16 July 2019

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Sedation in pediatric dentistry: which agent shall we chose?

Alessandra Abbà

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Many dental procedures can be performed with local anesthesia. Nonetheless in certain clinical situation and especially with pediatric patients it can be useful to associate local anesthesia with the administration of sedative agents in order to promote favorable operating conditions. The level of sedation required must be evaluated individually to achieve the right balance between the operator needs and the safety of the procedure. Inhalation sedation with nitrous oxide-oxygen sedation is a method for conscious sedation. This technique has nearly all the characteristics of an ideal analgesic agent:  safe and noninvasive delivery, lack of serious side effects, simplicity of use, a rapis onset and offset of action.  Triclofos sodium is a commonly used sedative drug used for oral sedation but there is scarce literature to substantiate its use and effectiveness in pediatric oral sedation.  

In this study published on Journal of Indian Society of Pedodontics and Preventive Dentistry in 2017, the authors want to evaluate the efficacy of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents in 5-10-year-old children.     

MATERIALS AND METHODS
Ninety-three children aged 5-10 years showing anxious and uncooperative behavior were selected for the study. Among the patients screened, only sixty requiring extractions, restorations, and endodontic treatment were selected for the study. Physical evaluation and preanesthetic evaluation were carried out by a pediatrician and an anesthesiologist, respectively. The sedative agents were administered by the anesthesiologist. Patients were randomly divided and assigned into two groups. Group A received 40% nitrous oxide-60% oxygen. The level of 40% nitrous oxide was maintained throughout the dental procedure and at the end of the treatment, 100% oxygen was administered for at least 3–5 min before removing the nasal mask. Group B received triclofos sodium in the dose of 70 mg/kg body weight, given 30 min before the treatment procedure. For both the groups, ventilator frequency, pulse, and oxygen saturation were recorded at baseline and during the entire procedure at 5 min interval for 30–45 min. During the whole treatment procedure, the child's response was recorded using the first three categories of the Houpt's behavior rating scale for sleep, body movement  and crying.  The acceptance of route of drug administration by the patient and parent was also assessed. Data obtained were statistically evaluated using the Mann-Whitney U-test and Chi-square test.    

RESULTS 
Children sedated with triclofos sodium were significantly more sleepy and disoriented compared to those sedated with nitrous oxide, with mean values of  3.73 ± 0.52 and 4.00 ± 0.00, respectively, which was significantly different (P = 0.005). The overall behavior of children in both the groups was similar. Good parental acceptance was observed for both the routes of administration. Parent of only one child showed poor acceptance of the route of administration in Group A, while 100% acceptance was observed among parents from Group B. Patients accepted the oral route significantly better than inhalation route (73.33% of acceptance in Group A and 100% for Group B) with a statistically significant difference between the groups (P = 0.002). (table 1) 

CONCLUSION
Both nitrous oxide-oxygen and triclofos sodium were observed to be effective sedative agents, for successful and safe use in 5-10-year-old dental patients. Nonetheless children seemed to prefer the oral route compared to the inhalation route for sedation whereas parental acceptance for both routes was good.

For additional informations: 
Evaluation of nitrous oxide-oxygen and triclofos sodium as conscious sedative agents