Comparative evaluation of intranasal dexmedetomidine, intranasal midazolam, and nitrous oxide for conscious sedation of anxious children undergoing dental treatment: A randomized cross-over trial.

BACKGROUND: Pharmacological methods, specifically sedatives, have gained popularity in managing the behavior of children during dental appointments. AIM: The aim of this study was to compare 1 m/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide in evaluating the level of sedation, behavior of the child, onset of sedation, physiologic signs, and adverse effects. MATERIALS AND METHODS: In this cross-over trial, 15 children aged 6-8 years were randomized to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhalation nitrous oxide at three separate visits. After administering the sedative agent, a single pulpectomy was performed during each appointment, and the outcomes were recorded. The washout period between each visit was 1 week. RESULTS: All three sedative agents were equally effective in controlling overall behavior. Dexmedetomidine showed lower sedation level scores (agitated; score 9) than the other groups. There was a statistically significant difference in the onset of sedation, with dexmedetomidine having the longest onset of 36.2 ± 9.47 min. Coughing and sneezing were predominantly observed after administration of intranasal midazolam. Oxygen saturation levels were statistically lower in the intranasal midazolam group during local anesthesia administration and post-treatment. CONCLUSION: 0.3 mg/kg intranasal midazolam is as effective as nitrous oxide sedation for controlling behavior and providing adequate sedation in pediatric dental patients. However, 1 m/kg dexmedetomidine did not provide the same level of sedation and had a significantly longer onset. 0.3 mg/kg intranasal midazolam is an effective alternative to nitrous oxide sedation in anxious children.

Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review / Comparison of Efficacy and Safety of Midazolam versus Nitrous Oxide as Sedative Agents during Paediatric Dental Treatment: A Systematic Review

ABSTRACT Objective: To identify and study the existing literature on the efficacy and safety of midazolam compared to inhalation of nitrous oxide in children undergoing dental treatment. Material and Methods: Electronic resources such as PubMed Central, Cochrane Database of Systematic Reviews, Lilacs, Science Direct, and SIGLE were thoroughly searched. The title scan was used to find randomised controlled trials reviewed for inclusion by reading the abstract. Studies comparing the sedative, behavioural, and anxiolytic effects and safety in children undergoing dental treatment under midazolam and nitrous oxide inhalation were included. The Cochrane Reviews system software, Revman 5.4.1, was used to assess the quality of the included studies. Results: 11328 articles were identified by screening the electronic databases, of which 10906 were eliminated after titles were read and duplicates were removed. Ten full-text articles were examined, of which three were excluded as they did not match the eligibility criteria. Hence, a total of 7 studies were included. Midazolam and nitrous oxide inhalation were not statistically different in terms of the success of treatment and behaviour modification. However, midazolam showed a deeper level of sedation and resulted in amnesia in more children when compared to nitrous oxide sedation. All of the included studies were found to have a high risk of bias. Conclusion: Though all the studies included showed an increased risk of bias, midazolam and nitrous oxide inhalation seem equally effective sedative agents for controlling behaviour in children undergoing dental treatment. Midazolam shows a deeper sedation level when given orally and produces a higher rate of anterograde amnesia.

Influence of Temperament on the Acceptance of Two Conscious Sedation Techniques in Toddlers Undergoing Dental Treatment: A Randomised Cross Over Trial.

