Guideline of nitrous oxide-oxygen inhalation sedation technique in dental outpatient / 中华口腔医学杂志

The use of nitrous oxide-oxygen inhalation sedation to relieve anxiety and pain in dental outpatient treatment has been a very mature and safe technique in the world. This technology has been introduced into China for nearly 20 years, and many clinical cases have proved its safety, practicability and effectiveness, which can meet the clinical needs of patients. To further standardize and popularize this technique, the Society of Sedation and Analgesia, Chinese Stomatological Association formed the recommended application guidelines after many discussions and revisions on the basis of widely soliciting opinions and referring to relevant literatures. It covers indications, contraindications, standardized operation procedures, occupational protection, identification and treatment of adverse reactions, training and other aspects. This guideline can be used as a reference for the use of nitrous oxide-oxygen inhalation sedation techniques in the outpatient setting of dentistry.

Avaliação e manejo da ansiedade e fobia odontológica: a psicologia na formação do cirurgião-dentista / Evaluation and management of anxiety and dental fear: psychology in the formation of the dentist

Dental fear and anxiety arise from several factors, among them, exposure to previous traumatic experiences with needles, injections and instruments that can cause discomfort. Anxious patients tend to reschedule appointments, avoid treatments and are only available for visits at the dentist when painful symptoms appear, so delayed treatment tends to be more invasive and cause even more emotional damage to the patient, consequently aggravate this feeling and, in turn, create a vicious cycle in which avoiding treatment only makes the oral health condition even worse. It is up to professionals of Dentistry to identify anxiety in patients and make use of resources to manage this anxiety in order to enable an effective dental treatment with less emotional damage to the patient. The aim of this study is to evaluate, by means of a integrative literature review, the importance of the study of Psychology by the dental professional and to expose the techniques for coping with dental anxiety, based on scientific evidences.

O medo e a ansiedade odontológica surgem por diversos fatores, entre eles, a exposição à experiências traumáticas anteriores com envolvimento de agulhas, injeções e instrumentos que possam causar incômodo. Os pacientes ansiosos tendem a adiar consultas, evitam os tratamentos odontológicos e só se dispõe às visitas ao dentista quando aparecem sintomas dolorosos, logo o tratamento tardio tende a ser mais invasivo causando ainda mais prejuízo emocional ao paciente, consequente agravo a tal sentimento e, por sua vez, origina um ciclo vicioso no qual evitar o tratamento agrava ainda mais a condição de saúde bucal. Cabe aos profissionais da Odontologia identificar a ansiedade nos pacientes e fazer uso de recursos de manejo dessa ansiedade de modo a possibilitar um tratamento odontológico eficaz e com menor prejuízo emocional ao paciente. Com este estudo pretende-se avaliar por meio de uma revisão integrativa de literatura, a importância do estudo da Psicologia pelo profissional da Odontologia e expor algumas técnicas de enfrentamento da ansiedade odontológica, com base em evidências científicas.

Miedo al tratamiento odontológico en escolares mexicanos / Dental fear among Mexican schoolchildren

RESUMEN Introducción: El miedo al tratamiento odontológico es una reacción emocional que se presenta en niños con una connotación especial. Puede influir en la conducta del niño durante el tiempo de la consulta e intervenir en la efectividad del tratamiento. El abordaje de sus características y de sus diferentes niveles de manifestación es importante para dimensionar este fenómeno psicológico y trazar estrategias futuras. Objetivo: Caracterizar el miedo al tratamiento odontológico en niños escolares mexicanos. Métodos: Se realizó una investigación descriptiva, observacional de corte transversal en 163 niños escolares de 6 a 12 años de edad de una escuela de Monterrey, México, en el período comprendido entre febrero y mayo del 2017. Se les aplicó la escala Dental Subscale of the Children's Fear Survey Schedule para determinar los niveles de miedo. Se asumieron para la investigación las variables sexo, edad y niveles de miedo. El análisis de los datos estadísticos se realizó mediante el programa SPSS versión 19.0 Resultados: Se destacó el miedo moderado con 45,4 por ciento y el componente asfixiarme de la escala con el 52,1 por ciento. Las "inyecciones" y que "un extraño me toque" constituyeron los ítems más relacionados con mucho miedo con un 42,7 por ciento y 47,9 por ciento, respectivamente. Se presentó la categoría mucho miedo solo a los 8 y 11 años de edad con 15,3 por ciento y 9,3 por ciento, respectivamente, así como el sexo femenino con el 48,4 por ciento. Conclusiones: El miedo al tratamiento odontológico en niños escolares mexicanos se manifiesta en niveles moderados, con una predilección a temer más a la asfixia durante el tratamiento dental. Edades tempranas de escolaridad, con ligero predominio en el sexo femenino, constituyeron las características más relacionadas con este fenómeno psicológico(AU)

