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Xing F, Zhang TT, Yang Z, Qu M, Shi X, Li Y, Li Y, Zhang W, Wang Z, Xing N. Comparison of dexmedetomidine and a dexmedetomidine-esketamine combination for reducing dental anxiety in preschool children undergoing dental treatment under general anesthesia: A randomized controlled trial. J Affect Disord 2024; 347:569-575. [PMID: 38065480 DOI: 10.1016/j.jad.2023.12.011] [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: 07/01/2023] [Revised: 11/06/2023] [Accepted: 12/02/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Dental anxiety is a widespread complication occurring in pediatric patients during dental visits and may lead to undesirable complications. Esketamine may be effective in anxiety. OBJECTIVE The objective of this study was to investigate the effect of premedication with a dexmedetomidine-esketamine combination compared with dexmedetomidine alone on dental anxiety in preschool children undergoing dental treatment under general anesthesia. METHODS This is a prospective, double-blinded, randomized controlled trial. A total of 84 patients were scheduled for elective outpatient dental caries treatment under general anesthesia. Patients were randomly premedicated with intranasal dexmedetomidine (group D) or intranasal dexmedetomidine-esketamine (group DS). The primary outcome was the level of dental anxiety assessed by the Modified Child Dental Anxiety Scale (MCDAS) at 2Â h after surgery. Secondary outcomes included level of dental anxiety at 1Â day and 7Â days after surgery, the incidence of dental anxiety at 2Â h, 1Â day, and 7Â days after surgery, sedation onset time, overall success of sedation, acceptance of mask induction, postoperative pain intensity, incidence of emergence agitation in PACU, adverse reactions, HR, and SpO2 before premedication (baseline) and at 10, 20, and 30Â min after the end of study drug delivery. RESULTS The dental anxiety in group DS was lower than that in group D at 2Â h, 1Â day, and 7Â days postoperatively (PÂ =Â 0.04, 0.004, and 0.006, respectively). The incidences of dental anxiety in group DS were lower than those in group D at 2Â h (53Â % vs 76Â %, PÂ =Â 0.03), 1Â day (47Â % vs 71Â %, PÂ =Â 0.04), and 7Â days (44Â % vs 71Â %, PÂ =Â 0.02) after surgery. Group DS had a higher success rate of sedation (PÂ =Â 0.03) but showed a lower MAS score (PÂ =Â 0.005) and smoother hemodynamics (PÂ <Â 0.01) after drug administration than group D. Group DS showed a significantly lower incidence rate of emergence agitation (PÂ =Â 0.03) and postoperative pain intensity (PÂ =Â 0.006) than that in group D during the anesthesia recovery time. The occurrence of adverse reactions was similar in both groups (PÂ >Â 0.05). LIMITATIONS We did not analyze and correct for the learning effect caused by repeated applications of the MCDAS and MCDAS scores on the 1Â day after surgery were obtained by telephone follow-up. CONCLUSIONS Compared to premedication with dexmedetomidine alone, premedication with intranasal dexmedetomidine combined with esketamine could significantly improve dental anxiety in preschool children undergoing dental treatment under general anesthesia.
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Affiliation(s)
- Fei Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan 450052, China
| | - Tong-Tong Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Zhihu Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Mingcui Qu
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Xiaoshan Shi
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yanna Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Yan Li
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Wei Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan 450052, China
| | - Zhongyu Wang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan 450052, China.
| | - Na Xing
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China; Henan Province International Joint Laboratory of Pain, Cognition and Emotion, Zhengzhou, Henan 450052, China.
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Fu SW, Li S, Shi ZY, He QL. Interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety: a Chinese cross-sectional study. BMC Oral Health 2023; 23:139. [PMID: 36899301 PMCID: PMC10007847 DOI: 10.1186/s12903-023-02834-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/23/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Children's dental anxiety is common in dental clinics. This study aimed to determine the interrater agreement between children's self-reported and their mothers' proxy-reported dental anxiety and its affecting factors. METHODS In this cross-sectional study performed in a dental clinic, primary school students and their mothers were assessed for enrollment eligibility. The Modified Dental Anxiety Scale plus Facial Image Scale (MDAS-FIS) was employed to test both the children's self-reported and their mothers' proxy-reported dental anxiety independently. The interrater agreement was analyzed using percentage agreement and the linear weighted kappa (k) coefficient. Factors affecting children's dental anxiety were analyzed using univariate and multivariate logistic regression models. RESULTS One hundred children and their mothers were enrolled. The median ages of the children and mothers were 8.5 and 40.0 years old, respectively, and 38.0% (38/100) of the children were female. The scores of children's self-reported dental anxiety were significantly higher than their mothers' proxy-reported dental anxiety (MDAS-Questions 1-5, all p < 0.05); moreover, there was no agreement between the two groups in terms of all anxiety hierarchies (kappa coefficient = 0.028, p = 0.593). In the univariate model, a total of seven factors (age, gender, maternal anxiety, number of dental visits, mother's presence or absence, oral health status, and having siblings or not) were involved for analysis, and age [every 1-year increase, odds ratio (OR) = 0.661, 95% confidence interval (CI) = 0.514-0.850, p = 0.001], several dental visits (every 1 visit increase, OR = 0.409, 95% CI = 0.190-0.880, p = 0.022), and mother presence (OR = 0.286, 95% CI = 0.114-0.714, p = 0.007) were affecting factors. In the multivariate model, only age (every 1 year increase) and maternal presence were associated with 0.697-fold (95% CI = 0.535-0.908, p = 0.007) and 0.362-fold (95% CI = 0.135-0.967, p = 0.043) decreases in the risk of children's dental anxiety during dental visits and treatment, respectively. CONCLUSION There was no significant agreement between elementary school students' self-reported dental anxiety and mothers' proxy ratings of children's dental anxiety, which suggests that self-reported dental anxiety by children should be encouraged and adopted, and the mother's presence during dental visits is strongly recommended.
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Affiliation(s)
- Su-Wei Fu
- Department of Stomatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China. .,Graduate School, University of Perpetual Help System Dalta, Las Piñas, Philippines.
| | - Shen Li
- Department of Stomatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zhi-Yan Shi
- Department of Stomatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Qing-Li He
- Department of Stomatology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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