Current state of sedation/analgesia care in dentistry

Bibliometric analysis of pediatric dental sedation research from 1993 to 2022

Statement of problem

Bibliometric analysis methods were used to evaluate pediatric dental sedation research and to identify topical hotspots using quantitative and qualitative methodologies.

Purpose

To conduct bibliometric analysis on the retrieved data and to foresee the development of trends and hotspots in this research area.

Material and methods

We retrieved appropriate research articles from the Web of Science Core Collection on January 1, 2023. VOSviewer, Citespace and the Bibliometrics website were used to conduct bibliometric analysis on the retrieved data. GraphPad Prism 10.0 (GraphPad, San Diego, CA, USA) was used to conduct the statistical analysis.

Results

A total of 396 publications on pediatric sedation in dentistry, published between 1993 and 2022, were retrieved from online databases. The USA published most papers. Furthermore, the most frequent countries who cooperated were the USA and Canada. Six of the top ten publishing establishments were USA based. Papers on the research have appeared primarily in the journals of Dentistry and Anesthesiology. Keyword co-occurrence and co-citation cluster analysis revealed that the most common topics mainly were: dental anxiety; conscious sedation; dental caries; midazolam; propofol; hypoxemia.

Conclusions

During the three decades, the focus of pediatric sedation research has been on drugs, dental anxiety and procedural sedation. Keyword burst detection indicated that procedural sedation; adverse event; respiratory depression is an emerging research hotspot.

Effect of opaque eye coverage on anxiety in candidates for surgical removal of impacted third molars: a randomized clinical trial

OBJECTIVE

To assess the effects of opaque eye coverage on anxiety in candidates for surgical removal of impacted third molars.

STUDY DESIGN

This randomized clinical trial was conducted in candidates for surgical extraction of bilateral, vertical, class IC impacted maxillary third molars or bilateral, mesioangular class IC impacted mandibular third molars. Patients with moderate anxiety (dental anxiety scale range, 9-14) were selected. Surgical extraction of the bilateral third molars was performed in 2 separate visits with and without covering the eyes using surgical drapes. Pulse rate (PR), systolic and diastolic blood pressure (BP), and respiratory rate (RR) were measured immediately after surgery. Moreover, after surgery, the patients were asked to rate their dental anxiety on a visual analog scale (VAS) from 0 to 10. The collected data were used for statistical analysis.

RESULTS

Sixty patients with a mean age of 21.31 years participated in the study. PR, systolic BP, RR, and VAS were significantly higher with eye coverage (P < .001). Diastolic BP was not significantly different between the 2 surgical sessions (with or without eye coverage) (P = .157).

CONCLUSION

In patients with moderate dental anxiety, covering the eyes during surgical extraction of third molars may contribute to the increase of dental anxiety.

Risks and benefits of pre-operative dexmedetomidine in oral and maxillofacial surgeries: a systematic review

INTRODUCTION

Oral and maxillofacial surgeries might induce anxiety and pain to the patients. Sedative agents are one of the best ways for eliminating such consequences. Dexmedetomidine (DEX) is a recent sedative agent which presents higher sedative quality with greater specificity than other drugs. The aim of present paper is to evaluate the risks and benefits of administrating DEX during oral and maxillofacial surgeries by reviewing high quality released articles. Areas covered: Searches on PubMed, Scopus and Web of Science databases were completed with focus on randomized controlled trials (RCT). Related articles, from 2000 to 2015, were selected based on inclusion criteria and quality assessments factors. Full texts of the selected articles were screened and their significant information were gathered for judgments. Expert opinion: 17 RCTs on a total of 765 patients were screened. Some of the difficulties during reviewing the articles were: different pharmacokinetic and pharmacodynamics of drugs when combined with DEX, different time spots and method of monitoring, including studies on both minor and major surgeries for better data collection. Recent researches are going to focus on application of DEX for in-office procedures because of its desirable properties. Nevertheless, the analgesic and amnesic features of DEX are still questionable.

Analysis of oxygen saturations recorded during dental intravenous sedations: a retrospective quality assurance of 3500 cases

The death of a patient under sedation in New South Wales, Australia, in 2002 has again raised the question of the safety of dental sedation. This study sought answers to 2 questions: Can safe oxygen saturation levels (≥ 94%) be consistently maintained by a single operator/sedationist? Does the additional use of propofol, in subanesthetic doses, increase the risk of exposure to hypoxemia? Three thousand five hundred cases generated between 1996 and 2006 were randomly examined and divided into 2 subcohorts: 1750 patients were sedated with midazolam and fentanyl, and 1750 patients received propofol, in subanesthetic increments, in addition to midazolam and fentanyl. Initial sedation was established using midazolam and fentanyl in both subcohorts. The second subcohort received propofol during times of noxious stimulation. Patient exposure to 2 or more oxygen desaturations below 94% was uncommon. The variables that were significantly associated with low saturations were age, gender, and weight. Neither the dose of midazolam nor the additional use of propofol was a significant risk factor. ASA classification (I or II) was not a determinant of risk. The data, within the limitations of the study, showed that a single operator/sedationist, supported by a well-trained team of nurses, can consistently maintain safe oxygen saturation levels. The additional use of propofol did not increase exposure to hypoxemia.