ABSTRACT Introduction: Dental fear is an emotional reaction occurring in children with a special connotation. It may influence the behavior of child patients during consultation and affect the effectiveness of treatment. Addressing its characteristics and its various forms of manifestation is important to gain insight into this psychological phenomenon and devise future strategies. Objective: Characterize dental fear among Mexican schoolchildren. Methods: A cross-sectional observational descriptive study was conducted of 163 schoolchildren aged 6-12 years from a school in Monterrey, Mexico, from February to May 2017. The Dental Subscale of the Children's Fear Survey Schedule was applied to determine fear levels. The variables analyzed in the study were sex, age and fear levels. Analysis of statistical data was performed with the software SPSS version 19.0. Results: The scale components moderate fear (45.4 percent) and fear of suffocation (52.1 percent) stood out among the results obtained. Injections and being touched by a stranger were the items most commonly related to great fear, with 42.7 percent and 47.9 percent, respectively. The great fear category was present only at 8 and 11 years of age, with 15.3 percent and 9.3 percent, respectively, and in the female sex with 48.4 percent. Conclusions: Dental fear is moderate among Mexican schoolchildren, with a prevalence of fear of suffocation during dental care. Early school ages and a predominance of the female sex were the features most commonly related to this psychological phenomenon(AU)

Prevalence of Dental Anxiety and Associated Factors among Indian Children

Objective: To determine the prevalence of dental anxiety and associated factors among 5 to10 years old Indian children. Material and Methods: In this cross-sectional study, the sample was composed by 462 children (240 male and 222 female). Questionnaires consisting of dental anxiety scales were distributed to mother-child pair participants. Children fear survey schedule-dental subscale was used to assess child dental anxiety and Corah's dental anxiety scale was used to measure maternal dental anxiety. Age, gender, religion were also recorded to check the correlation of these factors with the child dental anxiety. Data was analyzed using SPSS software. Fisher's exact test and Pearson correlation tests were applied. The level of significance was set at 5%. Results: The cut-off score for CFSS-DS was 36. The prevalence of dental anxiety was 24.5% among 5 to 10 year old children. Although a statistically significant association was found between maternal and child dental anxiety (p=0.000), no significant association existed between age, gender, culture (religion) and child dental anxiety (p>0.05). Conclusion: Prevalence of dental anxiety was high in the Indian child population. Maternal dental anxiety was found to significantly influence the child dental anxiety, as compared to age, gender or the religion.

Anxiety in Children submitted to Dental Appointment

Objective: To determine anxiety in children undergoing dental treatment and to evaluate associated factors. Material and Methods: The sample consisted of 48 children during dental appointment in dental clinics of the Franciscano University Center, 48 caregivers, and 46 dentistry students. The modified Venham Picture Test was used to determine anxiety of children during dental appointment, before and after treatment. For determining anxiety related to dental care among caregivers, the modified Corah's dental anxiety scale was used. The Lipp`s stress symptoms inventory for adults was applied to determine the stress level of dentistry students. In addition, the individual characteristics of participants were recorded to determine their association with the presence of anxiety. Results: Anxiety was observed in 60.4% of children, and it was related to invasive dental procedures (p = 0.021), history of dental pain (p = 0.002), presence of bruxism (p = 0.028), anxious caregivers (p = 0.023), and stress of the dental student that conducted the appointment (p = 0.005). Conclusion: Overall, the majority of pediatric patients showed anxiety, which was directly related to misbehavior during dental care. Moreover, anxiety was related to individual characteristics of children and was influenced by the anxiety level of caregivers, as well as the emotional state of dentistry students during the dental appointment.

Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study

Abstract There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.

