Managing Anxiety In Children: The Role Of Oral Sedation In Pediatric Dentistry
Main Article Content
Keywords
Children, Pediatric, Managing
Abstract
Conscious sedation is a commonly used technique in pediatric dentistry to manage anxiety and behavior of young patients during dental procedures. The goal of conscious sedation is to provide a safe and effective way to alleviate anxiety and pain while allowing the child to remain responsive and conscious. There are various drugs used for conscious sedation in pediatric dentistry, including benzodiazepines, barbiturates, and nitrous oxide. The advantages of conscious sedation in pediatric dentistry include reduced anxiety, improved cooperation, and reduced pain perception. However, there are also potential disadvantages, such as the risk of adverse events and the need for trained personnel to monitor the patient during and after the procedure. Despite the potential disadvantages, conscious sedation remains an important tool in pediatric dentistry for the management of anxious or uncooperative patients. It is important for dental professionals to carefully consider the benefits and risks of conscious sedation and choose the most appropriate technique and drug for each patient based on their medical history, age, and level of anxiety
References
1. Moore R. The Phenomenon of Dental Fear: Studies in Clinical Diagnosis, Measurement and Treatment. 1991.
2. Cushing SR. Have No Fear of the Dental Chair: A Guide for Reducing Dental Fear. Richer Press, 2016.
3. Campbell C. Dental Fear and Anxiety in Pediatric Patients: Practical Strategies to Help Children Cope. Springer, 2017.
4. Dean JA. McDonald and Avery’s Dentistry for the Child and Adolescent - E-Book. Elsevier Health Sciences, 2015.
5. Ganapathy D, Others. Awareness On Chelating Agents Used In Rct Among Dental Students. International Journal of Early Childhood Special Education; 14, https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=13085581&AN=162720711&h=2XOMGqR%2BzisGdfskW0DzmX7l23h62iwgWtnF0eJj4%2FUMPHy0COAteZUzysomThZJ9gtUJc9eEEiSKMKn0nKWYQ%3D%3D&crl=c (2022).
6. Mohanty S, Ramesh S. Comparing Quality and Quantity of Dentin Bridge Formed Using Mineral Trioxide Aggregate, Biodentine, and Propolis: A Double-blinded Randomized …. World Journal of Dentistry, https://www.wjoud.com/doi/WJOUD/pdf/10.5005/jp-journals-10015-1762 (2020).
7. Bramhecha A, Sandhya R. Analysis of Marginal Gap between Dentin and Biodentine on Irrigation with 3% Sodium Hypochlorite-An In Vitro study. Int J Den-tistry Oral Sci 2021; 8: 3766–3769.
8. Akshayaa L, Ravindran V, Madhulaxmi M. Choice Of Tricalcium Silicate Cements Among Children For Pulp Capping-A Retrospective Study. Int J Dentistry Oral Sci 2021; 8: 4527–4530.
9. Srinivasan NK, Karunagaran P, Panchal V, et al. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021; 14: S111–S116.
10. Baskran RNR, Nivethigaa B, Balaji Ganesh S. The Prevalence and Gender Distribution of Midline Diastema among Patients Attending A Private Dental College-An Original Study. Int J Dentistry Oral Sci 2021; 8: 4124–4127.
11. National Research Council, Institute of Medicine, Board on Children, Youth, and Families, et al. Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation. National Academies Press, 2015.
12. Kocabasoglu N, Caglayan HB. Anxiety Disorders: From Childhood to Adulthood. BoD – Books on Demand, 2019.
13. Porritt J, Rodd H, Morgan A, et al. Development and Testing of a Cognitive Behavioral Therapy Resource for Children’s Dental Anxiety. JDR Clin Trans Res 2017; 2: 23–37.
14. Coolidge T, Hillstead MB, Farjo N, et al. Additional psychometric data for the Spanish Modified Dental Anxiety Scale, andpsychometric data for a Spanish version of the Revised Dental Beliefs Survey. BMC Oral Health 2010; 10: 12.
