Oral sedation in dentistry: evaluation of professional practice of oral hydroxyzine in the University Hospital of Rennes, France

PURPOSE

Management of a child's anxiety early in their treatment is essential in dentistry. Sedative medications are used to overcome increased anxiety from previous appointments and to promote the cooperation of children during treatment. Hydroxyzine is currently prescribed to young patients as part of the first level of conscious sedation. The main objective was to evaluate the professional practice of oral hydroxyzine, when prescribed for children presenting anxiety during dental treatment procedure performed by students and senior practitioners.

METHODS

A retrospective study of dental records and questionnaires was conducted at the Dental Care Centre of the University Hospital of Rennes, France. Parameters related to the prescription of hydroxyzine in children were evaluated as potential predictors of the dental session success, with adjustments on potential confounders.

RESULTS

The therapeutic outcome was very encouraging with 78.3% of success during dental sessions under sedation with oral hydroxyzine. Anxiety levels before the dental procedure and the medication compliance of the child were the main predictors of success. On the other hand, lower age (< 6 years old) and longer treatments (such as pulpotomy) worsened the outcome.

CONCLUSIONS

Careful analysis of the literature and results of this work showed the safety of hydroxyzine within the maximum dose authorized without adverse effects, compared to other molecules described and commonly used in dentistry. No adverse effects during dental procedure were noted. This allows for minimal sedation with efficiency for the great majority of pediatric treatment. This solution should be the first step in sedation to help practicing clinicians.

Computer-assisted intraosseous anaesthesia for molar and incisor hypomineralisation teeth. A preliminary study

Anesthetizing MIH (Molar and Incisor Hypomineralisation) teeth is one of the major challenges in paediatric dentistry. Computer-assisted IO injection (CAIO) of 4% articaine with 1:200,000 epinephrine (Alphacaine, Septodont) has been shown to be an efficient way to anesthetize teeth in children. The aim of this study was to assess the efficacy of this method with MIH teeth. This preliminary study was performed using the Quick Sleeper system (Dental Hi Tec, Cholet, France) that allows computer-controlled rotation of the needle to penetrate the bone and computer-controlled injection of the anaesthetic solution. Patients (39) of the department of Paediatric Dentistry were included allowing 46 sessions (including 32 mandibular first permanent molars) to be assessed. CAIO showed efficacy in 93.5% (43/46) of cases. Failures (3) were due to impossibility to reach the spongy bone (1) and to achieve anaesthesia (2). This prospective study confirms that CAIO anaesthesia is a promising method to anesthetize teeth with MIH that could therefore be routinely used by trained practitioners.