RESUMEN
Oral behavior management methods include basic behavior management methods and drug behavior management methods. In many cases, dental treatment that cannot be done simply through basic behavior management is not possible. The uncooperative behavior of children with dental fear in oral treatment has increased the demand for medication based behavior management methods. Drug sedation can provide more effective analgesic and anti-anxiety effects, thereby helping to provide comfortable, efficient, and high-quality dental services. This article will review the drug sedation methods selected in clinical treatment of pediatric dental fear in recent years, as well as the safety and effectiveness of commonly used drugs, in order to provide guidance for dental professionals in clinical practice.
Asunto(s)
Anestesia Dental , Anestesia , Ansiolíticos , Niño , Humanos , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Ansiedad al Tratamiento Odontológico/prevención & control , Terapia Conductista , Sedación ConscienteRESUMEN
La evidencia científica presente en la literatura indica que el cannabis puede ser utilizado con fines terapéuticos para tratar distintas afecciones odontológicas. Dado el acceso sencillo a la cavidad bucal, las distintas formulaciones de cannabis pueden aplicarse de forma tópica. La aplicación local de dosis bajas de cannabis ha demostrado alta efectividad para tratar distintas afecciones bucales, constituyendo un tratamiento seguro con baja probabilidad de generar repercusiones sistémicas indeseadas. En la actualidad, está siendo incorporado a materiales convencionales de uso e higiene odontológica con la finalidad de aprovechar sus efectos terapéuticos. El cannabis tiene múltiples usos en odontología: como componen-te de enjuagues bucales y soluciones para la desinfección de conductos radiculares, en tratamientos de trastornos de ansiedad bucal, como complemento en terapias oncológicas, como analgésico para atenuar el dolor inflamatorio y el neuropático, como miorrelajante y condroprotector para tratar trastornos de articulación témporomandibular (ATM) y bruxismo, como osteomodulador para el tratamiento de patologías que comprometen la integridad ósea, como la enfermedad periodontal y la osteoporosis, y para la cicatrización ósea asociada a fracturas, extracciones dentarias e implantes, y como inmunomodulador con potencial terapéutico para tratar patologías autoinmunes como las enfermedades reumáticas. El trata-miento local con cannabis es efectivo, bien tolerado por el paciente y con pocos efectos adversos. Por lo tanto, se puede concluir que el cannabis aporta un enorme abanico de posibilidades terapéuticas para tratar distintas afecciones odontológicas, aunque aún se requiere mayor cantidad de estudios científicos que avalen su utilización en cada situación fisiopatológica particular (AU)
The scientific evidence present in the literature indicates that cannabis can be used for therapeutic purposes to treat different dental conditions. Given the easy access to the oral cavity, the different cannabis formulations can be applied topically. The local application of low doses of cannabis has shown high effectiveness in treating different oral conditions, constituting a safe treatment with a low probability of generating unwanted systemic repercussions. It is currently being incorporated into conventional materials for dental use and hygiene in order to take advantage of its therapeutic effects. Cannabis has multiple uses in dentistry: as a component of mouthwashes and solutions for disinfecting root canals, in the treatment of oral anxiety disorders, as a complement in oncological therapies, as an analgesic to reduce inflammatory and neuropathic pain, as a muscle relaxant and chondroprotective to treat temporomandibular joint disorders and bruxism, as an osteomodulator for the treatment of pathologies that compromise bone integrity, such as periodontal disease and osteoporosis, and or bone healing associated with fractures, dental extractions and implants, and as immunomodulator with therapeutic potential to treat autoimmune pathologies such as rheumatic diseases. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Local treatment with cannabis is effective, well tolerated by the patient and with few adverse effects. Therefore, it can be concluded that cannabis provides an enormous range of therapeutic possibilities to treat different dental conditions, although more scientific studies are still required to support its use in each particular pathophysiological situation (AU)
Asunto(s)
