Adherence to RCS recommendations for extraction of first permanent molars in a teaching hospital: To compensate or not to compensate?

OBJECTIVE: To observe whether paediatric dentists and orthodontists balance and compensate the extraction of first permanent molars (FPMs) in children aged 7-11 years. DESIGN: Service evaluation. SETTING: UK dental teaching hospital. METHODS: Retrospective analysis of FPM extraction patterns in patients aged 7-11 years that attended for extraction of FPMs from 1 January 2019 to 31 January 2020 (13-month period). RESULTS: A total of 194 patients were included and they collectively had 435 FPMs extracted. No balancing extractions to prevent dental centreline shifts and no lower FPM compensatory extractions were performed. Compensatory extraction of good prognosis upper FPMs were performed in 64% (94/146) of cases to avoid overeruption. Orthodontic input was sought for poor prognosis lower FPMs in 76% of cases compared to 51% for poor prognosis upper FPMs. CONCLUSION: Compensatory extraction of good prognosis upper FPMs to avoid overeruption appears to be a common practice at Guy's and St Thomas' Hospitals. There was also higher demand for orthodontic advice for cases presenting with poor prognosis lower FPMs compared to poor prognosis upper FPMs, which suggests that paediatric dentists may prefer for the final decision on upper FPM compensatory extractions to be made by an orthodontist, even with national guidelines available. More high-quality research on the topic is required to determine the necessity of this practice for achieving optimal long-term oral health in children.

Service evaluation of an intravenous sedation service within a hospital paediatric dentistry unit: ten-year results.

Background An intravenous sedation (IVS) service was established in 2008 for young people aged 12 years or over, within the paediatric dentistry department at the Eastman Dental Hospital in London. The aim of this study was to carry out a service evaluation and assess the case mix and success rate of this service over the last ten years.Materials and methods A retrospective service evaluation was carried out, including all patients attending the IVS clinic between April 2009 and March 2019.Results A total of 457 patients attended over 525 appointments. The mean age was 14. The success rate was over 98%. The average dose of midazolam was 4 mg and dosage ranged from 1.5-10 mg.Conclusion This IVS service has been established successfully and offers patients an alternative to general anaesthetic. This consequently reduced the general anaesthetic waiting list by 10%.

Sedation of children undergoing dental treatment.

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.