Article Data

  • Views 660
  • Dowloads 169

Original Research

Open Access

Considerations for the Use of Enteral Sedation in Pediatric Dentistry

  • Jeffrey S. Yasny1,*,
  • Ali Asgari2

1Departments of Dentistry and Anesthesiology, The Mount Sinai School of Medicine

2,Practicing Pediatric Dentistry in New York City

DOI: 10.17796/jcpd.32.2.20777386241103x8 Vol.32,Issue 2,March 2008 pp.85-94

Published: 01 March 2008

*Corresponding Author(s): Jeffrey S. Yasny E-mail: jeffrey.yasny@mssm.edu

Abstract

Treating an uncooperative, uncontrollable child can be unpleasant for all parties involved. Despite the dentist's best efforts to employ traditional techniques, the behavioral management of challenging pediatric dental patients often requires more than "tell, show, do." Consequently, pre-operative pharmacological intervention may be necessary. Enteral sedation may be the optimal adjunct for the dental treatment of such a challenging patient population. However, it must be utilized with caution and is not an appropriate treatment modality for all. This paper will present various considerations for the safe, appropriate and effective use of enteral sedation in contemporary pediatric dentistry. With the strong demand for this service, properly trained practitioners can broaden their practice and provide a win-win scenario for themselves and their patients.

Keywords

enteral sedation, oral sedation, anesthesia, pediatric dentistry

Cite and Share

Jeffrey S. Yasny,Ali Asgari. Considerations for the Use of Enteral Sedation in Pediatric Dentistry. Journal of Clinical Pediatric Dentistry. 2008. 32(2);85-94.

References

ing styles on dental practice; perceptions of diplomats of the American Board of Pediatric Dentistry presented to the College of Diplomates of the American Board of Pediatric Dentistry 16th Annual Session, Atlanta, GA. Pediatr Dent, 24(1): 18–22, 2002.

2. Peres MA, Peres KG, de Barros AJ, Victoria CG. The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours. J Epidemiol Community Health, 61(2): 141–5, 2007.

3. Arnup K, Broberg KG, Berggren U, Bodin L. Lack of cooperation in pediatric dentistry—the role of the child personality characteristics. Pediatr Dent, 24: 119–128. 2002

4. Baier K, Milgrom P, Russell S, Mancl L, Yoshida T. Children’s fear and behavior in private pediatric dentistry practices. Pediatr Dent, 26: 316–321, 2004.

5. AAPD Guidelines on Behavior Guidance for the Pediatric Dental Patient. Pediatr Dent, 27(7): 92–100, 2006.

6. Nathan JE. Effective and safe pediatric oral conscious sedation: philos-ophy and practical considerations. Alpha Omegan, 99(2): 78–82, 2006.

7. Guidelines for teaching the comprehensive control of anxiety and pain in dentistry, as adopted by the American Dental House of Delegates, October 2005.

8. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: Analysis of medications used for sedation. Pediatrics, 106: 633–44, 2000.

9. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: A critical incident analysis of contributing factors. Pediatrics, 105: 805–14, 2000.

10. Malamed SF. Sedation - A Guide to Patient Management. 3rd ed. St. Louis:Mosby, 8–11, 1995.

11. American Society of Anesthesiologists: New classification of physical status, Anesthesiology, 24: 111, 1963.

12. Radis FG, Wilson S, Griffen AL, Coury DL. Temperament as a predic-tor of behavior during initial dental examination in children. Pediatr Dent,16: 121–27. 1994.

13. Rothbart MK, Ahadi, SA, Hershey, KL, Fisher P. Investigation of tem-perament at three to seven years: The children’s Behavior Question-naire. Child Development, 72: 1394–08, 2001.

14. Fishbaugh DF, Wilson S, Preisch JW, Weaver JM. 2nd Relationship of tonsil size on an airway blockage maneuver in children during sedation. Pediatr Dent, 19: 277–81, 1997.

15. Jones, KL. Smith’s Recognizable Patterns of Human Malformation 6th ed, Philadelphia:WB Saunders, 82–3, 262–3, 280–1, 738–9, 888–9, 1997.

16. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthe-siologists task force on perioperative management of patients with obstructive sleep apnea. Anesthesiology, 104(5): 1081–93, 2006.

17. Cote CJ. The upper respiratory tract infection (URI) dilemma: fear of complication or litigation? Anesthesiology, 95: 283–5, 2001.

18. Tait AR, Reynolds PI, Gutstein HB. Factors that influence an anesthe-siologist’s decision to cancel elective surgery for the child with an upper respiratory tract infection. J Clin Anesth, 7: 491–9, 1995.

19. Tait AR, Voepel-Lewis T, Munro HM, Gutstein HB, Reynolds PI. Can-cellation of pediatric outpatient surgery: economic and emotional implications for patients and their families. J Clin Anesth, 9: 213–9, 1997.

