Effectiveness of Intranasal Dexmedetomidine with Nitrous Oxide Compared to Other Pediatric Dental Sedation Drug Regimens.

Purpose: The purpose of this study was to compare the effectiveness of intranasal dexmedetomidine (DEX), oral midazolam (MID), and oral midazolam combined with oral hydroxyzine (MIDHYD) with nitrous oxide when used for sedation during pediatric dental procedures. Methods: The charts of 146 patients who underwent dental procedures using moderate sedation with DEX, MID, or MIDHYD, all with nitrous oxide, from January 2014 to December 2019, were reviewed retrospectively. Sedations were evaluated for effectiveness based on sedation level and behavior using a modified University of Michigan Sedation Scale and behavior using the American Academy of Pediatric Dentistry sedation behavior scale. Procedures planned and completed were evaluated for each sedation regimen. Results: Overall, the effectiveness was not statistically different between sedation regimens (P=0.71). More stainless steel crowns were planned and completed with DEX, more resins were planned and completed with MIDHYD, and more extractions were planned and completed with MID. The onset of action and working time were found to be statistically significant between sedation regimens; DEX had the longest working time. Conclusions: This retrospective study found that intranasal dexmedetomidine with nitrous oxide showed no statistical difference in effectiveness, compared with oral midazolam or oral midazolam combined with oral hydroxyzine and nitrous oxide, in moderate sedation for pediatric dental procedures. The majority of stimulating time-consuming procedures were completed in the DEX sedation regimen.

Dental surgery and anesthetic precautions of a patient with Down syndrome and juvenile rheumatoid arthritis: a case report.

Down syndrome and juvenile rheumatoid arthritis have been associated with ligament laxity, specifically the atlantoaxial ligament, which maintains the proper positioning of the cervical first and second vertebrae. The joint consists of different pathological processes, and it is paramount that individuals with either condition be screened appropriately before surgery is contemplated. The purpose of this paper was to present a case of an individual with both conditions and describe precautionary measures that were undertaken to safely complete dental treatment under general anesthesia and avoid morbidity.