scholarly journals Best clinical practice guidance for conscious sedation of children undergoing dental treatment: an EAPD policy document

2021 ◽  
Author(s):  
P. Ashley ◽  
P. Anand ◽  
K. Andersson
Keyword(s):  
Outcome Measures ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Guideline Development ◽  
Cochrane Review ◽  
Clinical Excellence ◽  
Policy Document ◽  
Behaviour Management ◽  
Wide Range ◽  
Oral Midazolam

Abstract Background Due to fear and/or behaviour management problems, some children are unable to cooperate for dental treatment using local anaesthesia and psychological support alone. Sedation is required for these patients in order for dentists to be able to deliver high quality, pain-free dental care. The aim of this guideline is to evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry and to provide guidance as to which sedative agents should be used. Methods These guidelines were developed using a multi-step approach adapted from that outlined by the National Institute for Clinical Excellence (NICE (2020) Developing NICE Guidelines: the manual. https://www.nice.org.uk/process/pmg20/chapter/introduction#main-stages-of-guideline-development. Accessed 7 Oct 2020). Evidence for this guideline was provided from a pre-existing Cochrane review (Ashley et al. Cochrane Database Syst Rev 12:CD003877, 2018) supplemented by an updated search and data extraction up to May 2020. Results Studies were from 18 different countries and had recruited 4131 participants overall with an average of 70 participants per study. Ages ranged from 0 to 16 years with an average age of 5.6 years across all included studies. A wide variety of drugs or combinations of drugs (n = 38) were used and delivered orally, intranasally, intravenously, rectally, intramuscularly, submucosally, transmucosally or by inhalation sedation. Twenty-four different outcome measures for behaviour were used. The wide range of drug combinations and outcome measures used greatly complicated description and analysis of the data. Conclusion Oral midazolam is recommended for conscious dental sedation. Midazolam delivered via other methods or nitrous oxide/oxygen sedation could be considered, but the evidence for both was very low.

Oxygen Saturation and Pulse Rate Change in Children during Sedation with Oral Midazolam and Nitrous Oxide

2018 ◽  
Vol 42 (6) ◽  
pp. 461-464
Author(s):  
Sigalit Blumer ◽  
Rabea Iraqi ◽  
Roly Bercovich ◽  
Benjamin Peretz
Keyword(s):  
Nitrous Oxide ◽  
Oxygen Saturation ◽  
Pulse Rate ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Retrospective Chart Review ◽  
Pediatric Dentistry ◽  
Oral Midazolam ◽  
Clinically Significant

Objective: We aimed to examine if changes in oxygen saturation and pulse rate of pediatric patients during conscious sedation with midazolam and nitrous oxide are associated with child's behavior, midazolam dose, the type and duration of the treatment and demographic parameters. Study Design: This study was a retrospective chart review of consecutive pediatric patients, aged 2.5–12.5 years, who had undergone conscious sedation for dental treatment with oral midazolam (with or without nitrous oxide) between January 2011 and September 2015 at the Department of Pediatric Dentistry of Tel Aviv University. Oral midazolam was administered according to the patients' weight, either at 0.4 mg/kg, 0.5 mg/kg or at a maximum dose of 10 mg. In all cases pulse rate and oxygen saturation were monitored every 15 minutes during treatment, Results: 147 sedation sessions (82 of females and 65 of males) were included in the study. Sedation was successful in 80% of cases. Children with poor behavior scores had statistically significant different mean saturation levels, albeit within normal range, during the treatment (p<0.012) as well as a clinically significant higher mean pulse rate (p=0.0001), compared to children with good or excellent behavior scores. Treatment duration, the type of dental procedure or the patients' weight were not correlated with the change in oxygen saturation or pulse rate during the treatment. Conclusions: Poor behavior of pediatric patients does not affect oxygen saturation, but it increases the pulse rate of children under sedation with midazolam and nitrous oxide.

Consideraciones para la atención odontológica en un paciente con síndrome de Asperger. reporte de un caso

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Claudia Butrón-Téllez Girón
Keyword(s):  
Oral Health ◽  
Primary Prevention ◽  
Asperger Syndrome ◽  
Pervasive Developmental Disorders ◽  
Developmental Disorders ◽  
Dental Treatment ◽  
Systematic Desensitization ◽  
Behaviour Management ◽  
Palabras Clave ◽  
Behavioral Techniques

El Síndrome de Asperger es una enfermedad del neurodesarrollo caracterizado por deficiencias en la interacción social y la comunicación,sin retraso en el desarrollo cognitivo y del lenguaje, considerado dentro de los Trastornos Generalizados del Desarrollo y de las Condiciones del Espectro Autista. Debido a las características de este síndrome estos pacientes requieren atención y técnicas conductuales específicas, parapoder realizar el tratamiento dental. El objetivo de este reporte es dar a conocer los cuidados y el manejo de conducta para el tratamiento dental en pacientes con Síndrome de Asperger. Palabras clave: Síndrome de Asperger, desensibilización sistemática, cuidado dental, salud bucal, prevención primaria, comportamiento.  AbstractAsperger syndrome is a disease of the neurodevelopmental characterized by deficiencies in social interaction and communication, without delay in cognitive development and language, and is considered within pervasive developmental disorders and the autism spectrumconditions. Due to the characteristics these patients require care and specific behavioral techniques, to perform dental treatment. The objective of this report is to present the care and behaviour management for dental treatment in patients with Asperger syndrome. Key words: Asperger syndrome, systematic desensitization, dental care, oral health, primary prevention, behaviour.