20. Gwaltney J Jr. The common cold. In: Mandell G, Bennett J, Dolin R, eds. Principles and practice of infectious diseases. New York:Churchill Livingstone, 561–6, 1995.

21. Tait AR, Malviya S. Anesthesia for the Child with an Upper Respira-tory Tract Infection: Still a Dilemma? Anesth Analg, 100: 59–5, 2005.

22. Parnis SJ, Barker DS, Van der walt JH. Clinical predictors of anaes-thetic complications in children with respiratory tract infections. Pedi-atric Anesthesia, 11: 29–40, 2001.

23. Tait AR, Malviya S, Voepel-Lewis T, Munro HM, Seiwert M, Pandit UA. Risk factors for perioperative adverse respiratory events in chil-dren with upper respiratory tract infections. Anesthesiology, 95: 299–306, 2001.

24. Empey DW, Laitinen LA, Jacobs L, Gold WM, Nadel JA. Mechanisms of bronchial hyperactivity in normal subjects after upper respiratory infection. Am Rev Respir Dis, 113: 131–9, 1976.

25. Aquilina AT, Hall WJ, Douglas RG Jr, Utell MJ. Airway reactivity in subjects with viral upper respiratory tract infections; the effects of exer-cise and cold air. Am Rev Respir Dis, 122: 3–10, 1980.

26. Rolf N, Cote CJ. Frequency and severity of desaturation events during general anesthesia in children with and without upper respiratory infec-tions. J Clin Anesth, 4: 200–3, 1992.

27. Bahn EL, Holt KR. Procedural sedation and analgesia: a review and new concepts. Emerg Med Clin North Am., 23(2): 503–17, 2005.

28. Murphy GS, Ault ML, Wong HY, Szokol JW. The effect of a new NPO policy on operating room utilization. J Clin Anesth, 12(1): 48–1, 2000.

29. Agrawal D, Manzi SF, Gupta R, Krauss B. Preprocedural fasting state and adverse events in children undergoing procedural sedation and analgesia in a pediatric emergency department. Ann Emerg Med, 42(5): 636–46, 2003.

30. Soreide E, Eriksson LI, Hirlekar G, et al. Pre-operative fasting guide-lines: an update. Acta Anaesthesiol Scand, 49(8): 1041–7, 2005.

31. Abrams, AC. Clinical Drug Therapy Rationale for Nursing Practice. 8th Edition Philadelphia: Lippincott, 2001: 111–128.

32. Katzung BG. Sedative-Hypnotic Drugs. In: Basic and Clinical Phar-macology, 8th ed. USA: The McGraw Hill Companies, Inc., 364–81, 2001.

33. Kost, M. Moderate Sedation/Analgesia Core Competencies For Prac-tice. Missouri:Saunders, 83–6, 2004.

34. Van der Bijl P, Roelofse JA, Joubert JJ, van Zyl JF. Comparison of var-ious physiologic and psychomotor parameters in patients sedated with intravenous lorazepam, diazepam, or midazolam during oral surgery. J Oral Maxillofac Surg, 49(7): 672–9, 1991.

35. Fraone G, Wilson S, Casamassimo PS, Weaver J, Pulido AM. The effect of orally administered midazolam on children of three age groups dur-ing restorative dental care. Pediatr Dent, 21(4): 235–41, 1999.

36. Bayrak F, Gunday I, Memis D, Turan A. A comparison of oral midazo-lam, oral tramadol, and intranasal sufentanil premedication in pediatric patients. J Opioid Manag, Mar-Apr; 3(2): 74–8, 2007.

37. Yemen, TA. Pediatric Anesthesia Handbook. New York: McGraw-Hill Medical Publishing, 47–53, 2002.

38. Reeves ST, Wiedenfeld KR, Wrobleski J, Hardin CL, Pinosky ML. A randomized double-blind trial of chloral hydrate/hydroxyzine versus midazolam/acetaminophen in the sedation of pediatric dental outpa-tients. ASDC J Dent Child, 63(2): 95–100, 1996.

39. Rosenberg M. Oral Midazolam Syrup as a Safe Sedative for Pediatric Dentistry. J Mass Dent Soc, 49(2): 32–5, 2000.

40. Marshall WR, Weaver BD, McCutcheon P. A study of the effectiveness of oral midazolam as a dental pre-operative sedative and hypnotic. Spec Care Dentist, 19(6): 259–66, 1999.

41. de Wildt SN, de Hoog M, Vinks AA, van der Giesen E, van den Anker JN. Population pharmacokinetics and metabolism of midazolam in pediatric intensive care patients. Crit Care Med, 31(7): 1952–8, 2003.

