1
|
Bangash M, Mustafa L, Irshad M, Omer Q, Alam MK. Short Term Effects of Inhalation Sedation on Child Dental Fear and Anxiety. Curr Pediatr Rev 2024; 20:89-93. [PMID: 35975868 DOI: 10.2174/1573396318666220816093731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/06/2022] [Accepted: 04/22/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Dental procedures profoundly affect a child's dental fear and anxiety, rendering dental treatment difficult. Inhalation sedation with a mixture of nitrous oxide and oxygen (NO2/02) breathed through a nosepiece is a form of light conscious sedation widely used in apprehensive children to help them relax and accept dental treatment. This, however, can have both shortand long-term effects on child dental fear and anxiety. This study aimed to assess the short-term immediate effect of inhalation sedation on child dental fear and anxiety scores. METHODS This analytical cross-sectional study was conducted at the Department of Paediatric Dentistry at Rehman College of Dentistry, Peshawar, Pakistan, over a period of 1.9 years (January 2019- October 2020). A total of 171 children aged 6-11 years were selected with moderate to severe dental anxiety using the Child Fear Survey Schedule-Dental Subscale (CFSS-DS), requiring pulp therapy in at least one of their deciduous molars. Baseline anxiety scores were calculated using Venham Clinical Anxiety Score (VCAS) and Venham Picture test (VPT) with a dental check-up and fluoride application. VCAS and VPT scores were then assessed at the end of their scheduled second dental visit involving dental anaesthesia and inhalation sedation. VCAS and VPT scores at the end of treatment were compared with the baseline scores. RESULTS Out of 171 children, 86 were male and 85 were female, with a mean age of 7.77. Females showed a higher range of VCAS and VPT scores (p ≤0.001) compared to males. The VCAS and VPT scores declined just at the end of the second dental visit following dental anaesthesia with inhalation sedation (mean difference = 1.96 and 3.39, respectively), which was statistically significant (p ≤0.001). CONCLUSION Inhalation sedation has a significant role in reducing child dental fear and anxiety in the short term.
Collapse
Affiliation(s)
- Madeeha Bangash
- Department of Paediatric Dentistry, Rehman College of Dentistry, Peshawar, Pakistan
| | - Laila Mustafa
- Consultant Paediatric Dentistry, Shifa College of Dentistry, Islamabad, Pakistan
| | - Muhammad Irshad
- Department of Oral Pathology, Rehman College of Dentistry, Peshawar, Pakistan
| | - Qaiser Omer
- Special Care dentistry, Dr. Qaiser & Associates Dental Practice, Islamabad, Pakistan
| | - Mohammad Khursheed Alam
- Preventive Dentistry Department, College of Dentistry, Jouf University, Sakaka, Saudi Arabia
| |
Collapse
|
2
|
Kunta S, Arora RV, Jain R, Rawat P. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023; 16:302-307. [PMID: 37519985 PMCID: PMC10373752 DOI: 10.5005/jp-journals-10005-2534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Aim The study aimed to assess the anxiety and stress levels on acceptance of dental treatment in child patients approaching dental extraction procedures before and after nitrous oxide (N2O) inhalation sedation (IHS) by measuring serum amyloid A (SAA) and salivary cortisol (SC). Materials and methods A total of 32 children, ages ranging from 6 to 10 years, were randomly grouped as TI (before N2O IHS) and TII (after N2O IHS). Saliva samples were taken for biochemical evaluation of SAA before and after the procedure. Subjectively anxiety and stress levels were evaluated using modified child dental anxiety scale (MCDAS). Wilcoxon rank-sum test was used to compare the means of dental anxiety, SAA, and SC before and after N2O IHS. The Karl Pearson correlation coefficient was employed to determine the correlation between dental anxiety and SAA and SC before and after N2O IHS. Results There were significant differences in the dental anxiety level in child patients after administration of N2O IHS, and it also showed an increased rate of acceptance of dental treatment. Conclusion This study showed that N2O is a safe and effective method in reducing dental anxiety and increasing acceptance of dental treatment in child patients with improved behavior and with no adverse effects. Clinical significance Anxiety and stress will always hinder the acceptance of dental treatment in child patients, especially during extraction procedures. N2O IHS is a safe and effective technique to overcome anxiety and stress in child patients and as well as allows them to undergo dental treatment with improved behavior. How to cite this article Kunta S, Arora RV, Jain R, et al. The Effect of Anxiety and Stress on Acceptance of Dental Procedure before and after Inhalation Sedation in Pediatric Patients: An In Vivo Study. Int J Clin Pediatr Dent 2023;16(2):302-307.