scholarly journals Long-term improvements following a residential combined physical and psychological programme for chronic low back pain

2021 ◽  
Vol 10 (2) ◽  
pp. e001068
Author(s):  
Shaun Wellburn ◽  
Cormac G Ryan ◽  
Andrew Coxon ◽  
Alastair J Dickson ◽  
D John Dickson ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Outcome Measures ◽  
Chronic Low Back Pain ◽  
Rating Scale ◽  
Secondary Outcome ◽  
Low Back ◽  
Residential Setting ◽  
Wide Range

ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.

Dental care for the bariatric patient

Dental Update ◽  
2021 ◽  
Vol 48 (4) ◽  
pp. 302-306
Author(s):  
Jessica Hamilton ◽  
Mary Gittins ◽  
Andrew Geddis-Regan ◽  
Graham Walton
Keyword(s):  
General Anaesthesia ◽  
Dental Care ◽  
Clinical Relevance ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Careful Consideration ◽  
Equitable Access ◽  
Bariatric Patient ◽  
Access To Dental Care ◽  
Obese Population

As the overweight and obese population increases, one must be mindful of the implications on the delivery of dental care to this group. Appropriate facilities must be available, which may warrant structural and equipment adaptations to clinical and non-clinical areas. The complexity of dental treatment planning and delivery may be compounded by medical comorbidities, and careful consideration must be given to the suitability and safety of conscious sedation and general anaesthesia in order to facilitate treatment. This article aims to discuss how safe provision and equitable access to dental care can be achieved for the bariatric population. CPD/Clinical Relevance: This article aims to discuss the challenges posed by the increase in the overweight and obese population and considerations to be taken for provision of safe and equitable bariatric dental care.

scholarly journals The most problematic symptoms of prion disease – an analysis of carer experiences

2018 ◽  
Vol 31 (08) ◽  
pp. 1181-1190
Author(s):  
Liz Ford ◽  
Peter Rudge ◽  
Kathy Robinson ◽  
John Collinge ◽  
Michele Gorham ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Prion Disease ◽  
Prion Diseases ◽  
Formal Analysis ◽  
Structured Interview ◽  
Disease Stage ◽  
Structured Interviews ◽  
Wide Range ◽  
The Uk ◽  
And Behavior

ABSTRACTObjectives:Prion diseases are rare dementias that most commonly occur sporadically, but can be inherited or acquired, and for which there is no cure. We sought to understand which prion disease symptoms are most problematic for carers, to inform the development of outcome measures.Design:Self-completed questionnaire with follow-up of a subset of participants by structured interview.Setting:A nested study in the UK National Prion Monitoring Cohort, a longitudinal observational study.Participants and measurements:71 carers, of people with different prion diseases with a wide range of disease severity, identified 236 of their four most problematic symptoms by questionnaire which were grouped into ten domains. Structured interviews were then done to qualitatively explore these experiences. Eleven family carers of people with prion disease were selected, including those representative of a range of demographics and disease subtypes and those who cared for people with prion disease, living or recently deceased. Interviews were transcribed and formally studied.Results:The six most problematic symptom domains were: mobility and coordination; mood and behavior; personal care and continence; eating and swallowing; communication; and cognition and memory. The prevalence of these symptoms varied significantly by disease stage and type. A formal analysis of structured interviews to explore these domains is reported.Conclusions:We make suggestions about how healthcare professionals can focus their support for people with prion disease. Clinical trials that aim to generate evidence regarding therapies that might confer meaningful benefits to carers should consider including outcome measures that monitor the symptomatic domains we have identified as problematic.

scholarly journals Conscious sedation for the management of dental anxiety in third molar extraction surgery: a systematic review.

2020 ◽  
Author(s):  
Matteo Melini ◽  
Andrea Forni ◽  
Francesco Cavallin ◽  
Matteo Parotto ◽  
Gastone Zanette
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Conscious Sedation ◽  
Dental Treatment ◽  
Meta Analysis ◽  
Dental Anxiety ◽  
Third Molar ◽  
Future Research ◽  
Third Molar Extraction ◽  
Molar Extraction

