Nociception associated with pain/distress in young children sedated for dental treatment: a clinical study with objective and subjective measures.

PURPOSE: To evaluate the association between children's pain/distress levels and patient characteristics (age, sex, history of dental pain), sedation type (level of sedation, sedative regimen), nociception and pain intensity reported by the parents in sedated children undergoing minimally invasive dental treatment. METHODS: This clinical study evaluated secondary outcomes of an RCT that evaluated the efficacy of dexmedetomidine sedation with or without ketamine. Only children who had nociception levels recorded using the Analgesia Nociception Index (ANI) were included (0-100; 0 = highest nociception). FLACC scale (Face, Legs, Activity, Cry and Consolability) was used to assess children's pain/distress (0-10; 0 = no pain/distress). Parental proxy report of the child's pain intensity during the treatment was performed using the Visual Analogue Scale (VAS; 0-100; 0 = no pain). The association between ANI, children's age and sex, dental pain history, sedation level, sedative regimen, and VAS with the FLACC was verified using the generalised estimation equation analysis (alpha 0.05). RESULTS: Participants were 31 children (51.6% boys) and their parents (90.3% mothers). Median FLACC was 3.3 (25th-75th percentiles 1.7-8.2), ANI 80.9 (74.7-85.8), and VAS 10 (1-23). FLACC associated with ANI (OR 0.96; 95% CI 0.93-0.99; p = 0.02), moderate sedation (0.13; 0.03-0.50; p = 0.003), and VAS (1.05; 1.01-1.10; p = 0.01). CONCLUSION: Pain/distress was generally low and more prominent with minimal (versus moderate) sedation and higher nociception.

Paediatric dentists' stress during dental care for children under sedation: a cross-sectional study.

PURPOSE: The knowledge of the stress related to the practice of paediatric dentistry is scarce. The aim of this study was to verify the stress perceived by paediatric dentists related to young children's dental treatment under sedation and their association with child's behaviour and other independent variables. METHODS: A cross-sectional repeated measures study was performed with four paediatric dentists who treated 81 sedated preschoolers. Paediatric dentists reported their stress at the end of the session using the visual analog scale (VAS 0-100 mm). Samples of saliva were collected to measure the dentists' salivary cortisol level throughout the dental session. The sessions of dental treatment were video recorded for evaluation of the child's behaviour. Children's behaviour was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS). The association between the VAS scores and the other variables was verified using bivariate tests and generalised estimating equation (alpha 0.05). RESULTS: Paediatric dentists felt slightly stressed in most of the sessions (VAS median 7 points; minimum 0, maximum 97 points). VAS associated with the struggling behaviour of the child (B 0.53; 95%CI 0.32-0.74; p ≤ 0.001) and the time since dentist's graduation (B - 1.41, 95% CI - 1.87 to - 0.94; p ≤ 0.001) but not with dentist's salivary cortisol (rho - 0.053, p = 0.639). CONCLUSION: The more frequent the child's struggling behaviour during dental treatment and the shorter the time elapsed since the professional's graduation, the higher the level of objectively and subjectively measured stress of the paediatric dentist during the dental procedure.