Humanos , Dronabinol/uso terapéutico , Cannabinoides/uso terapéutico , Receptores de Cannabinoides/uso terapéutico , Higiene Bucal/instrumentación , Enfermedades Periodontales/tratamiento farmacológico , Pulpitis/tratamiento farmacológico , Neuralgia del Trigémino/tratamiento farmacológico , Enfermedades Óseas/tratamiento farmacológico , Dolor Facial/tratamiento farmacológico , Bruxismo/tratamiento farmacológico , Neoplasias de la Boca/tratamiento farmacológico , Enfermedades Reumáticas/tratamiento farmacológico , Administración Oral , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Enfermedades de la Boca/tratamiento farmacológicoRESUMEN
Perioperative arrhythmias may be induced by an imbalance between sympathetic and parasympathetic activities owing to excessive mental and physical stress. To date, no studies have been conducted on intravenous sedation (IVS) during dental procedures in a serious dental anxiety patient with atrioventricular junctional rhythm (AVJR). We describe herein the management of IVS in an outpatient with dental phobia who experienced the AVJR followed by vasovagal reflex (VVR) during dental care. A 26-year-old woman with serious dental anxiety was scheduled for dental extraction under intravenous conscious sedation. A II-lead electrocardiogram revealed AVJR following sinus rhythm. Immediately afterwards, she experienced VVR with dimmed vision, cold sweat, hypotension, and bradycardia. She was made to relax in the supine position, which restored hemodynamics to normal, and sinus rhythm followed. She was optimally sedated with midazolam 4 mg and uneventfully treated under a preparation of intravenous atropine, and hemodynamic and respiratory statuses were closely monitored to ensure spontaneous breathing without any signs of AVJR or cardiorespiratory disorders. Finally, flumazenil 0.5 mg was administered, and she recovered without re-sedation or prolonged sedation. The autonomic nervous system and endocrine system are closely related in order to control the stress responses. The present case suggests that an electrocardiographic change such as AVJR is induced by an imbalance of autonomic activity owing to excessive psychosomatic stress and is considered as a possible prodromal sign of VVR as the dental procedures are likely to be stressful for some patients.
Asunto(s)
Pacientes Ambulatorios , Informe de Investigación , Adulto , Arritmias Cardíacas , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Femenino , Humanos , Midazolam/uso terapéutico , ReflejoRESUMEN
Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.
Asunto(s)
Anestesia Local/psicología , Sedación Consciente/métodos , Atención Odontológica/métodos , Odontología/normas , Administración Oral , Adulto , Atención Ambulatoria/psicología , Atención Ambulatoria/normas , Anestesia Dental/tendencias , Anestesia Local/efectos adversos , Anestésicos por Inhalación/administración & dosificación , Ansiolíticos , Benzodiazepinas/administración & dosificación , Benzodiazepinas/farmacocinética , Sistema Nervioso Central/efectos de los fármacos , Niño , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Ansiedad al Tratamiento Odontológico/epidemiología , Ansiedad al Tratamiento Odontológico/prevención & control , Atención Odontológica/psicología , Humanos , Óxido Nitroso/administración & dosificación , Tempo Operativo , Periodo Posoperatorio , Seguridad/normasRESUMEN
OBJECTIVE: To investigate the effectiveness of lavender oil (Lavandula angustifolia Mill) inhalation on anxiety, mood, and vital signs (blood pressure, respiratory rate, heart rate, and saturation) of patients undergoing oral surgery. Vital signs were considered as primary outcome measures. Paired anxiety tests were used as secondary outcome measures. METHODS: Patients who had dental anxiety according to the Dental Anxiety Questionnaire (DAQ) were enrolled in the study. One hundred twenty-six patients who were undergoing wisdom tooth removal under local anaesthesia were randomly assigned to the lavender oil and control groups. Paired anxiety tests (Modified Dental Anxiety Scale and State-Trait Anxiety Inventory-State Scale were performed. Vital signs were noted pre-, intra-, and post-operatively. Visual analogue scale (VAS) results were assessed. The patients' degree of satisfaction was noted. RESULTS: Pre-operative anxiety levels were similar in both groups. Significant changes in blood pressure were observed in the lavender oil group post-operatively (pâ¯<â¯.05). Most (79.4%) of the patients in the lavender oil group enjoyed the scent, 89.68% were satisfied with their experience, and 97.62% of the patients stated that they would prefer the same protocol when needed. CONCLUSION: Inhalation of lavender oil, which is one of the most powerful anxiolytic essential oils, reduces peri-operative anxiety and can be prospectively considered in future studies for its potential sedative characteristics in patients undergoing surgical procedures under local anaesthesia. TRIAL REGISTRATION NUMBER: NCT03722771 (Influence of Lavender Oil on Vital Signs in Oral Surgery Patients) https://clinicaltrials.gov/ct2/show/NCT03722771.