Background: Pediatric dentists often find it challenging to handle pediatric patients due to their fear, unease, and anxiety toward dental procedures. To address this, sedation agents such as intranasal midazolam and nitrous oxide are commonly used as pharmacological behavior management methods. A child's temperament affects their behavior in unfamiliar settings. Aim: To study the effect of child temperament on the acceptance of the nasal mask and intranasal drug administration in children undergoing dental treatment. Methods: Thirty-two anxious children aged three to five were randomly assigned to two groups. During the first visit, one group received intranasal midazolam sedation, while the other group received nitrous oxide administered through a mask. On the subsequent visit, the groups crossed over. The parent assessed the child's temperament, and the acceptance of the sedation methods was recorded. The Ohio State University Behavioral Rating Scale (OSUBRS) was employed to assess behavior during the administration of local anesthesia. Statistical analysis was carried out using the chi-square test and Mann-Whitney U test (p value <0.05). Results: Children exhibited greater acceptance of the nasal mask compared to using the intranasal route for delivering midazolam during the induction process. A significant statistical influence of temperament was observed on the acceptance of the nasal mask and the intranasal atomisation device (p value <0.05). The mean OSUBRS scores did not show any statistically significant differences between the sedation groups (p = 0.14). Conclusion: Most children demonstrated a more favorable acceptance of the nasal mask during the induction process; however, intranasal midazolam can serve as an effective alternative for anxious patients who struggle to keep the nitrous oxide mask on during the dental procedure. The adoption of these methods is influenced directly by the child's temperament.

Assessment of Pain During Pediatric Dental Treatment Using Different Sedative Agents: A Crossover Trial.

Background Behavioral management techniques are employed for children who are fearful and uncooperative. Pharmacologic sedation and anesthesia are frequently utilized to manage pain and anxiety in pediatric dental patients. Aim  To evaluate the intraoperative and postoperative pain levels during dental treatment of children sedated with 1.5 µg/kg intranasal dexmedetomidine, 0.3 mg/kg intranasal midazolam, and nitrous oxide. Materials and methods In this crossover study, 24 children between the ages of five and seven years were randomly assigned to receive intranasal atomized dexmedetomidine, intranasal atomized midazolam, and inhaled nitrous oxide during three different visits. At each visit, a single pulp therapy procedure was conducted after administering the respective sedative agent, and the pain levels were documented. There was a one-week interval between each visit to allow for a washout period. The data were analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp, Armonk, NY, United States) using the Wilcoxon signed-rank test and Kruskal-Wallis H test (p < 0.05). Results All three sedative agents were equally effective in controlling postoperative and intraoperative pain. Although there was no statistically significant difference among the groups, clinically, midazolam showed lower intraoperative pain levels (mean 1.78 ± 1.42). Conclusion  In pediatric dental patients, intranasal midazolam at a dosage of 0.3 mg/kg and intranasal dexmedetomidine at a dosage of 1.5 µg/kg demonstrate comparable effectiveness to nitrous oxide sedation in pain management. These options serve as effective alternatives for anxious children who may not tolerate nitrous oxide sedation.

Assessment and Correlation between Dactyloscopy and Behavior of Children Undergoing Dental Treatment: A Cross-sectional Study.

Aim: To assess and correlate dactyloscopy and behavior of children undergoing dental treatment. Materials and methods: A total of 30 children aged 4-8 years who needed at least one restoration without administration of local anesthesia were included. Two examiners recorded the behavior of the child as per Frankl's behavior rating scale and after the treatment, the subjects' fingerprints were taken using an ink pad and white paper. The data were analyzed using Statistical Package for the Social Sciences (SPSS) versions 23 and a Chi-squared test was carried out (p < 0.05). Results: The loop type fingerprint had the highest frequency, while the archtype had the lowest. The child's behavior differed greatly (p < 0.05) based on dermatoglyphic characteristics, with the loop pattern being seen in cooperative children and the whorl pattern in uncooperative children. Conclusion: There is a positive correlation between fingerprint type and children's dental care. Clinical significance: Dactyloscopy can be used to determine the behavior of children coming for dental treatment and hence help in their management. How to cite this article: Janiani P, Subramanian EMG. Assessment and Correlation between Dactyloscopy and Behavior of Children Undergoing Dental Treatment: A Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(3):444-447.

Comparative evaluation of the antimicrobial effects of probiotic milk and probiotic powder on the salivary Streptococcus mutans counts and the plaque scores in children aged 3-6 years: A randomized controlled trial.

