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Dental Sedation in Children

  • Pediatric Anesthesia (J Lerman, Section Editor)
  • Published:
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Abstract

Dental caries, a common ailment in children, often requires sedation. A majority of these sedations are provided by the dentist and take place in their offices. Dentists undergo training to deliver moderate sedation. The American Academy of Pediatric Dentists has published guidelines and policies for dentists who administer sedation and anesthesia in their offices. Oral sedation is the most common sedation technique used for dental caries, historically in the form of a “cocktail.” However, safety concerns of the “cocktail” combined with the improved safety and efficacy of midazolam have shifted the sedation regimen toward midazolam. The intranasal route for moderate sedation is used increasingly in dental sedation. An anesthesiologist may provide moderate or deep IV sedation or general anesthesia in the office. Hospital-based anesthesia is also used, but access and cost restrict its use. Sedation is an important service, but patient safety always comes first.

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References

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  1. Centers for Disease Control and Prevention. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis—United States, 1988–1994 and 1999–2002. MMWR Surveill Summ. 2005;54(No. SS-3):1–44.

    Google Scholar 

  2. New York State Department of Health. Oral Health Status of 3rd Grade Children. 2005. https://www.health.ny.gov/prevention/dental/docs/child_oral_health_surveillance.pdf.

  3. U.S. Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.

    Google Scholar 

  4. Dean J, McDonald R, Avery D. McDonald and Avery dentistry for the child and adolescent, 9th ed Mosby, VitalBook file; 2011.

  5. Aminabadi NA, Puralibaba F, Erfanparast L, Najafpour E, Jamali Z, Adhami SE. Impact of temperament on child behavior in the dental setting. J Dent Res Dent Clin Dent Prospect. 2011;5(4):119–22.

    PubMed Central  Google Scholar 

  6. Levering NJ, Welie JV. Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child. 2011;78:24–30.

    Google Scholar 

  7. Guelmann M, Brackett R, Beavers N, Primosch RE. Effect of continuous versus interrupted administration of nitrous oxide-oxygen inhalation on behavior of anxious pediatric dental patients: a pilot study. J Clin Pediatr Dent. 2012;37(1):77–82.

    Article  PubMed  CAS  Google Scholar 

  8. •• Tobias JD. Applications of nitrous oxide for procedural sedation in the pediatric population. Pediatr Emerg Care. 2013;29:245–65. A review highlighting the physiology and pharmacology of nitrous oxide as well as its many uses for pediatric sedation including dentistry. Delivery mechanisms and exposure concerns are discussed.

    Article  PubMed  Google Scholar 

  9. Wilson S, et al. Conscious sedation experiences in graduate pediatric dentistry programs. Pediatr Dent. 2001;23:3.

    Google Scholar 

  10. LaPointe L, Guelmann M, Primosch R. State regulations governing oral sedation in dental practice. Pediatr Dent. 2012;34:489–92.

    PubMed  Google Scholar 

  11. Originating Committee Clinical Affairs Committee – Sedation and General Anesthesia Subcommittee. Guideline on use of anesthesia personnel in the administration of office-based deep sedation general anesthesia to the pediatric dental patient. REFERENCE MANUAL V 3 4/N O 6 1 2/13.

  12. Kapur A, Chawla HS, Gauba K, Goyal A, Bhardwaj N. Effect of oral-transmucosal midazolam sedation on anxiety levels of 3–4 years old children during a Class II restorative procedure. Contemp Clin Dent. 2014;5(3):334–9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  13. Heard C, Creighton P, Lerman J. Intranasal Flumazenil and naloxone to reverse over-sedation in a child undergoing dental restorations. Pediatr Anesth. 2009;19:795–9.

    Article  Google Scholar 

  14. Heard C, Smith J, Creighton P, Joshi P, Feldman D, Lerman J. A comparison of four sedation techniques for pediatric dental surgery. Pediatr Anesth. 2010;20:924–30.