Oral midazolam reduces cortisol levels during local anaesthesia in children: a randomised controlled trial

Little is known about whether midazolam sedation can reduce salivary cortisol levels and consequently influence children’s behaviour during dental treatment. The aim of this study was to evaluate the effect of midazolam sedation on salivary cortisol and its correlation with children’s behaviour during restorative dental treatment. Eighteen healthy children, aged two to five years, were randomly assigned to two dental treatment appointments, both with physical restraint: oral midazolam 1 mg/kg (MS) and placebo (PS). An observer assessed the children’s behaviour (videos) using the Ohio State University Behavioral Rating Scale (OSUBRS). The children’s saliva was collected just after waking up, on arrival at the dental school, 25 minutes after local anaesthesia, and 25 minutes after the end of the procedure. Salivary cortisol levels were determined using the enzyme-linked immunoabsorbent assay. The data were analysed by bivariate tests and multivariate analysis of variance (5% level). Salivary cortisol levels were lower in the MS group than in the PS group at the time of anaesthesia (p = 0.004), but did not vary during the appointment within sedation (p = 0.319) or placebo (p = 0.080) groups. Children’s behaviour was negative most of the time and did not differ between MS and PS; however, the behaviour (OSUBRS) did not correlate with salivary cortisol levels. Oral midazolam is able to control salivary cortisol levels during dental treatment of pre-schoolers, which might not lead to better clinical behaviour.

Belenofobia en odontología / Belenophobia in dentistry

La calidad de la salud bucal puede estar disminuida no sólo por razones culturales y socio-económicas, sino además por el miedo que algunos pacientes experimentan en relación a la atención odontológica. La atención odontológica despierta en numerosos pacientes, especialmente en los niños, miedo y ansiedad, que pueden originar conductas de rechazo a la misma o dificultar el trabajo del profesional. Elmiedo persistente a objetos cortantes o punzantes en particular a las agujas se denomina: Belenofobia, un trastorno común que afecta al 10 por ciento de la población. En tal sentido el objetivo de este trabajo fue identificar los miedos que pueden presentarse en relación a la atención odontológica, estudiando 210 pacientes seleccionados al azar, que concurrieron a la visita odontológica para realizarse una extracción dentaria. Nuestros resultados mostraron un alto porcentaje (72,38 por ciento) de miedo a las agujas, lo que nos permitió concluir que la Belenofobia en Odontología usualmente se debe al miedo a las agujas. Registrar la información, las experiencias e identificar losinstrumentos dentales que se relacionan con el miedo a la atención odontológica permite identificar factores que dificultan la atención de los pacientes y que se evidencian en su comportamiento cuando se enfrentan al miedo. Acompañar al paciente a afrontar las dificultades en relación a la atención odontológica contribuirá a la promoción de su salud y de su desarrollo psíquico y emocional...

Musicoterapia en la primera consulta odontopediátrica: musicoprofilaxis clínica en odontopediatría / Music therapy in the first visit to the pediatric dentist: clinical music prophylaxis in pediatric dentistry

Objetivos: evaluar la validez de la musicoterapia para promover una mejor adherencia al tratamiento odontológico en niños que realizaron su primera consulta odontológica. Materiales y métodos: se llevó a cabo un estudio clínico randomizado en ciento cuarenta niños de ambos sexos entre 2 y 7 años de edad, divididos aleatoriamente en Grupo 1 o Grupo control sin musicoterapia y Grupo 2 o Grupo Experimental con musicoterapia. Se contó con con consentimiento de los padres de los niños. Se registró el comportamiento de los niños con la escala de Spencer N. Frankl y la ansiedad dental de los padres con la escala de ansiedad dental de Corah (CDAS). Se computaron las siguientes estadísticas: número de casos, valor mínimo hallado, valor máximo hallado, mediana, promedio y desviación estándar, y las siguientes pruebas de significación: prueba de Student, Prueba de Mann Whitney, prueba de Chi cuadrado y prueba de Fisher; nivel de significacióne establecido alfa 0,05. Resultados: la edad promedio era 4 +-1. En los niños del grupo experimental, el comportamiento fue significativamente positivo y la adherencia al tratamiento odontológico fue mayor que en el grupo control. Los padres con niveles más altos de ansiedad correspondieron a los niños con comportamiento negativo o significativamente negativo, con dificultades para aceptar las consignas y que necesitaron más tiempo durante la visita al consultorio. Conclusión: la musicoterapia es un método válido para favorecer una mejor adherencia al tratameinto odontológico en niños que realizaron su primera consulta.

