Which is the most effective drug or method of sedation used for anxious children? What are the most effective techniques for the use of conscious sedation behaviour management in paediatric dentistry?

Abstract

Data sources: Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, Dissertation Abstracts, SIGLE, the World Wide Web (Google) and the Community of Science Database were searched for relevant trials and references. Reference lists from relevant articles were scanned and the authors contacted to identify trials and obtain additional information. There were no language restrictions. Trials pre-1966 were not searched.

Study selection: Studies were selected if they met the following criteria: randomised controlled trials of conscious sedation comparing two or more drugs/techniques/placebo undertaken by the dentist or one of the dental team in anxious children up to 16 years of age.

Data extraction and synthesis: Information regarding methods, participants, interventions and outcome measures and results was independently extracted, in duplicate, by two authors. Specialist advice was sought to categorise interventions. Authors of trials were contacted for details of randomisation and withdrawals and a quality assessment was carried out not using any formal scoring system. The Cochrane Oral Health Group statistical guidelines were followed.

Results: Fifty-three studies were included with 2345 subjects in total. Overall quality of studies was found to be disappointing with poor reporting, often the main problem. Data reported could not easily be aggregated into groups to facilitate description of results. Meta-analysis of the available data was also not possible for the same reason. The variety of differing drug regimens compared made it difficult to isolate groups of studies that were sufficiently similar in design to allow sensible comparison. Where groups of studies could be isolated, the differing outcome measures used made their meta-analysis impossible.

Conclusions: Authors were not able to reach any definitive conclusion on which was the most effective drug or method of sedation used for anxious children. A list of proposed areas of study was described.