42. Sagir, A, Schmitt M, Dilger K, Haussinger D. Inhibition of cytochrome P450 3A: relevant drug interactions in gastroenterology. Digestion, 68(1): 41–8, 2003.

43. Dresser GK, Spence JD, Bailey DG. Pharmacokinetic-pharmacody-namic consequences and clinical relevance of cytochrome P450 3A4 inhibition. Clin Pharmacokinet, 38(1): 41–57, 2000.

44. Goho C. Oral midazolam-grapefruit juice drug interaction. Pediatr Dent, 23(4): 365–6, 2001.

45. Yuan R, Flockhart DA, Balian JD. Pharmacokinetic and pharmacody-namic consequences of metabolism-based drug interactions with alpra-zolam, midazolam, and triazolam. J Clin Pharmacol, 39: 1109–25, 1999.

46. Martinez JL, Sutters KA, Waite S, Davis J, Medina E, et al A compar-ison of oral diazepam versus midazolam, administered with intravenous meperidine, as premedication to sedation for pediatric endoscopy. J Pediatr Gastroenterol Nutr, Jul; 35(1): 51–8, 2002.

47. Wiener-Kronish, Jeanine P, Gropper, MA. Conscious Sedation. Philadelphia: Hanley & Belfus, 2001: 8–10.

48. Shannon M, Albers G, Burkhart K, Liebelt E, Kelley M, et al. Safety and efficacy of flumazenil in the reversal of benzodiazepine-induced conscious sedation. The Flumazenil Pediatric Study Group. J Pediatr, Oct; 131(4): 582–6, 1997.

49. Euliano TY, Gravenstein JS. Essential Anesthesia From Science To Practice. New York: Cambridge University Press, 169, 2004.

50. Kost, M. Moderate Sedation/Analgesia Core Competencies For Prac-tice. Missouri: Saunders, 249–51, 2004.

51. Christophe B, Maleux MR, Gillard M, Chatelain P, Peck MJ, Massing-ham M. The histamine H(1)-receptor antagonist cetirizine does not interact with bradykinin B(1) or B(2)-receptors in vitro. Inflamm Res, 53(1): 81–2, 2004.

52. Martinez D, Wilson S. Children sedated for dental care: a pilot study of the 24-hour postsedation period. Pediatr Dent, 28(3): 260–4, 2006.

53. Alfonzo-Echeverri EC, Berg JH, Wild TW, Glass NL Oral ketamine for pediatric outpatient dental surgery sedation. Pediatr Dent, May-Jun; 15(3): 182–5, 1993.

54. Wright GZ, Chiasson RC. The use of sedation drugs by Canadian pedi-atric dentists. Pediatr Dent, 9: 308, 1978.

55. Dionne RA, Yagiela JA, Moore PA, Gonty A, Zuniga J, Beirne OR. Comparing efficacy and safety of four intravenous sedation regimens in dental outpatients. JADA, 132: 740–51, 2001.

56. Aubuchon RW. Sedation liabilities in pedodontics. Pediatr Dent, 4: 171–80, 1982.

57. Gregory, GA. Pediatric Anesthesia. Pennsylvania: Churchill Living-stone, 36–7, 2002.

58. McKee KC, Nazif MM, Jackson DL, Barnhart DC, Close J, Moore PA. Dose-response characteristics of meperidine sedation in preschool chil-dren. Pediatr Dent,12: 222–7, 1990.

59. Wiener-Kronish, Jeanine P, Gropper MA. Conscious Sedation. Philadelphia: Hanley & Belfus, 10–2,102, 2001.

60. Chudnofsky CR, Wright SW, Dronen SC, Borron SW, Wright MB. The safety of fentanyl use in the emergency department. Ann Emerg Med, Jun; 18(6): 635–9. 1989.

61. Litman, RS. Pediatric Anesthesia The Requisites in Anesthesiology. Pennsylvania: Elsevier Mosby, 151,201,202, 2004.

62. Buck ML. Naloxone For The Reversal Of Opoid Adverse Effects. Pedi-atric Pharmacotherapy, 8(8): 1–5, 2002.

63. Bell C, Kain ZN. The Pediatric Anesthesia Handbook. 2nd Edition. St. Louis. Mosby, 378, 1997.

64. Chowdhury J, Vargas KG. Comparison of chloral hydrate, meperidine, and hydroxyzine to midazolam regimens for oral sedation of pediatric dental patients. Pediatr Dent, May-Jun; 27(3): 191–7, 2005.

65. Twersky RS. The Ambulatory Anesthesia Handbook. St. Louis: Mosby, 348–9, 1995.

66. Krauss B, Brustowicz RM. Pediatric Procedural Sedation and Analge-sia. Philadelphia: Lippincott Williams & Wilkins, 39–45, 1995.