    Article  Google Scholar 

  15. • Peretz B, Kharouba J, Somri M. A comparison of two different dosages of oral midazolam in the same pediatric dental patients. Pediatr Dent. 2014;36:228–32. The use of two different midazolam doses demonstrates a better response with 0.75 mg/kg. A single agent, midazolam based technique can provide safe effective moderate sedation, rather than using a more risky poly-pharmacy approach.

  16. Antonio C, Zurek J, Creighton P, Johnson K, Heard C. Reducing the pain of intranasal drug administration. Pediatr Dent. 2011;33:415–9.

    PubMed  Google Scholar 

  17. Tanaka S, Uchida S, Miyakawa S, Inui N, Takeuchi K, Watanabe H, Namiki N. Comparison of inhibitory duration of grapefruit juice on organic anion-transporting polypeptide and cytochrome P450 3A4. Biol Pharm Bull. 2013;36:1936–41.

    Article  PubMed  CAS  Google Scholar 

  18. Farkas D, Oleson LE, Zhao Y, Jerold S, Harmatz JS, Zinny MA, Court MH, Greenblatt DJ. Pomegranate juice does not impair clearance of oral or intravenous midazolam, a probe for cytochrome P450-3A activity: comparison with grapefruit juice. J Clin Pharmacol. 2007;47:286–94.

    Article  PubMed  CAS  Google Scholar 

  19. Isik B, Baygin O, Bodur H. Effect of drinks that are added as flavoring in oral midazolam premedication on sedation success. Pediatr Anesth. 2008;18:494–500.

    Article  Google Scholar 

  20. Reed MD, Rodarte A, Blumer JL, Khoo KC, Akbari B, Pou S, Kearns GL. The single-dose pharmacokinetics of midazolam and its primary metabolite in pediatric patients after oral and intravenous administration. J Clin Pharmacol. 2001;41:1359–69.

    Article  PubMed  CAS  Google Scholar 

  21. Payne K, Mattheyse FJ, Liebenberg D, Dawes T. The pharmacokinetics of midazolam in pediatric patients. Eur J Clin Pharmacol. 1989;37:267–72.

    Article  PubMed  CAS  Google Scholar 

  22. Coté CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics. 2000;106(4):633–44.

    Article  PubMed  Google Scholar 

  23. Ritwik P, Cao LT, Curran R, Musselman RJ. Post-sedation events in children sedated for dental care. Anesth Prog. 2013;60:54–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Salmon AG, Kizer KW, Zeise L, Jackson RJ, Smith MT. Potential carcinogenicity of chloral hydrate—a review. J Toxicol Clin Toxicol. 1995;33(2):115–21.

    Article  PubMed  CAS  Google Scholar 

  25. Gauillard J, Cheref S, Vacherontrystram MN, Martin JC. Chloral hydrate: a hypnotic best forgotten? Encephale. 2002;28:200–4.

    PubMed  CAS  Google Scholar 

  26. Sheroan MM, Dilley DC, Lucas WJ, Vann WF. A prospective study of 2 sedation regimens in children: chloral hydrate, meperidine, and hydroxyzine versus midazolam, meperidine and hydroxyzine. Anesth Prog. 2006;53:83–90.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Paton DM, Webster DR. Clinical pharmacokinetics of H1-receptor antagonists (the antihistamines). Clin Pharmacokinet. 1985;10(6):477–97.

    Article  PubMed  CAS  Google Scholar 

  28. • Costa LR, Costa SP, Brasileiro SV, Bendo CB, Viegas CM, Paiva SM. Post-discharge adverse events following pediatric sedation with high doses of oral medication. J Pediatr. 2012;160:807–13. A review of chloral hydrate and midazolam based pediatric dental sedation publications with respect to post discharge complications, demonstrated that the chloral group had many more complications. Midazolam’s 3 hour half-life is a much better suited to outpatient sedation and is as such a much safer choice.

    Article  PubMed  Google Scholar 

  29. McCormack L, Chen JW, Trapp L, Job A. A comparison of sedation-related events for two multiagent oral sedation regimens in pediatric dental patients. Pediatr Dent. 2014;36:302–8.

    PubMed  Google Scholar 

  30. Singh C, Pandey RK, Saksena AK, Chandra G. A comparative evaluation of analgo-sedative effects of oral dexmedetomidine and ketamine: a triple-blind, randomized study. Pediatr Anesth. 2014;24:1252–9.