15. Lee J. Your Brain Electric: Everything You Need to Know about Optimising Neurotransmitters Including Serotonin, Dopamine and Noradrenaline. Createspace Independent Publishing Platform, 2014.
16. Metz KL. Predictive Factors of Post-Traumatic Stress Disorder in Pediatric Medical Trauma Patients: The Influence of Cognitive Development on Appraisal Factors. 2011.
17. Dryden M. Assessing Caregiver Stress in a School-age Specialized Pediatric Population. 2019.
18. Lozano IA. The Impact of Parenting on the Development and Maintenance of Social Anxiety Disorder. 2021.
19. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Board on Children, Youth, and Families, et al. Parenting Matters: Supporting Parents of Children Ages 0-8. National Academies Press, 2016.
20. Telman LGE, van Steensel FJA, Maric M, et al. What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders. Eur Child Adolesc Psychiatry 2018; 27: 615–624.
21. Harvey K. Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors. Heart Lung 2023; 57: 130–139.
22. Dutheil S, Watson LS, Davis RE, et al. Lumateperone Normalizes Pathological Levels of Acute Inflammation through Important Pathways Known to Be Involved in Mood Regulation. J Neurosci 2023; 43: 863–877.
23. Leyfer O. Anxiety Disorders in Children with Williams Syndrome, Their Mothers, and Their Siblings: Implications for the Etiology of Anxiety Disorders. 2007.
24. Bale-Griffeth D. Dental Fear: The Relationship of Generalized Anxiety, Beliefs, Cognitions, Sex, Age, Sex of the Dentist, and Attendance. 1998.
25. Godois L da S, Knorst JK, Noronha TG, et al. Pathways to dental fear from childhood to adolescence: A 10-year cohort study. Int J Paediatr Dent. Epub ahead of print 20 March 2023. DOI: 10.1111/ipd.13065.
26. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. John Wiley & Sons, 2014.
27. Husack E, Ouanounou A. Pharmacological Management of the Dentally Anxious Patient. Compend Contin Educ Dent 2023; 44: 128–134; quiz 135.
28. Kupietzky A. Wright’s Behavior Management in Dentistry for Children. John Wiley & Sons, 2021.
29. Mozafar S, Bargrizan M, Golpayegani MV, et al. Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial. Dent Res J 2018; 15: 411–419.
30. Stern J, Pozun A. Pediatric Procedural Sedation. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023.
31. Salazar D, Chapple AG, Pilly V, et al. Recall Attendance After General Anesthesia Versus Oral Conscious Sedation. Pediatr Dent 2022; 44: 326–329.
32. Salerno C, Cirio S, Zambon G, et al. Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health; 20. Epub ahead of print 18 January 2023. DOI: 10.3390/ijerph20031779.
33. Bregstein JS, Wagh AM, Tsze DS. Intranasal Lorazepam for Treatment of Severe Agitation in a Pediatric Behavioral Health Patient in the Emergency Department. Ann Emerg Med 2020; 75: 86–89.
34. Garret-Bernardin A, Festa P, Matarazzo G, et al. Behavioral Modifications in Children after Repeated Sedation with Nitrous Oxide for Dental Treatment: A Retrospective Study. Int J Environ Res Public Health; 20. Epub ahead of print 24 February 2023. DOI: 10.3390/ijerph20054037.
35. Wilson S. Oral Sedation for Dental Procedures in Children. Springer, 2015.
36. Dressman JB, Reppas C. Oral Drug Absorption: Prediction and Assessment, Second Edition. CRC Press, 2016.
37. Chiu, T. H., Chen, Y. H., Lee, H. H., Chang, C. C., & Cherng, C. H. (. Effects of lorazepam on sleep and motor activity in rats. International Journal of Neuropsychopharmacology, 9(3), 305-314.