Asunto(s)
Ansiolíticos/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Frecuencia Cardíaca/efectos de los fármacos , Lavandula , Aceites Volátiles/administración & dosificación , Aceites de Plantas/administración & dosificación , Frecuencia Respiratoria/efectos de los fármacos , Administración por Inhalación , Adolescente , Adulto , Ansiolíticos/uso terapéutico , Ansiedad al Tratamiento Odontológico/fisiopatología , Femenino , Humanos , Masculino , Aceites Volátiles/uso terapéutico , Aceites de Plantas/uso terapéutico , Extracción Dental/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
PURPOSE: The objective of the present study was to compare 3 sedation protocols using diazepam, midazolam, and nitrous oxide. PATIENTS AND METHODS: A total of 120 patients with an indication for extraction of third molars were selected. All 120 patients had had moderate to severe levels of anxiety according to the Corah Dental Anxiety Scale. The patients were randomly divided into 3 groups. The patients' vital signs were measured, and the results analyzed by descriptive statistical analysis and statistical tests of comparison. RESULTS: No statistically significant differences were found in the patients' heart rate. However, the differences in the systolic and diastolic blood pressure were statistically significant after 15 minutes of nitrous oxide sedation. The oximetry data showed no differences among the 3 sedation protocols. We also found no statistically significant differences in the retrograde amnesia test. The differences in anxiety from preoperatively to postoperatively were statistically significant for all techniques, demonstrating their effectiveness in anxiety control. CONCLUSIONS: All 3 preoperative sedation techniques for anxious patients undergoing extraction of third molars used in the present study were effective in controlling the anxiety, with little effect on the patients' vital signs and retrograde amnesia.
Asunto(s)
Sedación Consciente , Ansiedad al Tratamiento Odontológico , Diazepam , Hipnóticos y Sedantes , Midazolam , Óxido Nitroso , Extracción Dental , Anestesia Dental , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Diazepam/administración & dosificación , Humanos , Hipnóticos y Sedantes/administración & dosificación , Midazolam/administración & dosificación , Tercer Molar , Óxido Nitroso/administración & dosificaciónRESUMEN
OBJECTIVE: The aim of this review was to evaluate the implementation of shared decision-making (SDM) in dentistry and the roles of informed consent and patient decision-making aids (PDAs) as part of this process. MATERIALS AND METHODS: A review of pertinent literature was performed using PubMed and MEDLINE to determine the current position of the application of SDM in dentistry and the influence of informed consent and PDAs on this process. RESULTS: Limited number of published studies on the implementation of SDM in dental practice is available. These studies demonstrated that SDM is influenced by many factors. Informed consent intertwines with the SDM process and begins with providing high quality information to patients and employing PDAs. PDAs have been developed for some dental fields to facilitate the SDM process. CONCLUSIONS: SDM is applied in dentistry and is influenced by many factors. Informed consent is an important part of this process. PDAs in more dental fields need to be further developed, in order to ensure a satisfactory integration of patients in the SDM process.
Asunto(s)
Toma de Decisiones Conjunta , Técnicas de Apoyo para la Decisión , Atención Odontológica/métodos , Consentimiento Informado/normas , Participación del Paciente/métodos , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Odontológica/normas , Relaciones Dentista-Paciente , Humanos , Prioridad del Paciente , EspecializaciónRESUMEN
The use of medical management techniques for the management of anxiety is fundamental to the practice of dentistry. Around 7% of the population are likely to need these techniques for general dental care and a higher proportion for more invasive treatment such as oral surgery. This paper highlights the current expectation of effective and safe practice of conscious sedation techniques in light of recent updated guidance from several UK institutions.