Abstract Background: Dental anxiety is a condition associated with avoidance of dental treatment and increased medical and surgical risks. This systematic review aims to summarize available evidence on conscious sedation techniques used for the management of Dental anxiety in patients scheduled for third molar extraction surgery, to identify best approaches and knowledge gaps. Methods: A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov and the Cochrane Database of Systematic Reviews through March 2019. Only randomized controlled trials were included. PRISMA guidelines were followed. Risk of bias was appraised as reported in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Seventeen RCTs with a total of 1,788 patients were included. Some aspects limited the feasibility of a meaningful meta-analysis, thus a narrative synthesis was conducted. Conscious sedation was associated with improvement in Dental anxiety in six studies. One study reported lower cortisol levels with midazolam vs. placebo, while another study found significant variation in perioperative renin levels with remifentanil vs. placebo. Conclusions: This review found inconclusive and conflicting findings about the role of Conscious sedation in managing Dental anxiety during third molar extraction surgery. Relevant questions remain unanswered due to the lack of consistent, standardized outcome measures. Future research may benefit from addressing these limitations in study design.

scholarly journals Independent Factors Affecting Recovery Time After Sedation in Patients with Intellectual Disabilities

2015 ◽  
Vol 9 (1) ◽  
pp. 146-149 ◽  
Author(s):  
Shigeru Maeda ◽  
Yumiko Tomayasu ◽  
Hitoshi Higuchi ◽  
Minako Ishii-Maruhama ◽  
Ayaka Yamane ◽  
...  
Keyword(s):  
Intellectual Disabilities ◽  
Psychotropic Drugs ◽  
Recovery Time ◽  
Dental Treatment ◽  
Outcome Variable ◽  
Intravenous Sedation ◽  
Factors Affecting ◽  
Oral Midazolam ◽  
Prolonged Recovery ◽  
Independent Determinant

Purpose:The purpose of this study was to identify independent factors associated with prolonged recovery time after intravenous sedation for dental treatment in patients with intellectual disabilities.Methods:This study was designed as a prospective cohort study. Participants were patients with intellectual disabilities, for whom sedation for dental treatment was planned in Okayama University Hospital. The outcome variable was recovery time. The predictor variables were patient background, antiepileptic and psychotropic drugs, and anesthesia-related variables. Factors affecting the outcome were examined with multiple regression analysis.Results:We enrolled 260 cases in this study. Oral midazolam was a strong independent determinant in prolonged recovery time. Teeth extraction, short treatment time and lower body mass index were significant independent predictors of prolonged recovery time.Conclusion:Oral midazolam is a clear independent determinant of prolonged recovery time after sedation, while psychotropic drugs and antiepileptic drugs were not independent determinants in this study.

scholarly journals Legitimating inaction: Differing identity constructions of the Scots language

2010 ◽  
Vol 13 (1) ◽  
pp. 99-117 ◽  
Author(s):  
Johann W. Unger
Keyword(s):  
Focus Group ◽  
Cultural Landscape ◽  
Historical Perspective ◽  
Language Ideologies ◽  
Public Attitudes ◽  
The Political ◽  
Policy Document ◽  
Identity Constructions ◽  
Wide Range ◽  
Scottish Executive

The Scots language plays a key role in the political and cultural landscape of contemporary Scotland. From a discourse-historical perspective, this article explores how language ideologies about the Scots language are realized linguistically in a so-called ‘languages strategy’ drafted by the Scottish Executive, and in focus groups consisting of Scottish people. This article shows that although the decline of Scots is said to be a ‘tragedy’, focus group participants seem to reject the notion of Scots as a viable, contemporary language that can be used across a wide range of registers. The policy document also seems to construct Scots in very positive terms, but is shown to be unhelpful or potentially even damaging in the process of changing public attitudes to Scots.

Attitudes to Conscious Sedation in Patients Attending an Emergency Dental Clinic

2005 ◽  
Vol os12 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Edith M Allen ◽  
Nick M Girdler
Keyword(s):  
Conscious Sedation ◽  
Dental Treatment ◽  
Dental Health ◽  
Dental Anxiety ◽  
Dental Clinic ◽  
Dental Patients ◽  
The Past ◽  
Anxious Group ◽  
Dental Appointment ◽  
The Impact

Introduction Anxiety and fear in relation to dentistry are long-standing problems and the incidence of dental fear does not appear to be decreasing. It can result in poor dental health and wastage of clinical time. Conscious sedation is one method of allaying anxiety in dental patients and enables such patients to accept dental treatment. Aims, Materials and Methods A questionnaire survey was undertaken among patients attending an emergency dental clinic. Its aims were to assess the levels of dental anxiety in these subjects, the impact on their attendance for dental treatment, and their knowledge of and desire to have conscious sedation, should it be available. Results The results indicated that in the 72 patients who responded, levels of anxiety regarding dental treatment were high, with 49 (68%) claiming some nervousness or worse. Thirty-one (43%) cited fear/nervousness as a reason for delaying making a dental appointment. Twenty-seven (38%) were not aware of the existence of conscious sedation for dental treatment, of whom half reported that they were in the highly anxious group. Forty (56%) respondents said they would like to have sedation if it were available. Twenty-five (35%) claimed to have received sedation for dental treatment in the past. Conclusion It was concluded that the availability of dental sedation was currently not matching the needs and demands of several patients who took part in the survey. Increased availability of dental sedation could remove a barrier to dental care for many highly anxious dental patients.

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