38. Steiner MA, Marsicano G, Wotjak CT, Lutz B. (. Conditional cannabinoid receptor type 1 mutants reveal neuron subtype-specific effects on anxiety and nicotine intake. Psychopharmacology, 200(1), 45-56 doi: 101007/s00213-008-1129-2.
39. Thomovsky SA, Seim HB 3rd, Gleed RD. The cardiopulmonary and behavioral effects of intravenous lorazepam in dogs duringanesthesia with isoflurane. Vet Surg 1995;24(4):361-7 doi: 101111/j1532-950x1995.tb01303.x PMID: 7562352.
40. Tofsky NS, Driscoll CF, Henson SJ, Manhold JH. Comparison of oral lorazepam and hydroxyzine for premedication in pediatric dental patients. J Clin Pediatr Dent 1994;18(3):191-195 PMID: 8052315.
41. Paniagua, R., Siu, A., & Almeida, J. (2005). A randomized double-blind study of oral lorazepam and midazolam for pediatric dental sedation. Journal of Dental Research, 84(9), 830-836 doi: 101177/154405910508400908.
42. Sarojini B., Krishnamurthy V., Raghavendra Swamy N.R., et al. A comparative evaluation of oral lorazepam and oral chloral hydrate sedation in paediatric dentistry: a double-blind randomised controlled trial. Journal of Indian Society of Pedodontics and Preventive Dentistry 2017 Jul-Sep;35(3):236-243 doi: 104103/JISPPDJISPPD_68_17 PMID: 28836568.
43. Smith MA WJM. Effects of the phenothiazine antihistaminic promethazine on schedule-controlled behavior and in vivo neurochemistry in rats. J Pharmacol Exp Ther.
44. Huang, Y. H., & Sharpley, A. L. (. Effects of promethazine on the sleep-wake cycle of cats. Journal of Pharmacology and Experimental Therapeutics, 218(1), 38-43 doi: 101016/S0022-3549(17)32651-8.
45. Koskela, T., & Virtanen, R. (2015). Sedative effects of promethazine in mice: potentiation by diazepam. Psychopharmacology, 232(3), 603-610 doi: 101007/s00213-014-3727-1.
46. H. S. Al-Anazi, S. M. Al-Sarheed, M. Al-Khudhairy, and R. Al-Hazmi. Oral Promethazine for Sedation in Children Undergoing Dental Treatment: A Prospective Study 2018. J Clin Pediatr Dent.
47. Eberl S, Ahne G, Toni I, et al. Safety of clonidine used for long-term sedation in paediatric intensive care: A systematic review. Br J Clin Pharmacol 2021; 87: 785–805.
48. V.K. Kumari and S.N. Dwivedi. Effects of clonidine on locomotor activity in rats. Psychopharmacology
49. M. F. Al-Ghazlat and A. W. Muir. Sedative effects of clonidine in the rabbit. J Vet Pharmacol Ther.
50. Cameron AC, Widmer RP, Field HW, et al. Oral clonidine as a sedative agent in pediatric dentistry. J Dent Child (Chic) 2003;70(2):89-93 PMID: 12901508.
51. M. Mansouri, S. Shokri, and M. Mahmoudi. Effectiveness of Oral Clonidine as a Premedication in Children Undergoing General Anesthesia for Dental Procedures". J Clin Pediatr Dent.
52. Rajwar A, Goswami M, Verma M. Assessment of Dental Fear and Anxiety. LAP Lambert Academic Publishing, 2015.
53. Saikiran KV, Elicherla SR, Mounika SVM, et al. Memojis Pain Scale: A novel pain assessment tool. Int J Paediatr Dent. Epub ahead of print 11 January 2023. DOI: 10.1111/ipd.13044.
54. Shelley KA. The Validity of the FLACC Scale in Adult Verbal Patients. 2009.
55. Smith JM. Is the FLACC Scale a Reliable and Valid Tool to Measure Pain in the Neonate Population? 2002.
2. Cushing SR. Have No Fear of the Dental Chair: A Guide for Reducing Dental Fear. Richer Press, 2016.
3. Campbell C. Dental Fear and Anxiety in Pediatric Patients: Practical Strategies to Help Children Cope. Springer, 2017.