Collapse
Affiliation(s)
- Sravanthi Kunta
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Ruchi V Arora
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Rashmi Jain
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| | - Parul Rawat
- Department of Pediatric Dentistry, Darshan Dental College and Hospital, Udaipur, Rajasthan, India
| |
Collapse
|
3
|
The burden of dental care in Amelogenesis Imperfecta paediatric patients in the UK NHS: a retrospective, multi-centred analysis. Eur Arch Paediatr Dent 2021; 22:929-936. [PMID: 34146252 DOI: 10.1007/s40368-021-00638-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The burden of dental care in Amelogenesis Imperfecta (AI) has not been well described. This condition results in weak, discoloured and often sensitive teeth. Specialist paediatric care is available for AI patients in the UK, but treatment protocols and care provided are inconsistent. The aim of this study was therefore to analyse the provision of treatment and burden of care for children and families with AI across four Paediatric Dentistry centres in the UK. METHODS A retrospective evaluation of AI patient clinical records across four UK consultant-led Paediatric Dentistry centres was completed. Frequency and duration of care were recorded along with treatment and experience of inhalation sedation, local and general anaesthetic. RESULTS In total, 138 records were available for analysis. The average patient age at first referral was 7.7 years (range 1-16 years) and families travelled an average 21.8 miles per appointment (range 0.2-286 miles). Patients attended on average 4.5 appointments per year for 5.8 years. In total, 65.2% had experience of local anaesthetic, 27.5% inhalation sedation and 31.9% general anaesthetic. Dental treatment including restorations and extractions were commonly required on multiple teeth per patient. CONCLUSION AI carries a high burden of specialist dental care to patients and families. Specialist centres are required to provide longitudinal, comprehensive care.
Collapse
|
4
|
Wallace A, Hodgetts V, Kirby J, Yesudian G, Nasse H, Zaitoun H, Marshman Z, Gilchrist F. Evaluation of a new paediatric dentistry intravenous sedation service. Br Dent J 2021:10.1038/s41415-021-2700-1. [PMID: 33707732 DOI: 10.1038/s41415-021-2700-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/02/2020] [Indexed: 11/08/2022]
Abstract
Introduction Intravenous sedation (IVS) with propofol offers an alternative to inhalation sedation or general anaesthesia (GA) for dentally anxious young people who require treatment. It offers a greater level of anxiolysis than inhalation sedation and reduced morbidity when compared with GA.Methods Data were collected prospectively from a convenience sample of children requiring IVS. Participants completed the Children's Experiences of Dental Anxiety Measure (CEDAM) at the start of every visit. Patient demographics, treatment completed, surgery and recovery time were recorded. Feedback was obtained following their first visit.Results Treatment was successful for 91.5% (43/47) of patients. The average surgery and discharge time was 32.9 (8-105 minutes) and 33.1 (5-84 minutes), respectively. The CEDAM scores were between 14 and 30 (mean score 20.8). Thematic content analysis of the feedback was carried out and themes relating to communication, environment, appointment times, service satisfaction and advice to other patients emerged.Discussion CEDAM scores may have been lower than expected due to under-reporting by patients or clinicians' perception of higher anxiety levels. Feedback was reviewed regularly and improvements made where possible.Conclusion The majority of patients successfully received dental treatment under IVS. Changes have been made to the service to improve patient experience and maximise productivity.
Collapse
Affiliation(s)
- Ann Wallace
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK.
| | | | - Jen Kirby
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | - Grainne Yesudian
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | | | - Halla Zaitoun
- Paediatric Dentistry, Charles Clifford Dental Hospital, 76 Wellesley Road, Sheffield, S10 2SZ, UK
| | - Zoe Marshman
- School of Clinical Dentistry, University of Sheffield, Oral Health and Development, Claremont Crescent, Sheffield, S10 2TA, UK
| | - Fiona Gilchrist
- School of Clinical Dentistry, University of Sheffield, Oral Health and Development, Claremont Crescent, Sheffield, S10 2TA, UK
| |
Collapse
|
5
|
Dixon C, Aspinall A, Rolfe S, Stevens C. Acceptability of intravenous propofol sedation for adolescent dental care. Eur Arch Paediatr Dent 2020; 21:295-302. [PMID: 31595459 PMCID: PMC7256104 DOI: 10.1007/s40368-019-00482-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 09/18/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Propofol is an intravenous anaesthetic agent commonly utilised in general anaesthesia, however in sub-anaesthetic concentrations can be utilised to provide sedation through automated dosing of target-controlled infusion (TCI). TCI has been shown to provide accurate and stable predicted plasma and effect-site concentrations of propofol. A four-part mixed-method prospective study was undertaken to evaluate the safety and patient acceptability of intravenous propofol sedation in adolescent patients requiring dental care. There is a paucity in the literature on patient-reported outcomes and patient safety in the management of adolescent patients for dental treatment. METHODS Demographics were recorded including age, gender, ASA Classification and Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) completed pre-operatively. Behaviour ratings of the Frankl and Houpt scales were recorded followed by post-operative questionnaire and telephone consultation. Consultation was completed following the procedure to determine patient satisfaction, memory of the procedure and any reported side effects of treatment. Qualitative thematic analysis was utilised. RESULTS 55 patients were recruited for the study, of which 49 (mean age 14.67 years) completed the sedation study and were treated safely with no post-operative complications. The mean lowest oxygen saturation was 98.12% SpO2 (SD 2.6). Thematic analysis demonstrated positive patient-reported outcomes to IV sedation. CONCLUSION Propofol TCI sedation is an effective treatment modality for the management of dentally anxious adolescents as a safe alternative to general anaesthesia, allowing the opportunity for increased provision of treatment per visit on those patients with a high dental need. Further randomised controlled trials comparing propofol TCI to other pharmacological managements are required.