67. Hershensen M, Brouillette RT, Olsen E, Hunt CE. The effect of chloral hydrate on genioglossus and diaphragmatic activity. Pediatr Res, 18: 516–19, 1984.

68. Hardman JG, Lee EL. Goodman & Gilman’s: The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill, 419–21, 2001.

69. Wilson S, Farrell K, Griffen A, Coury D. Conscious Sedation Experi-ences in Graduate Pediatric Dentistry Programs. Pediatr Dent, 23: 307–14, 2001.

70. Hulland SA, Freilich MM, Sandor GK. Nitrous oxide or oral midazo-lam for pediatric outpatient sedation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 93(6): 643–6, 2002.

71. Erlandsson AL, Backman B, Stenstrom A, Stecksen-Blicks C. Con-scious sedation by oral administration of midazolam in pediatric dental treatment. Swed Dent J, 25(3): 97–104, 2001.

72. Haas DA, Nenniger SA, Yacobi R. A Pilot study of the efficacy of oral midazolam for sedation in pediatric dental patients. Anesth Prog, 43(1): 1–8, 1996.

73. Pisalchaiyong T, Trairatvorakul C, Jirakijja J, Yuktarnonda W. Compar-ison of the effectiveness of oral diazepam and midazolam for the seda-tion of autistic patients during dental treatment. Pediatr Dent, 27(3): 198–206, 2005.

74. Poorman T, Farrington FH, Mourino AP. Comparison of chloral hydrate/hydroxyzine combination with and without meperidine in the sedation of pediatric dental patients. Pediatr Dent, 12(5): 288–91, 1990.

75. Hasty MF, Vaan WF, Dilley DC, Anderson JA. Conscious sedation of pediatric dental patients: an investigation of chloral hydrate, hydrox-yzine pamoate, and meperidine vs. chloral hydrate and hydroxyzine pamoate. Pediatr Dent, 13(1): 10–9, 1991.

76. Sams DR, Russell CM. Physiologic response and adverse reactions in pediatric dental patients sedated with promethazine and chloral hydrate or meperdine. Pediatr Dent, 15(6): 422–24, 1993.

77. Sams DR, Cook EW, Jackson JG, Roebuck BL. Behavioral assessments of two drug combinations for oral sedation. Pediatr Dent, 15: 186–9, 1993.

78. Houpt MI, Kupietzky A, Tofsky NS, Koenigsberg SR. Effects of nitrous oxide on diazepam sedation of young children. Pediatr Dent, 18(3): 236–41, 1996.

79. Nathan JE, Vargas KG. Oral midazolam with and without meperidine for management of the difficult young pediatric dental patient: a retro-spective study. Pediatr Dent, 24(2): 129–38. 2002.

80. Cathers JW, Wilson CF, Webb MD, Alvarez ME, Schiffman T, Taylor S. A comparison of two meperidine/hydroxyzine sedation regimens for the uncooperative pediatric dental patients. Pediatr Dent, 27(5): 395–400, 2005.

81. Lee-kim SJ, Fadavi S, Indru P, Koerber A. Nasal versus oral midazolam sedation for pediatric dental patients. J Dent Child, 71: 126–30, 2004.

82. McComb M, Koenigsberg Sr, Broder HL, Houpt M. The Effects of oral conscious sedation on future behavior and anxiety in pediatric dental patients. Pediatr Dent, 24(3): 207–11, 2002.

83. Guidelines for the use of conscious sedation, deep sedation and general anesthesia for dentists. Adopted by the American Dental Association House of Delegates, October, 2005.

84. Cote CJ, Wilson S. Guidelines for monitoring and management of pedi-atric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics, 118(6): 2587–602, 2006.

85. Cote CJ, Karl HW, Notterman DA, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: analysis of medications used for sedation. Pediatrics, 106(4): 633–44, 2000.

86. Cote CJ, Notterman DA, Karl HW, Weinberg JA, McCloskey C. Adverse sedation events in pediatrics: a critical incident analysis of contributing factors. Pediatrics, 105: 805–14, 2000.

87. Dionne R, Yagiela JA, Cote CJ, et al. Balancing efficacy and safety in the use of oral sedation in dental outpatients. JADA, 137: 502–13, 2006.

88. Lewis CW, Nowak AJ. Stretching the safety net too far waiting times for dental treatment. Pediatr Dent, 24(1) 6–10. 2002.

89. Weaver JM. Managing real anesthesia emergencies on human simula-tors. Anesth Prog, 53: 117–18, 2006.

90. Loyd GE, Lake CL, Greenberg RB. Practical Health Care Simulations. Philadelphia: Hanley & Belfus Medical Publishers, 230–3, 2004


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Scopus: CiteScore 2.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Submission Turnaround Time

Conferences

Top