Because most children are afraid of the process, convincing a child to cooperate when a tooth needs to be pulled is a major challenge for dentists. Researchers have been studying sedatives in the hopes of finding a safe, effective, low-dose solution that reduces the amount of anxiety that children experience prior to these types of procedures.
A new study in the current issue of the journal Anesthesia Progress looks at one particular method that may make it easier to give sedatives to children before extracting a tooth. The researchers compared the effectiveness of different doses of a sedative administered to children using a special device similar to a decongestant nasal sprayer and also measured how long it took those children to recover from the sedation.
The need for sedation during dental procedures has received increasing scrutiny in recent years, as many dentists find sedation necessary when children are frightened and nervous in the chair. Giving a sedative by mouth is standard in the United States, but it is difficult to judge the proper dose. Oversedating kids can have serious consequences and even lead to death, prompting lawmakers in several US states to consider changing how and when anesthesia is administered. The device used in this study, a mucosal atomizer, has been used in pediatric hospitals for some time and is slowly gaining favor in dental applications.
In the current study, researchers gave a sedative to 118 South African children between the ages of 4 and 6 years old. All of the children needed to have a tooth extracted in an emergency dental clinic. A mucosal atomizer was used to spray intranasal midazolam, a commonly used sedative that is absorbed directly into the bloodstream through the lining of the nose, at doses of 0.3 or 0.5 mg/kg.
The researchers found that all of the children were sedated to some degree, and pulse rate and oxygen saturation levels were within normal ranges. The children who received the larger dose had less anxiety and a better behavior score, and only took a couple of minutes longer to waken from the sedation.
The only common complaint of the mucosal atomizer was a burning sensation felt when the drug was being sprayed. In these cases, a nurse gave a nasal anesthesia a few minutes before the main sedative. As a result, only 9% of children in the study said they felt burning in their nasal cavity.
The researchers concluded that the mucosal atomizer is best for children during short procedures. Additionally, the study showed that either dose of intranasal midazolam is safe and effective; however, the stronger dose causes less anxiety during the procedure, making the child easier to work with. The authors recommend using the larger dosage of the drug in emergency medical and dental hospitals. American pediatric dentists may need an additional permit and training before they can use this tool.
Full text of the article “Intranasal Midazolam Sedation in a Pediatric Emergency Dental Clinic,” Anesthesia Progress, Vol. 63, No. 3, 2016, is now available at https://www.anesthesiaprogress.org/doi/abs/10.2344/15-00016.1.