BACKGROUND: Probiotics have been shown to have a positive influence on systemic and oral health. The prevention of dental caries and gingival diseases through the consumption of probiotics has been studied extensively. OBJECTIVES: The aim of this research was to determine the effects of a short-term intake of probiotic milk and powder on the salivary levels of Streptococcus mutans (S. mutans) and the plaque scores in children. MATERIAL AND METHODS: In this short-term study, 34 healthy 3-6-year-old children were randomly assigned to group A (control), group B (enKor­D) or group C (Yakult). The probiotics were taken for 7 days. To screen for the amount of S. mutans measured in colony-forming units per milliliter of saliva (CFU/mL), unstimulated saliva samples were collected and cultured on Mitis Salivarius Agar plates before and after the intervention. The plaque scores were also recorded at preand post-intervention visits. RESULTS: A statistically significant reduction of salivary S. mutans was recorded after the consumption of probiotic milk (Yakult®) and powder (enKor®-D) (p < 0.05), with the decrease being greater for the enKor­D group. However, only the consumption of Yakult decreased the plaque scores significantly (p < 0.05). CONCLUSIONS: A short-term use of Yakult and enKor­D can have a cariostatic effect by lowering oral microbial load in children with certain risk profiles. Further research is required to confirm this probiotic effect over a long-term period. Prior to prescribing or promoting Yakult or enKor­D as an adjunct caries prevention therapy for children, a thorough risk evaluation may be needed.

Effectiveness of Pre-administered Natural Sweet-tasting Solution for Decreasing Pain Associated with Dental Injections in Children: A Split-mouth Randomized Controlled Trial.

AIM: This study aimed to discern if a prior intake of a natural sweet remedy (honey) impacted pain perception during intraoral injections. MATERIALS AND METHODS: One hundred healthy children who needed the same treatment bilaterally in either arch which required local anesthetic administration (infiltration in maxillary arch and inferior alveolar nerve block in mandibular arch) were recruited. The patients' demographic details were recorded. Local anesthesia was administered after taking 5 mL of honey solution on the test side and 5 mL of sterile water on the control side. Subjective pain perception during injection was measured using Wong-Baker Faces Pain Rating Scale and objective pain by sound, eye, body movement (SEM) rating scale. The parametric data were analyzed using a paired Student's t-test (p <0.05). Level of consensus between the two scales was assessed using Pearson's correlation. RESULTS: The test side yielded lower mean Wong-Baker Faces Pain Rating Scale (3.72 ± 1.80) and SEM (4.12 ± 1.04) scores than the control side (6.00 ± 2.06 and 5.00 ± 1.45 respectively). This was statistically significant. CONCLUSION: The administering of a natural sweet solution such as honey before dental injections in children tends to reduce the discomfort and pain associated with the procedure. CLINICAL SIGNIFICANCE: Pain management is of utmost importance in dentistry, especially among children. The consumption of natural foods such as honey helps in decreasing injection pain perception, making the child cooperative, and thereby allowing the dentist to provide the best dental care.

Evaluation of the intensity of gingival melanin pigmentation at different age groups in the Indian population: An observational study.

BACKGROUND: The brownish-black pigmentation of the gingiva has been reported in several countries. However, the available literature pertaining to the Asian population suggests that this pigmentation is more predominant in individuals with dark complexion. Although there is available literature on the intensity of gingival pigmentation with different age groups in Japanese and Israel population, no such literature pertaining to age and intensity of melanin pigmentation is available in the Indian population. AIM: This study aims to observe the intensity of melanin pigmentation in different age groups in the Indian population. METHODS AND MATERIALS: Intensity of melanin pigmentation was observed by the gingival melanin pigmentation index as given by Ponnaiyan et al. in 250 individuals who were grouped under the age group of 0-5 years, 6-9 years, 10-12 years, 13-15 years, and 16-20 years. Each group comprised 25 individuals. RESULTS AND CONCLUSION: The results were subjected to statistical analysis so as to observe the intensity of melanin pigmentation at different age groups in the Indian population. It was concluded that with age, the intensity of gingival melanin pigmentation, as well as its distribution to the posterior gingiva was increased. As age increased, gingival pigmentation was more in the attached and interdental papilla, while in the younger age groups, it was confined either only to the interdental, marginal or attached gingival, or both depending on the skin color.