Podcast: Sedation of children undergoing dental treatment

Fear associated with going to the dentist is common and, among children especially it can make it difficult to deliver the treatment they need. Therefore, among their many reviews of the effects of dental treatments, the Cochrane Oral Health Group maintains a review of the effects of sedation on children undergoing such treatment. The review’s third update was published in December 2018 and lead author, Paul Ashley, from the UCL Eastman Dental Institute in London England tells us where things now stand in this podcast.

"Children who are scared of the dentist will often express this as uncooperative or difficult behaviour during their visit. If this prevents effective treatment, it can result in a child's tooth decay going untreated. Behaviour management techniques might help but aren’t always enough. For children who can’t manage, dentists may consider using sedation and we examined the effectiveness of drugs to sedate a child whilst keeping them conscious in order to carry out dental treatment; but found that there are many more holes than fillings in the evidence.

We did identify a total of 50 randomised trials involving more than 3,700 children, from countries across the world; but most of these studies were at high risk of bias. It was also difficult to combine their data because of reasons such as the variety of outcomes reported, the mixture of dosage and delivery methods used for the drugs, and the large number of different drugs and drug combinations that were tested. In fact, we recorded 34 different combinations in the review and of all the interventions assessed, we could only do one meta-analysis, which combined the results of the six small trials comparing oral midazolam to placebo. This did show that oral midazolam is probably effective, but it means we can say little about the effects of treatments, but lots about the need for future research.

We made several recommendations for new studies in order to deal with some of the issues we encountered. In general, there are the problems seen in many other Cochrane Reviews around poor quality reporting, randomization, studies being too small, and so on. But there were some issues specific to our review and these included the need for greater consistency in the outcome measures used; better consideration of the age ranges assessed, since sedative techniques appropriate for a 3-year old may be different to those for a 12-year old; and more studies of the same drug and drug combinations to allow better assessment of overall effectiveness.

In summary, although our review shows moderate‐certainty evidence that oral midazolam is an effective sedative agent for children undergoing dental treatment, there is a need for further well‐designed and well‐reported clinical trials to evaluate other potential sedation agents. This research should also consider evaluating experimental regimens against oral midazolam or inhaled nitrous oxide."

Wednesday, March 6, 2019