Collapse
Affiliation(s)
- C Dixon
- University of Manchester, Manchester, UK.
| | - A Aspinall
- Birmingham Dental Hospital, Birmingham, UK
| | - S Rolfe
- Manchester University Foundation Trust, Manchester, UK
| | - C Stevens
- Manchester University NHS Foundation Trust, University of Manchester, Manchester, UK
| |
Collapse
|
6
|
A single-centre investigator-blinded randomised parallel-group study protocol to investigate the influence of an acclimatisation appointment on children's behaviour during N 2O/O 2 sedation as measured by psychological, behavioural and real-time physiological parameters. BDJ Open 2020; 6:5. [PMID: 32194987 PMCID: PMC7078273 DOI: 10.1038/s41405-020-0031-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 02/05/2020] [Accepted: 02/19/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS AND OBJECTIVES To describe a study protocol of a randomised control trial (RCT) assessing the effectiveness, in reducing dental anxiety, of an acclimatising nitrous oxide sedation (N2O) session prior to actual dental treatment with N2O. MATERIALS AND METHODS A single-centre investigator-blinded parallel-group RCT conducted in a postgraduate dental hospital in Dubai, United Arab Emirates (UAE). Anxious children requiring N2O (aged 5-15 years) will be randomly assigned to; a study group: children who will have a preparatory N2O trial experience or; a control group: children who will only have N2O explained to them. Treatment with N2O for both groups will start at the second visit. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment (using the Modified Child Dental Anxiety Scale faces), behaviour of the child (using Frankl Rating Behaviour Scale) and the acquisition of real-time physiological anxiety-related parameters (using E4® electronic wrist devices). RESULTS The data will be analysed statistically. DISCUSSION There is a paucity of research regarding dental N2O acclimatising appointments. This RCT will supplement existing literature. CONCLUSIONS This RCT will report whether prior acclimatising of a child to N2O sedation is effective, or not, in improving dental treatment behaviour.
Collapse
|
7
|
Halabi MA, Hussein I, Salami A, Awad R, Alderei N, Wahab A, Kowash M. A study protocol of a single-center investigator-blinded randomized parallel group study to investigate the effect of an acclimatization visit on children's behavior during inhalational sedation in a United Arab Emirates pediatric dentistry postgraduate setting as measured by the levels of salivary Alpha Amylase and Cortisol. Medicine (Baltimore) 2019; 98:e16978. [PMID: 31464945 PMCID: PMC6736477 DOI: 10.1097/md.0000000000016978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/06/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Inhalation sedation is a proven safe method for reducing children's dental anxiety and has been used worldwide for decades. There is controversy regarding the use of acclimatization or familiarization visits for dental sedation treatment pathways for children. This may increase acceptance to the treatment based on desensitization and acclimatization principles underpinning many behavior management techniques. This study aims to identify whether, an inhalation sedation acclimatization visit is effective in reducing the stress level in anxious children as measured by salivary Alpha Amylase and Cortisol levels. METHODS The study is a single-center, single blinded, parallel group 2 arm clinical trial. Children in need of inhalation sedation aged 5 to 15 years from September 2019 through March 2020 attending the Postgraduate Pediatric Clinic at the Hamdan Bin Mohammed College of Dental Medicine, in Dubai, will be allocated randomly and equally to either:At the initial visit a salivary sample will be collected at the beginning of the visit and the sedation need score will be recorded using the pediatric indicator of sedation need. Treatment for both groups will commence at the second visit. Salivary samples will be collected 15 minutes before the start of the treatment and 15 minutes after the conclusion of the treatment. The following outcomes will be recorded: completion of dental treatment, anxiety scores at baseline and after treatment using Frankl rating behavior scale and physiological anxiety related changes will be recorded using salivary Alpha Amylase and Cortisol levels. Mean changes of physiologic anxiety levels and corresponding 95% confidence intervals will be determined to compare the 2 treatments (sedation with familiarization and sedation without familiarization). DISCUSSION This is will be the first study to measure the effect of the acclimatization visit of nitrous oxide inhalation sedation on the level of physiological anxiety and the behavior of the pediatric patients during treatment.