    Article  Google Scholar 

  31. Folayan MO, Faponle AF, Oziegbe EO, Adetoye AO. A prospective study on the effectiveness of ketamine and diazepam used for conscious sedation in paediatric dental patients’ management. Eur J Paediatr Dent. 2014;15:1–5.

    Article  Google Scholar 

  32. Toomarian L, Salem K, Ansari G. Assessing the sedative effect of oral vs submucosal meperidine in pediatric dental patients. Dent Res J. 2013;10(2):173–9.

    Article  Google Scholar 

  33. Walbergh EJ, Wills RJ, Eckhert J. Plasma concentrations of midazolam following intranasal administration. Anesthesiology. 1991;74:233–5.

    Article  PubMed  CAS  Google Scholar 

  34. Chiaretti A, Barone G, Rigante D, Ruggiero A, Pierri F, Barbi E, et al. Intranasal lidocaine and midazolam for procedural sedation in children. Arch Dis Child. 2011;96:160–3.

    Article  PubMed  Google Scholar 

  35. Scheepers LD, Montgomery CJ, Kinahan AM, Dunn GS, Bourne RA, McCormack JP. Plasma concentrations of flumazenil following intranasal administration in children. Can J Anesth. 2000;47L:120–4.

    Article  Google Scholar 

  36. Robinson A, Wermeling DP. Intranasal naloxone administration for treatment of opioid overdose. Am J Health Syst Pharm. 2014;71(24):2129–35.

    Article  PubMed  CAS  Google Scholar 

  37. Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, Olkkola KT. Bioavailability of dexmedetomidine after intranasal administration. Eur J Clin Pharmacol. 2011;67(8):825–31.

    Article  PubMed  CAS  Google Scholar 

  38. Sheeta SA, Al-Sarheed MA, Abdelhalim AA. Intranasal dexmedetomidine vs midazolam for premedication in children undergoing complete dental rehabilitation: a double-blinded randomized controlled trial. Pediatr Anesth. 2014;24:181–9.

    Article  Google Scholar 

  39. •• Hitt JM, Corcoran T, Michienzi K, Creighton P, Heard C. An evaluation of intranasal sufentanil and dexmedetomidine for pediatric dental sedation. Pharmaceutics. 2014;6:175–84. A combination of intranasal dexmedetomidine and sufentanil was shown to be effective, providing procedural sedation for about an hour. Onset was slow at least 45 minutes. There were no complications, however the potent nature of sufentanil must be considered and capnography is recommended when using potent IN opiates.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Lundeberg S, Roelofse JA. Aspects of pharmacokinetics and pharmacodynamics of sufentanil in pediatric practice. Pediatr Anesth. 2011;21:274–9.

    Article  Google Scholar 

  41. Davis PJ, Fertal KM, Boretsky KR, Fedel GM, Ingram MD, Woelfel SK, Hoffmann PC, Gurnaney H, Young MS. The effects of oral ondansetron disintegrating tablets for prevention of at-home emesis in pediatric patients after ear-nose-throat surgery. Anesth Analg. 2008;106:1117–21.

    Article  PubMed  CAS  Google Scholar 

  42. Pandey RK, Bahetwar SK, Saksena AK, Chandra G. A comparative evaluation of drops versus atomized administration of intranasal ketamine for the procedural sedation of young uncooperative pediatric dental patients: a prospective crossover trial. J Clin Pediatr Dent. 2011;36:79–84.

    Article  PubMed  CAS  Google Scholar 

  43. Surendar NM, Pandey KR, Saksena KA, Kumatr R, Chnadra G. A comparative evaluation of intrnasal dexmedetomidine, midazolam and ketamine for their sedative and analgesic properties: a triple blind randomized study. J Clin Pediatr Dent. 2014;38:255–61.

    Article  PubMed  Google Scholar 

  44. Chopra R, Marwaha M. Assessment of buccal aerosolized midazolam for pediatric conscious sedation. J Investig Clin Dent. 2013;5:1–5.