Asunto(s)
Anestesia Dental , Ansiedad al Tratamiento Odontológico , Cirugía Bucal , Sedación Consciente , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Odontológica , HumanosRESUMEN
BACKGROUND: One contributing factor to the development of nocebo effects is information provided about possible side effects. However, nondisclosure of information can be problematic. PURPOSE: We assessed whether positively framed side effect information (highlighting likelihood of not experiencing side effects) can reduce nocebo effects compared to negatively framed information (highlighting likelihood of experiencing side effects). METHODS: One hundred twelve participants took part in research ostensibly assessing the influence of benzodiazepines (actually sham capsules) on anxiety. Participants were randomized to receive a sham capsule with positively or negatively framed information about four side effects, or a no-treatment control condition. Side effect expectations were assessed after information provision. Framed side effects and other unmentioned symptoms were assessed during the session and 24-hr follow-up. RESULTS: Nocebo effects occurred in symptoms presented as side effects (regardless of framing) during the study session and follow-up (ps < .003). At follow-up, there was also a nocebo effect in other unmentioned symptoms (p = .018). Positive framing reduced side effect symptoms compared with negative framing during the study session (p = .037), but this effect was no longer present at follow-up (p = .53). Side effect expectations did not differ between the framing conditions (p = .14). CONCLUSIONS: Positive framing reduced side effects short-term, but not at follow-up. Expectations did not differ between negative and positive framing. Nocebo effects appeared to generalize to other unmentioned symptoms over a 24-hr period. Further research is needed to determine whether the initial impact of positive framing can be maintained over time.
Asunto(s)
Información de Salud al Consumidor , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Efecto Nocebo , Adolescente , Adulto , Benzodiazepinas/efectos adversos , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Placebos , Adulto JovenRESUMEN
BACKGROUND: Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012. OBJECTIVES: To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in children up to 16 years of age. We excluded cross-over trials. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed. MAIN RESULTS: We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both. AUTHORS' CONCLUSIONS: There is some moderate-certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment. There is a need for further well-designed and well-reported clinical trials to evaluate other potential sedation agents. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.
Asunto(s)
Ansiolíticos/uso terapéutico , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Dental para Niños/psicología , Hipnóticos y Sedantes/uso terapéutico , Analgésicos no Narcóticos/administración & dosificación , Ansiolíticos/administración & dosificación , Niño , Hidrato de Cloral/administración & dosificación , Atención Dental para Niños/métodos , Humanos , Hidroxizina/administración & dosificación , Hipnóticos y Sedantes/administración & dosificación , Meperidina/administración & dosificación , Midazolam/administración & dosificación , Óxido Nitroso/administración & dosificación , Medicación Preanestésica/métodos , Ensayos Clínicos Controlados Aleatorios como AsuntoAsunto(s)
Anestesia Dental , Anestésicos por Inhalación/administración & dosificación , Atención Dental para Niños , Óxido Nitroso/administración & dosificación , Anestesia Dental/instrumentación , Anestesia Dental/métodos , Anestésicos por Inhalación/efectos adversos , Niño , Sedación Consciente/instrumentación , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Dental para Niños/instrumentación , Atención Dental para Niños/métodos , Humanos , Monitoreo Fisiológico , Óxido Nitroso/efectos adversos , Salud Laboral , Oxígeno/administración & dosificación , Oxígeno/efectos adversos , Odontología Pediátrica , Estados UnidosRESUMEN
INTRODUCTION: Several techniques have been proposed to manage dental fear/dental anxiety (DFA) in children and adolescents undergoing dental procedures. To our knowledge, no widely available compendium of therapies to manage DFA exists. We propose a study protocol to assess the evidence regarding pharmacological and non-pharmacological interventions to relieve dental anxiety in children and adolescents. METHODS AND ANALYSIS: In our systematic review, we will include randomised trials, controlled clinical rials and systematic reviews (SRs) of trials that investigated the effects of pharmacological and non-pharmacological interventions to decrease dental anxiety in children and adolescents. We will search the Cochrane Database of Systematic Reviews, the Cochrane Database of Abstracts of Reviews of Effects=, the Cochrane Central Register of Controlled Trials, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature and the Web of Science for relevant studies. Pairs of review authors will independently review titles, abstracts and full texts identified by the specific literature search and extract data using a standardised data extraction form. For each study, information will be extracted on the study report (eg, author, year of publication), the study design (eg, the methodology and, for SRs, the types and number of studies included), the population characteristics, the intervention(s), the outcome measures and the results. The quality of SRs will be assessed using the A Measurement Tool to Assess Reviews instrument, while the quality of the retrieved trials will be evaluated using the Cochrane Handbook for Systematic Reviews of Interventions criteria. ETHICS AND DISSEMINATION: Approval from an ethics committee is not required, as no participants will be included. Results will be disseminated through a peer-reviewed publications and conference presentations.