Effect of a combination of oral midazolam and low-dose ketamine on anxiety, pain, swelling, and comfort during and after surgical extractions of mandibular third molars.

Purpose: To assess the clinical efficacy of a combination of oral midazolam plus low-dose ketamine for reducing anxiety during surgery and in preventing postoperative pain and swelling after the surgical extraction of third molars. Materials and Methods: Thirty patients requiring bilateral surgical extraction of mandibular third molars were included in this study. Prior to extraction of the tooth on the right side, a combination of oral midazolam and low-dose ketamine was given to the patient, while this protocol was not followed for extraction of the tooth on the left side. Anxiety levels were checked before surgery. The postoperative pain and swelling and patient's comfort with and without the premedication were compared. Results: Facial swelling on the postoperative days was lower on the right side than on the left. Pain scores at 30 minutes and 24 hours after surgery were significantly higher on the left side. Also, anxiety during the surgery was less and comfort levels were higher postoperatively when the combination of oral midazolam plus low-dose ketamine was used. Conclusions: Premedication with midazolam plus low-dose ketamine prior to surgical extraction of third molars can provide the patient with a comfortable procedure and good postoperative analgesia, with less swelling and significantly less pain.

Dental anxiety and pain related to ART

Atraumatic Restorative Treatment (ART) is considered to be well accepted, both by children and by adult patients. The objective of this review is to present and discuss the evidence regarding the acceptability of ART, from the patient's perspective. Aspects related to dental anxiety/fear and pain/discomfort have been highlighted, to facilitate better understanding and use of the information available in the literature. CONCLUSIONS: The ART approach has been shown to cause less discomfort than other conventional approaches and is, therefore, considered a very promising "atraumatic" management approach for cavitated carious lesions in children, anxious adults and possibly, for dental-phobic patients.

Controle da ansiedade em Odontologia: enfoque atuais / Anxiety control in the Dentistry current approaches

A literatura mostra-se muito carente no que diz respeito à ansiedade na odontolgia. Como o tratamento odontológico pode representar um grande problema para pacientes ansiosos, a proposta deste estudo foi revisar a literatura a fim de avaliar o que existe de mais atual a esse respeito, objetivando contribuir com os profissionais odontológicos no sentido de embasá-los para o controle da ansiedade no consultório.

A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients.

Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.

Comportamiento clínico del miedo infantil al estomatólogo con tratamiento de flores de Bach / Clinical behaviour of the child fear to the dentist after Bach´ flower therapy

Se realizó un estudio descriptivo, transversal en niños de 6 a 7 años de edad, de ambos sexos, procedentes del Centro Escolar 26 de Julio, que asistieron a la Clínica Estomatológica Provincial Docente con manifestaciones de temor y miedo al dentista, en un período comprendido de octubre del 2005 a junio del 2006. El universo de estudio estuvo constituido por 50 pacientes que presentaron este desequilibrio emocional. Se realizaron encuestas a niños y padres para la identificación del tipo de miedo y el hábito, indicándose el remedio floral combinado con otras esencias florales, de acuerdo con el tipo de miedo diagnosticado. Los resultados del comportamiento en clínica del miedo se evaluaron a los 7, 14, 21 y 30 días de tratamiento. Los resultados se reflejaron en tablas. Se observó la mejoría en 38 niños del total de los casos, para el 82 por ciento a los 30 días de tratamiento. Se recomendó profundizar en los resultados de este estudio y realizar un ensayo clínico terapéutico(AU)

A descriptive cross-sectional study of children of both sexes aged 6 to 7 years, from 26 de Julio school, who went to the Provincial Dental Clinic with signs of fear to the dentist in the period from October 2005 to June 2006, was conducted. The universe of study was made up of 50 patients who presented with emotional impairment. Children and parents were surveyed to identify the type of fear and habit; then flower remedies combined with other flower scents were indicated to treat the diagnosed type of fear. The behavioral results in the clinic were evaluated at the 7th, 14th, 21st and 30th days of treatment. The final outcomes were shown in tables. Thirty eight children improved their behavior towards the dentist, accounting for 82 per cent of the total number after 30 days of treatment. It was recommended to thoroughbly analyze the results of this study and to make a further therapeutical clinical assay(AU)

Propuestas didácticas en el manejo odontológico de pacientes pediátricos con discapacidad visual / Didactic proposals in the dental management of pediatric patients with visual disabilities

