.

Longitudinal Changes in Dental Fear and Coping Behavior in Children, Adolescents, and Young Adults With Cleft Lip and/or Cleft Palate.

OBJECTIVE: To determine changes in dental anxiety levels of cleft lip and/or palate (CL/P) children and to explore the role of coping strategies in the development of their dental anxiety. DESIGN: Prospective study. SETTING: Free University Medical Center Amsterdam. PATIENTS: A sample of CL/P children (at T1: n = 153, 4 to 18 years, 67 girls; at T2: n = 113, 7 to 21 years, 51 girls). Data were available at both time points for 102 children. MEASURES: Dental anxiety and coping strategies were assessed at the start of the study (T1; mean age: 9.8 years, standard deviation 4.1) and 3 years later (T2; mean age: 13.4 years, standard deviation 3.8). These scores were compared to a normative group of Dutch children. MAIN OUTCOME MEASURE(S): The severity of dental anxiety was indexed using the Parental Version of the Dental Subscale of the Children's Fear Survey Schedule. Dental coping strategies were assessed with the Dental Cope Questionnaire. RESULTS: Overall, dental anxiety decreased to a level equal to normative scores of Dutch children. However, 5% of the children became more anxious. At T2, children used significantly fewer coping strategies. Children whose level of dental anxiety increased significantly used more destructive coping strategies than children whose level of dental anxiety decreased significantly or remained stable. CONCLUSIONS: Results suggest that dental anxiety levels of most CL/P children gradually decline over time. Whereas some coping strategies have the potential to be protective, more destructive coping strategies may put children at greater risk for developing and maintaining their dental anxiety.

Measuring dental fear using the CFSS-DS. Do children and parents agree?

BACKGROUND: In most studies, the parental version of the CFSS-DS is used; however, no information is available concerning the extent to which parents are able to report dental fear on behalf of their children. AIM: This study aims to assess whether parents are accurate reporters of their child's dental fear. METHODS: The CFSS-DS was filled out by 326 children in a classroom setting and by 167 parents (mostly mothers) at home on behalf of their child. Intraclass correlation coefficients were used as a measure of agreement between both CFSS-DS versions, and reasons for nonagreement were assessed. RESULTS: Mean CFSS-DS for children was 21.15 (SD = 6.4) and for parents 23.26 (SD = 6.7). The intraclass correlation coefficient was 0.57. After selection of the 73.1% most accurate reporting parents, the ICC was 0.90. In general, parents estimate the dental fear of their children higher than their children do (P ≤ 0.001), whereas parents of high anxious children (HAC) estimate this fear lower, and parents of low anxious children (LAC) estimate this fear higher. Anxious parents (AP) estimate the dental fear of their children significantly higher than nonanxious parents (NAP) (P ≤ 0.001), but the children of AP do not estimate their own dental fear higher than children of NAP. CONCLUSIONS: In general, parents tend to estimate the dental fear of their children slightly higher than their children.