Asunto(s)
Ansiedad al Tratamiento Odontológico/terapia , Odontología Basada en la Evidencia , Miedo , Odontología Pediátrica , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Humanos , Proyectos de Investigación , Revisiones Sistemáticas como AsuntoRESUMEN
BACKGROUND: Anxiety symptoms are frequently observed in dental patients, whether they are undergoing simple or more invasive procedures such as surgery. This research aimed to compare the effects of Passiflora incarnata and midazolam for the control of anxiety in patients undergoing mandibular third molar extraction. MATERIAL AND METHODS: Forty volunteers underwent bilateral extraction of their mandibular third molars in a randomized, controlled, double-blind, crossover clinical trial. Passiflora incarnata (260 mg) or midazolam (15 mg) were orally administered 30 minutes before surgery. The anxiety level of participants was evaluated by questionnaires and measurement of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2 ). RESULTS: Considering each procedure independently, there were no significant differences between the protocols in BP, HR, and SpO2 . Over 70% of the volunteers responded that they felt quiet or a little anxious under both protocols. With midazolam, 20% of the participants reported amnesia (not remembering anything at all), while Passiflora showed little or no ability to interfere with memory formation. CONCLUSIONS: Passiflora incarnata showed an anxiolytic effect similar to midazolam, and was safe and effective for conscious sedation in adult patients who underwent extraction of their mandibular third molars
Asunto(s)
Humanos , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Extracción Dental/métodos , Passiflora/uso terapéutico , Midazolam/uso terapéutico , Procedimientos Quirúrgicos Orales/psicología , Ansiolíticos/uso terapéuticoRESUMEN
A group of authors presents the rationale for local anesthesia selection in patients with concomitant disease based on case history; interaction analysis of drugs with local anesthetic and sedation agents; estimation of patient functional status; patient anxiety correction; dental care with hemodynamics monitoring. It was found that adhering to this algorithm promotes the prevention of urgent conditions in outpatient settings.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Manejo del Dolor/métodos , Estrés Psicológico/tratamiento farmacológico , Algoritmos , Atención Ambulatoria , Interacciones Farmacológicas , Hemodinámica , Humanos , Monitoreo FisiológicoRESUMEN
This article highlights the commonly used medications used in dentistry and oral surgery. General dentists and specialists must be knowledgeable about the pharmacology of the drugs currently available along with their risks and benefits. Enteral sedation is a useful adjunct for the treatment of anxious adult and pediatric patients. When enteral sedation is used within the standards of care, the interests of the public and the dental profession are served through a cost-effective, effective service that can be widely available. Oral sedation enables dentists to provide dental care to millions of individuals who otherwise would have unmet dental needs.
Asunto(s)
Anestesia Dental , Sedación Consciente , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Odontológica , Consultorios Odontológicos , HumanosRESUMEN
Some patients have transient hypertension before dental treatment as a result of anxiety and stress. Midazolam is an anxiolytic, and thought to be effective for the management of this sort of transient hypertension. We have evaluated in a randomised, controlled trial whether a low dose of midazolam can lower blood pressure in dental patients to an acceptable level without excessive sedation. Suitable patients were randomised to be given midazolam (trial group) or physiological saline (control group) intravenously. Blood pressure, heart rate, degree of anxiety, and amount of sedation were measured before and after injection. After injection, blood pressure in the trial group significantly decreased to clinically acceptable levels compared with controls. The degree of anxiety in the trial group was also significantly less than that in the control group, but there were no significant differences in sedation. These results suggest that injection of a low dose of midazolam stabilises the blood pressure of dental patients with transient hypertension.