    Google Scholar 

  45. Chopra R, Mittal M, Bansal K, Chaudhuri P. Buccal midazolam spray as an alternative to intranasal route for conscious sedation in pediatric dentistry. J Clin Pediatr Dent. 2013;38:171–3.

    Article  PubMed  Google Scholar 

  46. Wood M. The safety and efficacy of using a concentrated intranasal midazolam formulation for paediatric dental sedation. SAAD Dig. 2011;27:16–23.

    PubMed  Google Scholar 

  47. Olabi NF, Jones JE, Saxen MA, Sanders BJ, Walker LA, Weddell JA, Schrader SM, Tomlin AM. The use of office-based sedation and general anesthesia by board certified pediatric dentists practicing in the United States. Anesth Prog. 2012;59:12–7.

    Article  PubMed  PubMed Central  Google Scholar 

  48. • Tarver M, Guelmann M, Primosch R. Impact of office-based intravenous deep sedation providers upon traditional sedation practices employed in pediatric dentistry. Pediatr Dent. 2012;34: 62–68. This paper outlines the use and need for office based dental sedation. The opportunity for office based anesthesia is presented, the changing practice observed as it is utilized as well as some of the financial constraints involved with this service.

  49. Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit. Int J Paediatr Dent. 2004;14(1):2–8.

    Article  PubMed  CAS  Google Scholar 

  50. • Mittal N, Goyal A, Gauba K, Kapur A, Jain K. A double blind randomized trial of ketofol versus propofol for endodontic treatment of anxious pediatric patients. J Clin Pediatr Dent. 2013;37:415–20. Ketamine is considered by some to be a drug that has minimal side effects This study shows that when used to provide sedation with propofol compared to propofol alone there were more respiratory complications, including desaturation and laryngospasm. Ketamine may not be a good choice when performing oral operative procedures under deep sedation.

    Article  CAS  Google Scholar 

  51. Kim HS, Kim JW, Jang KT, Lee SH, Kim CC, Shin TJ. Initial experience with dexmedetomidine for dental sedation in children. J Clin Pediatr Dent. 2013;38:79–81.

    Article  PubMed  Google Scholar 

  52. Yu C, Li S, Deng F, Yao Y, Qian L. Comparison of dexmedetomidine/fentanyl with midazolam/fentanyl combination for sedation and analgesia during tooth extraction. Int J Oral Maxillofac Surg. 2014;43:1148–53.

    Article  PubMed  CAS  Google Scholar 

  53. Hasan MS, Chan L. Dexmedetomidine and ketamine sedation for dental extraction in children with cyanotic heart disease. J Oral Maxillofac Surg. 2014;72(10):1920.e1–4.

    Article  Google Scholar 

  54. Kim SO, Kim YK, Hyun HK, Koo YS, Shin TJ. Deep sedation with sevoflurane inhalation via a nasal hood for brief dental procedures in pediatric patients. Pediatr Emerg Care. 2013;29:926–8.

    Article  PubMed  Google Scholar 

  55. Kurrek MM, Dain SL, Kiss A. The effect of the double mask on anesthetic waste gas levels during pediatric mask inductions in dental offices. Anesth Analg. 2013;117:43–6.

    Article  PubMed  CAS  Google Scholar 

  56. Zhao N, Deng F, Yu C. Anesthesia for pediatric day-case dental surgery: a study comparing the classic laryngeal mask airway with nasal trachea intubation. J Craniofac Surg. 2014;25:e245–8.

    Article  PubMed  Google Scholar 

  57. Dag C, Bezgin T, Ozalp N, Golcuklu AG. Utility of bispectral index monitoring during deep sedation in pediatric dental patients. J Clin Pediatr Dent. 2014;39:291–6.

    Article  Google Scholar 

  58. Baygin O, Tuzuner T, Isik B, Kusgoz A, Tanriver M. Comparison of pre-emptive ibuprofen, paracetamol, and placebo administration in reducing post-operative pain in primary tooth extraction. Int J Pediatr Dent. 2011;21:306–13.

