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Meta-Analysis
. 2018 Dec 17;12(12):CD003877.
doi: 10.1002/14651858.CD003877.pub5.

Sedation of children undergoing dental treatment

Paul F Ashley  1 , Mohsin Chaudhary, Liege Lourenço-Matharu
Affiliations
Meta-Analysis

Sedation of children undergoing dental treatment

Paul F Ashley et al. Cochrane Database Syst Rev. .

Abstract

Background: Children's fear about dental treatment may lead to behaviour management problems for the dentist, which can be a barrier to the successful dental treatment of children. Sedation can be used to relieve anxiety and manage behaviour in children undergoing dental treatment. There is a need to determine from published research which agents, dosages and regimens are effective. This is the second update of the Cochrane Review first published in 2005 and previously updated in 2012.

Objectives: To evaluate the efficacy and relative efficacy of conscious sedation agents and dosages for behaviour management in paediatric dentistry.

Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 February 2018); the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1) in the Cochrane Library (searched 22 February 2018); MEDLINE Ovid (1946 to 22 February 2018); and Embase Ovid (1980 to 22 February 2018). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: 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 children up to 16 years of age. We excluded cross-over trials.

Data collection and analysis: Two review authors independently extracted, in duplicate, information regarding methods, participants, interventions, outcome measures and results. Where information in trial reports was unclear or incomplete authors of trials were contacted. Trials were assessed for risk of bias. Cochrane statistical guidelines were followed.

Main results: We included 50 studies with a total of 3704 participants. Forty studies (81%) were at high risk of bias, nine (18%) were at unclear risk of bias, with just one assessed as at low risk of bias. There were 34 different sedatives used with or without inhalational nitrous oxide. Dosages, mode of administration and time of administration varied widely. Studies were grouped into placebo-controlled, dosage and head-to-head comparisons. Meta-analysis of the available data for the primary outcome (behaviour) was possible for studies investigating oral midazolam versus placebo only. There is moderate-certainty evidence from six small clinically heterogeneous studies at high or unclear risk of bias, that the use of oral midazolam in doses between 0.25 mg/kg to 1 mg/kg is associated with more co-operative behaviour compared to placebo; standardized mean difference (SMD) favoured midazolam (SMD 1.96, 95% confidence interval (CI) 1.59 to 2.33, P < 0.0001, I2 = 90%; 6 studies; 202 participants). It was not possible to draw conclusions regarding the secondary outcomes due to inconsistent or inadequate reporting or both.

Authors' conclusions: There is some 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. Further recommendations for future research are described and it is suggested that future trials evaluate experimental regimens in comparison with oral midazolam or inhaled nitrous oxide.

PubMed Disclaimer

Conflict of interest statement

Paul F Ashley: no interests to declare. Mohsin Chaudhary: no interests to declare. Liege Lourenço‐Matharu: no interests to declare.

Figures

1
1
Study flow diagram.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Sedatives versus placebo, Outcome 1 Mean Houpt/other behavioural score.
1.2
1.2. Analysis
Comparison 1 Sedatives versus placebo, Outcome 2 Good or better behaviour.
2.1
2.1. Analysis
Comparison 2 Chloral hydrate (CH), Outcome 1 Overall behaviour (ordinal scale, Houpt or similar).
2.2
2.2. Analysis
Comparison 2 Chloral hydrate (CH), Outcome 2 Good or better behaviour.
3.1
3.1. Analysis
Comparison 3 Ketamine, Outcome 1 Overall behaviour (ordinal scale, Houpt or similar).
3.2
3.2. Analysis
Comparison 3 Ketamine, Outcome 2 Good or better behaviour.
4.1
4.1. Analysis
Comparison 4 Midazolam (versus other), Outcome 1 Overall behaviour (ordinal scale, Houpt or similar).
4.2
4.2. Analysis
Comparison 4 Midazolam (versus other), Outcome 2 Good or better sedation.
5.1
5.1. Analysis
Comparison 5 Nitrous oxide, Outcome 1 Overall behaviour (ordinal scale, Houpt or similar).
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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Meyer 1990 {published data only}
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Reeves 1996 {published data only}
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References to studies excluded from this review

Al‐Zahrani 2009 {published data only}
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Haas 1996 {published data only}
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Hall 2006 {published data only}
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Hartgraves 1994 {published data only}
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Hasty 1991 {published data only}
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Heard 2010 {published data only}
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Henry 1990 {published data only}
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Houpt 1985a {published data only}
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Houpt 1985b {published data only}
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References to other published versions of this review

Matharu 2002
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Matharu 2005
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Matharu 2006
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Matharu 2012
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