4. Dean JA. McDonald and Avery’s Dentistry for the Child and Adolescent - E-Book. Elsevier Health Sciences, 2015.
5. Ganapathy D, Others. Awareness On Chelating Agents Used In Rct Among Dental Students. International Journal of Early Childhood Special Education; 14, https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=13085581&AN=162720711&h=2XOMGqR%2BzisGdfskW0DzmX7l23h62iwgWtnF0eJj4%2FUMPHy0COAteZUzysomThZJ9gtUJc9eEEiSKMKn0nKWYQ%3D%3D&crl=c (2022).
6. Mohanty S, Ramesh S. Comparing Quality and Quantity of Dentin Bridge Formed Using Mineral Trioxide Aggregate, Biodentine, and Propolis: A Double-blinded Randomized …. World Journal of Dentistry, https://www.wjoud.com/doi/WJOUD/pdf/10.5005/jp-journals-10015-1762 (2020).
7. Bramhecha A, Sandhya R. Analysis of Marginal Gap between Dentin and Biodentine on Irrigation with 3% Sodium Hypochlorite-An In Vitro study. Int J Den-tistry Oral Sci 2021; 8: 3766–3769.
8. Akshayaa L, Ravindran V, Madhulaxmi M. Choice Of Tricalcium Silicate Cements Among Children For Pulp Capping-A Retrospective Study. Int J Dentistry Oral Sci 2021; 8: 4527–4530.
9. Srinivasan NK, Karunagaran P, Panchal V, et al. Comparison of the Sedative Effect of Inhaled Nitrous Oxide and Intranasal Midazolam in Behavior Management and Pain Perception of Pediatric Patients: A Split-mouth Randomized Controlled Clinical Trial. Int J Clin Pediatr Dent 2021; 14: S111–S116.
10. Baskran RNR, Nivethigaa B, Balaji Ganesh S. The Prevalence and Gender Distribution of Midline Diastema among Patients Attending A Private Dental College-An Original Study. Int J Dentistry Oral Sci 2021; 8: 4124–4127.
11. National Research Council, Institute of Medicine, Board on Children, Youth, and Families, et al. Transforming the Workforce for Children Birth Through Age 8: A Unifying Foundation. National Academies Press, 2015.
12. Kocabasoglu N, Caglayan HB. Anxiety Disorders: From Childhood to Adulthood. BoD – Books on Demand, 2019.
13. Porritt J, Rodd H, Morgan A, et al. Development and Testing of a Cognitive Behavioral Therapy Resource for Children’s Dental Anxiety. JDR Clin Trans Res 2017; 2: 23–37.
14. Coolidge T, Hillstead MB, Farjo N, et al. Additional psychometric data for the Spanish Modified Dental Anxiety Scale, andpsychometric data for a Spanish version of the Revised Dental Beliefs Survey. BMC Oral Health 2010; 10: 12.
15. Lee J. Your Brain Electric: Everything You Need to Know about Optimising Neurotransmitters Including Serotonin, Dopamine and Noradrenaline. Createspace Independent Publishing Platform, 2014.
16. Metz KL. Predictive Factors of Post-Traumatic Stress Disorder in Pediatric Medical Trauma Patients: The Influence of Cognitive Development on Appraisal Factors. 2011.
17. Dryden M. Assessing Caregiver Stress in a School-age Specialized Pediatric Population. 2019.
18. Lozano IA. The Impact of Parenting on the Development and Maintenance of Social Anxiety Disorder. 2021.
19. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Board on Children, Youth, and Families, et al. Parenting Matters: Supporting Parents of Children Ages 0-8. National Academies Press, 2016.