Los problemas de salud bucodental en pacientes con discapacidad visual se ven exacerbados debido a que no están en posición de identificar alguna patología en etapas tempranas y por lo tanto tomar acciones para solucionarla. Es importante que el cirujano dentista acepte al niño ciego con una actitud positiva, en lugar de enfatizar la discapacidad, deberá incorporar los sentidos restantes del mismo al plan de tratamiento, que no sólo se enfocará a la rehabilitación bucodental sino también comprenderá un programa preventivo de salud dental. Dicho programa exige que junto con la enseñanza de las técnicas para el aseo bucal en casa, se establezca un plan educativo donde el niño aprenderá cuáles son los tejidos que conforman a los dientes y el proceso evolutivo de la caries, los beneficios que reportan los procedimientos de higiene bucal adecuada y la necesidad de una correcta nutrición. Pero, ¿cómo enseñar a estos pacientes?, si la mayoría del material a nuestro alcance es de tipo audiovisual. Por lo tanto es importante establecer un programa que se apoye en el tacto. El objetivo del presente artículo es presentar material didáctico táctil que tiene dos funciones principales: la primera, es reducir el estrés del paciente, ya que a través del mismo se explicarán los procedimientos de operatoria dental, y la segunda, es cumplir con la parte educativa de nuestro programa preventivo. Esto nos permitirá proporcionar técnicas de cepillado, explicar la anatomía dental, así como la importancia de la higiene oral en la prevención de caries y otras patologías.

Sedación consciente: una alternativa en el manejo del dolor y la ansiedad en odontología / Conscious sedation: an alternative in the management of pain and anxiety in dentistry

El manejo del dolor y la ansiedad es uno de los desafíos más importantes en la atención odontológica diaria. Por diferentesrazones, los pacientes concurren a la consulta dental con grados variables de ansiedad y dolor y es obligación del profesionalbrindarle una atención libre de ambas. Se han descrito diferentes formas para manejar la ansiedad y el dolor. En el presentetrabajo se presenta la sedación consciente, como una alternativa válida y viable para complementar la asistencia, en aquellospacientes en los cuales las técnicas habituales para realizar la atención libre de ansiedad y estrés no son efectivas.Se describen, además, las diferentes formas de realizarla y las indicaciones de cada una de ellas y se presenta la experiencia de losautores.

One of the most important challenge of the daily dental clinic is the management of patient’s pain and anxiety. All of the patientswho came to seek attention suffers from them but in a wide range of manifestations and the dentist should offers the patients themeans to deal with that situations and treatments free of pain and anxiety. There are different ways to help to cope pain andanxiety. In the present paper the conscious sedation, in its different way and its indications, is described like a valid and secureadjunct procedure in those patients for whom the behavioral technique alone are no longer sufficient. Also the authors experienceis presented.

Para deixar o paciente Zen / To leave the patient Zen

O cirugião-dentista atualizado precisa estar atento a iniciativas capazes de reduzir o estresse e a ansiedade de uma clientela que foge constantemente dos consultórios: os pacientes odontofóbicos. Algumas práticas alternativas - como a hipnose, a acupuntura e o RPG, têm conseguido diminuir as tensões do tratamento dentário e evitar a dor durante as consultas. Outro método bastante eficaz começa a se popularizar entre os dentitas. É a sedação consiente, um processo indolor de inalação respiratória, que proporciona um estado de leve sedação, deixando o paciente cooperativo e tranquilo

Atualiza-se sobre o uso da sedaçäo consciente por óxido nitroso e oxigênio em odontologia / Conscious sedation by nitrous oxide and oxigen in dental treatment- an update

A maioria dos pacientes odontológicos podem ser submetidos ao tratamento com recurso do condicionamento psicológico associado ao anestésico local para controle de dor. O anestésico local, no entanto, näo tem efeito algum sobre a ansiedade do paciente, para aqueles extremamente ansiosos (odontofóbicos) e com deficiências físicas e/ou mentais. O recurso da sedaçäo consciente é indicado para viabilizar o tratamento dentário. O emprego da sedaçäo consciente por óxido nitroso em razäo de seu potencial ansiolítico (relaxante) atua como coadjuvante nas técnicas de condicionamento psicológicos, pois o paciente encontra-se consciente e com cooperaçäo aumentadas, melhorando sua coloraçäo