Collapse
Affiliation(s)
| | | | - Anas Salami
- Hamdan Bin Mohammed College of Dental Medicine
| | - Rawan Awad
- Hamdan Bin Mohammed College of Dental Medicine
| | | | - Ahtiq Wahab
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | | |
Collapse
|
8
|
Muller TM, Alessandretti R, Bacchi A, Wentz Tretto PH. Eficácia e segurança da sedação consciente com óxido nitroso no tratamento pediátrico odontológico: uma revisão de estudos clínicos. JOURNAL OF ORAL INVESTIGATIONS 2018. [DOI: 10.18256/2238-510x.2018.v7i1.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Métodos: foi realizada uma busca nas bases de dados do Pubmed/Medline e uma busca manual nas principais revistas da área. Toda via, não avaliando somente eficácia e segurança, mas também, comparando a sedação com óxido nitroso com as demais técnicas tradicionais, sendo usado este como complemento de técnicas ou analisando a diferenças na aplicação do óxido nitroso. Resultados: os estudos, demonstraram que a sedação consciente foi eficaz no tratamento odontopediátrico, sendo seguro quando realizado por profissionais treinados e qualificados para exercer esta aplicação em determinados pacientes, sendo que os mesmos devem ser corretamente avaliados se estão aptos a receber a sedação, nos demais resultados, foi obtido um bom atendimento, com diminuição do choro e estado alerta da criança, ao combinar por exemplo gestão comportamental com óxido nitroso, o medo diminuiu ainda mais, entretanto, não foi apresentado efeitos analgésicos na maioria dos casos e não houve diminuição no tempo de consulta com o uso do óxido nitroso, embora, também não requereu um número maior de seções. Conclusão: A sedação consciente com oxido nitroso foi uma técnica segura e eficaz para ser realizada em crianças, desde que o profissional seja habilitado e a criança apta para passar pelo processo de sedação.
Collapse
|
9
|
Comparing the profile of child patients attending dental general anaesthesia and conscious sedation services. Br Dent J 2017; 222:683-687. [DOI: 10.1038/sj.bdj.2017.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/15/2022]
|
10
|
Madouh M, Tahmassebi JF. Utilising a paediatric version of the indicator of sedation need for children's dental care: a pilot study. Eur Arch Paediatr Dent 2016; 17:265-70. [PMID: 27468835 DOI: 10.1007/s40368-016-0238-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
AIM To assess the treatment outcomes of using inhalation sedation for comprehensive dental care in children by utilising a modified version of the indicator of sedation need tool. METHODS Investigating the outcomes of dental treatment of patients referred to the sedation unit at the Leeds Dental Institute when the paediatric version of the indicator of sedation need (p-IOSN) was utilised. RESULTS Forty patients of mean age 9.99 (SD = 3.14) years were followed up to ascertain treatment outcomes when the p-IOSN was used. Of the total of 40 children included, 20 scored 6 on p-IOSN. Treatment completion rate was 72.5 %. Although major differences existed between age and treatment outcomes, they failed to achieve statistical significance. No significant association was found between gender and p-IOSN of any score with any treatment outcome. CONCLUSIONS p-IOSN may be a useful tool that can be used to predict those child patients who would benefit from sedation for their dental treatment. However, the p-IOSN is still in a developmental stage and further research is required prior to its use on clinical grounds.
Collapse
Affiliation(s)
- M Madouh
- Al-Adan Dental Centre, Kuwait City, Kuwait
| | - J F Tahmassebi
- Department of Paediatric Dentistry, Leeds Dental Institute, University of Leeds, Clarendon Way, Leeds, LS2 9LU, UK.
| |
Collapse
|
11
|
Kebriaee F, Sarraf Shirazi A, Fani K, Moharreri F, Soltanifar A, Khaksar Y, Mazhari F. Comparison of the effects of cognitive behavioural therapy and inhalation sedation on child dental anxiety. Eur Arch Paediatr Dent 2014; 16:173-9. [DOI: 10.1007/s40368-014-0152-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 09/18/2014] [Indexed: 10/24/2022]
|
12
|
Porritt J, Buchanan H, Hall M, Gilchrist F, Marshman Z. Assessing children's dental anxiety: a systematic review of current measures. Community Dent Oral Epidemiol 2012; 41:130-42. [DOI: 10.1111/j.1600-0528.2012.00740.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 07/07/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Jenny Porritt
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Heather Buchanan
- Institute of Work, Health & Organisations, University of Nottingham; Nottingham; NG8 1BB; UK
| | - Melanie Hall
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Fiona Gilchrist
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| | - Zoe Marshman
- Academic Unit of Oral Health and Development; School of Clinical Dentistry, University of Sheffield; Sheffield; S10 2TA; UK
| |
Collapse
|