20. Telman LGE, van Steensel FJA, Maric M, et al. What are the odds of anxiety disorders running in families? A family study of anxiety disorders in mothers, fathers, and siblings of children with anxiety disorders. Eur Child Adolesc Psychiatry 2018; 27: 615–624.
21. Harvey K. Parents of children with congenital heart defects during the COVID-19 pandemic: An examination of mental health variables, risk factors, and protective factors. Heart Lung 2023; 57: 130–139.
22. Dutheil S, Watson LS, Davis RE, et al. Lumateperone Normalizes Pathological Levels of Acute Inflammation through Important Pathways Known to Be Involved in Mood Regulation. J Neurosci 2023; 43: 863–877.
23. Leyfer O. Anxiety Disorders in Children with Williams Syndrome, Their Mothers, and Their Siblings: Implications for the Etiology of Anxiety Disorders. 2007.
24. Bale-Griffeth D. Dental Fear: The Relationship of Generalized Anxiety, Beliefs, Cognitions, Sex, Age, Sex of the Dentist, and Attendance. 1998.
25. Godois L da S, Knorst JK, Noronha TG, et al. Pathways to dental fear from childhood to adolescence: A 10-year cohort study. Int J Paediatr Dent. Epub ahead of print 20 March 2023. DOI: 10.1111/ipd.13065.
26. Wright GZ, Kupietzky A. Behavior Management in Dentistry for Children. John Wiley & Sons, 2014.
27. Husack E, Ouanounou A. Pharmacological Management of the Dentally Anxious Patient. Compend Contin Educ Dent 2023; 44: 128–134; quiz 135.
28. Kupietzky A. Wright’s Behavior Management in Dentistry for Children. John Wiley & Sons, 2021.
29. Mozafar S, Bargrizan M, Golpayegani MV, et al. Comparison of nitrous oxide/midazolam and nitrous oxide/promethazine for pediatric dental sedation: A randomized, cross-over, clinical trial. Dent Res J 2018; 15: 411–419.
30. Stern J, Pozun A. Pediatric Procedural Sedation. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023.
31. Salazar D, Chapple AG, Pilly V, et al. Recall Attendance After General Anesthesia Versus Oral Conscious Sedation. Pediatr Dent 2022; 44: 326–329.
32. Salerno C, Cirio S, Zambon G, et al. Conscious Sedation for Dental Treatments in Subjects with Intellectual Disability: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health; 20. Epub ahead of print 18 January 2023. DOI: 10.3390/ijerph20031779.
33. Bregstein JS, Wagh AM, Tsze DS. Intranasal Lorazepam for Treatment of Severe Agitation in a Pediatric Behavioral Health Patient in the Emergency Department. Ann Emerg Med 2020; 75: 86–89.
34. Garret-Bernardin A, Festa P, Matarazzo G, et al. Behavioral Modifications in Children after Repeated Sedation with Nitrous Oxide for Dental Treatment: A Retrospective Study. Int J Environ Res Public Health; 20. Epub ahead of print 24 February 2023. DOI: 10.3390/ijerph20054037.
35. Wilson S. Oral Sedation for Dental Procedures in Children. Springer, 2015.
36. Dressman JB, Reppas C. Oral Drug Absorption: Prediction and Assessment, Second Edition. CRC Press, 2016.
37. Chiu, T. H., Chen, Y. H., Lee, H. H., Chang, C. C., & Cherng, C. H. (. Effects of lorazepam on sleep and motor activity in rats. International Journal of Neuropsychopharmacology, 9(3), 305-314.
38. Steiner MA, Marsicano G, Wotjak CT, Lutz B. (. Conditional cannabinoid receptor type 1 mutants reveal neuron subtype-specific effects on anxiety and nicotine intake. Psychopharmacology, 200(1), 45-56 doi: 101007/s00213-008-1129-2.
39. Thomovsky SA, Seim HB 3rd, Gleed RD. The cardiopulmonary and behavioral effects of intravenous lorazepam in dogs duringanesthesia with isoflurane. Vet Surg 1995;24(4):361-7 doi: 101111/j1532-950x1995.tb01303.x PMID: 7562352.