Effects of Pleasant Ambient Fragrances on Dental Fear: Comparing Apples and Oranges

Previous studies showed that orange odor reduces the anticipatory anxiety and improves the mood of patients waiting for scheduled appointments in small dental practices. We replicated these previous studies in the setting of three large dental clinics. In addition, we investigated whether another pleasant fruity smell (apple odor) is similarly associated with reduced anxiety. We included 219 patients (117 males, 102 females) between the ages of 18 and 81 in this study. While they were waiting for dental treatment, the participants were either exposed to the ambient odor of orange (N = 81) or apple (N = 69), or they received no stimulation. State anxiety, mood, and perceived level of pain of the participants were assessed using questionnaires. Statistical analysis showed no significant difference between the responses of patients in each of the three experimental groups. We therefore conclude that orange and apple odors have no effect on the anticipatory anxiety or mood of patients waiting for scheduled appointments in large dental clinics.

Independent predictors of satisfaction in impacted third molar surgery patients

OBJECTIVES

Patient satisfaction and dissatisfaction are critical dimensions leading to favorable or unfavorable treatment outcomes. Although impacted third molar (ITM) surgery is one of the most common dental surgical procedures, it is a challenging operation because of numerous potential complications and patients generally suffer from severe psychosomatic symptoms as a result of severe perioperative anxiety. We hypothesize that multiple independent factors, including perioperative anxiety and various postoperative complications, affect satisfaction of the ITM surgery patients.

METHODS

Survey data from 219 participants encompassed basic patient demographic traits, difficulty of surgery, perioperative anxiety, pain sensation and common postoperative complications. The t-test and one-way anova with Duncan's multiple-range tests were applied to detect differences in mean values of perioperative anxiety, perioperative pain sensation and satisfaction based on basic demographic characteristics and postoperative complications. The significance of postoperative complications according to demographic data and difficulty of extraction was also analyzed. A paired t-test was applied to detect the significance of anxiety level and pain sensation changes over time. Lastly, univariate and multiple stepwise regression analyses were used to analyze the relationships among perioperative anxiety, pain sensation and satisfaction to determine the predictive factor of patient satisfaction.

RESULTS

Basic demographic traits proved not to have a direct significant effect on satisfaction in ITM surgery patients, but some demographic factors and difficulty of surgery showed significant relationships with postoperative complications. Univariate analysis revealed that perioperative anxiety, pain sensation, postoperative infection, numbness/paresthesia and ecchymoses have a significant influence on patient satisfaction. In particular, preoperative anxiety level and numbness/paresthesia were independent predictive factors of patient satisfaction upon multivariate analysis.

CONCLUSIONS

This study demonstrates that the patients who undergo ITM surgery often have severe anxiety that seriously impacts patient satisfaction and resultant treatment outcomes. In addition, patient satisfaction directly depends on the occurrence of some postoperative complications. Appreciation of these predictive factors and increasing patient satisfaction may help clinicians to provide optimal care for ITM surgery patients.

Premedication with melatonin vs midazolam in anxious children

AIM

Failure of dental treatment caused by anxiety is a common problem in children. Oral midazolam has been the most commonly used premedication for pediatric patient but the use of midazolam may be associated with paradoxical reactions in children. Melatonin may induce a natural sleepiness and improve sedation. We have investigated premedication with melatonin compared with midazolam in children under nitrous oxide/oxygen (N(2)O/O(2)) sedation for dental treatment.

METHODS

In a randomized study, 60 children received either 3 mg of melatonin [Melatonina (3 mg(R)) 60 min before the procedure (n = 15); group I], 0.5 mg.kg(-1) melatonin 60 min before the procedure (n = 15; group II), 0.75 mg.kg(-1) midazolam [Dormicum (15 mg/3 ml (R)) 15 min before the procedure (n = 15); group III] or 3 ml of 0.09 NaCl 15 min (n = 7) or 60 min before the procedure (n = 8; group IV) orally. The children were sedated with 40/60% N(2)O/O(2) inhalation. The heart rate and O(2) saturation were monitored during the treatment period. The level of sedation was assessed according to the Ramsay Sedation Scale. The children's sedation success during dental treatment was classified. The sedation success and other sedation-related events recorded. Comparisons among the four groups were made using one-way anova or Kruskal-Wallis test, and if any significant differences were noted, the Tukey's HSD or Mann-Whitney U-test were used for intergroup comparisons. All differences were considered significant at P < 0.05.

RESULTS

The evaluation of sedation success was as follows: group I: satisfactory (n = 1), average satisfactory (n = 4), and unsatisfactory (n = 10); group II: satisfactory (n = 2), average satisfactory (n = 3), and unsatisfactory (n = 10); group III: satisfactory (n = 9), average satisfactory (n = 6); and group IV: satisfactory (n = 1), average satisfactory (n = 3), and unsatisfactory (n = 11).

CONCLUSION

In these doses and clinical conditions, melatonin was similar to that of placebo and did not contribute to N(2)O/O(2) sedation of anxious children.