    Article  Google Scholar 

  59. Yagiela JA. Whats new with phemntolamine mesylate: a reversal agent for local anesthesia? SAAD Dig. 2011;27:3–7.

    PubMed  Google Scholar 

  60. Boynes SG, Riley AE, Milbee S, Bastin MR, Price ME, Ladson A. Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic. Gen Dent. 2013;61(5):70–6.

    PubMed  Google Scholar 

  61. • Nourbakhsh N, Shirani F, Babaaei M. Effect of phentolamine mesylate on duration of soft tissue local anesthesia in children. J Res Pharm Pract. 2012;1:55–9. Phentolamine is now approved for reversal of local anesthesia in children 6 years and older. This paper showed that the duration of local anesthesic effect could be shorted by 70 minutes. This may be useful for children post sedation or general anesthesia who may be at risk of chewing their gums or lips whilst recovering, especially those with some cognitive disability.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Nosrat N, Farzaneh S, Mahdi B, Beringer RM, Segar P, Pearson A, Greamspet M, Kilpatrick N. Observational study of perioperative behavior changes in children having teeth extracted under general anesthesia. Pediatr Anesth. 2014;24:499–504.

    Article  Google Scholar 

  63. Millar K, Bowman AW, Burns D, McLaughlin P, Moores T, Mortson NS, Musiello T, Wallace E, Wray A, Welbury R. Children’s cognitive recovery after day-case general anesthesia: a randomized trial of propofol or isoflurane for dental procedures. Pediatr Anesth. 2014;24:201–7.

    Article  Google Scholar 

  64. Bernards CM, Hadzic A, Suresh S, Neal JM. Regional anesthesia in anesthetized or heavily sedated patients. Reg Anesth Pain Med. 2008;33(5):449–60.

    Article  PubMed  CAS  Google Scholar 

  65. Balicer RD, Kitai E. Methemoglobinemia caused by topical teething preparation: a case report. Scientific World J. 2004;15(4):517–20.

    Article  Google Scholar 

  66. Gutenberg LL, Chen JW, Trapp L. Methemoglobin levels in generally anesthetized pediatric dental patients receiving prilocaine versus lidocaine. Anesth Prog. 2013;60:99–108.

    Article  PubMed  PubMed Central  Google Scholar 

  67. • Latham GJ, Jardine DS. Oxymetazoline and hypertensive crisis in a child: can we prevent it? Pediatr Anesth. 2013;23:952–56. A case report that outline how the inappropriate use of an oxymetazoline spray bottle can result in extremely high doses of this hypertensive agent being given to a child.

    Article  PubMed  Google Scholar 

  68. Watt S, Pickhardt D, Lerman J, Armstrong J, Creighton P, Feldman L. Telescoping tracheal tubes into catheters minimizes epistaxis during nasotracheal intubation in children. Anesthesiology. 2007;106:238–42.

    Article  PubMed  Google Scholar 

  69. Coté CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics. 2000;105:805–14.

    Article  PubMed  Google Scholar 

  70. Coté CJ. Conscious sedation: time for this oxymoron to go away! J Pediatr. 2001;139:15–7.

    Article  PubMed  Google Scholar 

  71. Lee HH, Milgrom P, Starks H, Burke W. Trends in death associated with pediatric dental sedation and general anesthesia. Paediatr Anaesth. 2013;23(8):741–6.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Kang J, Vann WF, Lee JY, Anderson JA. The safety of sedation for overweight/obese children in the dental setting. Pediatr Dent. 2012;34:392–6.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Anesthesiology, Pediatrics, Pediatric & Community Dentistry, SUNY at Buffalo, Buffalo, NY, USA

    Christopher Heard

  2. Pediatric & Community Dentistry, SUNY at Buffalo, Buffalo, NY, USA

    Carrie Wanamaker

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  1. Christopher Heard
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  2. Carrie Wanamaker
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Correspondence to Christopher Heard.

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This article is part of the Topical Collection on Pediatric Anesthesia.

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Heard, C., Wanamaker, C. Dental Sedation in Children. Curr Anesthesiol Rep 5, 115–124 (2015). https://doi.org/10.1007/s40140-015-0110-0

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