40. Tofsky NS, Driscoll CF, Henson SJ, Manhold JH. Comparison of oral lorazepam and hydroxyzine for premedication in pediatric dental patients. J Clin Pediatr Dent 1994;18(3):191-195 PMID: 8052315.
41. Paniagua, R., Siu, A., & Almeida, J. (2005). A randomized double-blind study of oral lorazepam and midazolam for pediatric dental sedation. Journal of Dental Research, 84(9), 830-836 doi: 101177/154405910508400908.
42. Sarojini B., Krishnamurthy V., Raghavendra Swamy N.R., et al. A comparative evaluation of oral lorazepam and oral chloral hydrate sedation in paediatric dentistry: a double-blind randomised controlled trial. Journal of Indian Society of Pedodontics and Preventive Dentistry 2017 Jul-Sep;35(3):236-243 doi: 104103/JISPPDJISPPD_68_17 PMID: 28836568.
43. Smith MA WJM. Effects of the phenothiazine antihistaminic promethazine on schedule-controlled behavior and in vivo neurochemistry in rats. J Pharmacol Exp Ther.
44. Huang, Y. H., & Sharpley, A. L. (. Effects of promethazine on the sleep-wake cycle of cats. Journal of Pharmacology and Experimental Therapeutics, 218(1), 38-43 doi: 101016/S0022-3549(17)32651-8.
45. Koskela, T., & Virtanen, R. (2015). Sedative effects of promethazine in mice: potentiation by diazepam. Psychopharmacology, 232(3), 603-610 doi: 101007/s00213-014-3727-1.
46. H. S. Al-Anazi, S. M. Al-Sarheed, M. Al-Khudhairy, and R. Al-Hazmi. Oral Promethazine for Sedation in Children Undergoing Dental Treatment: A Prospective Study 2018. J Clin Pediatr Dent.
47. Eberl S, Ahne G, Toni I, et al. Safety of clonidine used for long-term sedation in paediatric intensive care: A systematic review. Br J Clin Pharmacol 2021; 87: 785–805.
48. V.K. Kumari and S.N. Dwivedi. Effects of clonidine on locomotor activity in rats. Psychopharmacology
49. M. F. Al-Ghazlat and A. W. Muir. Sedative effects of clonidine in the rabbit. J Vet Pharmacol Ther.
50. Cameron AC, Widmer RP, Field HW, et al. Oral clonidine as a sedative agent in pediatric dentistry. J Dent Child (Chic) 2003;70(2):89-93 PMID: 12901508.
51. M. Mansouri, S. Shokri, and M. Mahmoudi. Effectiveness of Oral Clonidine as a Premedication in Children Undergoing General Anesthesia for Dental Procedures". J Clin Pediatr Dent.
52. Rajwar A, Goswami M, Verma M. Assessment of Dental Fear and Anxiety. LAP Lambert Academic Publishing, 2015.
53. Saikiran KV, Elicherla SR, Mounika SVM, et al. Memojis Pain Scale: A novel pain assessment tool. Int J Paediatr Dent. Epub ahead of print 11 January 2023. DOI: 10.1111/ipd.13044.
54. Shelley KA. The Validity of the FLACC Scale in Adult Verbal Patients. 2009.
55. Smith JM. Is the FLACC Scale a Reliable and Valid Tool to Measure Pain in the Neonate Population? 2002.
Article Sidebar
Published
May 18, 2023
Article Details
How to Cite
V.Ranjith Akshay Seshadri, & Mahesh Ramakrishnan. (2023). Managing Anxiety In Children: The Role Of Oral Sedation In Pediatric Dentistry. Journal of Population Therapeutics and Clinical Pharmacology, 30(10), 502–514. https://doi.org/10.47750/jptcp.2023.30.10.054
Section
Articles
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.