Asunto(s)
Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Hipertensión/tratamiento farmacológico , Midazolam/uso terapéutico , Ansiolíticos , Presión Sanguínea , Sedación Consciente , Método Doble Ciego , Humanos , Hipnóticos y SedantesRESUMEN
AIMS: The primary aim of this study was to assess whether parents' own anxiety and their perception of their child's dental fear and child's general fear can predict preoperatively their child's behaviour during dental treatment under oral sedation. The secondary aim was to assess whether the child's age, gender and ASA classification grade are associated with a child's behaviour under oral sedation. STUDY DESIGN: Cross-sectional prospective study. METHODS: The Corah's Dental Anxiety Scale (DAS), Children's Fear Survey Schedule Dental-Subscale (CFSS-DS) and Children's Fear Survey Schedule Short-Form (CFSS-SF) questionnaires were completed by parents of children undergoing dental treatment with oral midazolam. Behaviour was rated by a single clinician using the overall behaviour section of the Houpt-Scale and scores dichotomised into acceptable or unacceptable behaviour. Data were analysed using χ (2), t test and logistic regression analysis. RESULTS: In total 404 children (215 girls, 53 %) were included, with the mean age of 4.57 years, SD = 1.9. Behaviour was scored as acceptable in 336 (83 %) and unacceptable in 68 (17 %) children. STATISTICS: The level of a child's dental fear, as perceived by their parent, was significantly associated with the behaviour outcome (p = 0.001). Logistic regression analysis revealed that if the parentally perceived child's dental fear (CFSS-DS) rating was high, the odds of the child exhibiting unacceptable behaviour under oral sedation was two times greater than if their parents scored them a low dental fear rating (OR 2.27, 95 % CI 1.33-3.88, p = 0.003). CONCLUSIONS: CFSS-DS may be used preoperatively to help predict behaviour outcome when children are treated under oral sedation and facilitate treatment planning.
Asunto(s)
Conducta Infantil , Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Atención Dental para Niños/psicología , Hipnóticos y Sedantes/uso terapéutico , Midazolam/uso terapéutico , Niño , Conducta Infantil/efectos de los fármacos , Conducta Infantil/psicología , Preescolar , Estudios Transversales , Ansiedad al Tratamiento Odontológico/diagnóstico , Atención Dental para Niños/métodos , Miedo , Femenino , Humanos , Modelos Logísticos , Masculino , Padres/psicología , Estudios Prospectivos , Encuestas y CuestionariosRESUMEN
AIM: To conduct an exploratory investigation of public dental service (PDS) practitioners' planned sedation modality using a structural equation modelling approach, in order to identify the explanatory value of using the Index of Sedation Need (IOSN), or its component parts, to predict sedation modality in patients referred with dental anxiety. METHODS: A convenience sample of patients referred to the PDS for dental anxiety management was invited to take part. The IOSN was completed for each patient (patient dental anxiety, medical and behavioural indicators and dental treatment complexity) as well as the American Society of Anesthesiologists Physical Status Classification System and the Case Mix Tool. The practitioners completed details of their planned sedation modality and identified normative dental treatment need. The data were entered onto an SPSS v21 database and subjected to frequency distributions, t-tests, correlation analysis and exploratory partial structural equation modelling (SEM). RESULTS: Ninety-five percent of patients were ranked as MDAS 3 or 4, indicating high dental anxiety; 69% had a medical condition, which might impact on dental treatment and 82% had a dental treatment need, which was classified as intermediate/complex according to the IOSN. Eighty-eight percent of the patients in accordance with the IOSN required sedation: 62% of patients were assessed as requiring intravenous sedation. The IOSN discriminated between patients who were assessed as requiring more complex sedation modalities and had a greater normative treatment need. The SEM showed that the patient dental anxiety (P <0.02) and dental treatment complexity (P <0.02) predicted planned sedation modality. Functional morbidity was less strong, as a predictor, and was significant at the ten percent level. CONCLUSIONS: The IOSN is a useful and valid assessment of sedation need and predicted sedation modality for patients referred with high dental anxiety states and secondly, that component parts of the IOSN add explanatory value in practitioners' choice of planned sedation modality.
Asunto(s)
Ansiedad al Tratamiento Odontológico/tratamiento farmacológico , Hipnóticos y Sedantes/administración & dosificación , Derivación y Consulta , Adulto , HumanosRESUMEN
In the December 2014 issue of the Nederlands Tijdschrift voor Tandheelkunde, T.H. van den Berg and B. Preckel published an article entitled 'Mild intravenous sedation with midazolam by dentists'. Broers et al responded to this article arguing that the administration of intravenous sedation with midazolam by dentists is unsafe for patients. In the current article the authors, Van den Berg and Preckel, address the points of criticism.