Nasal spray to calm kids in dental chair

child

Adults might baulk at having a tooth pulled but will stoically endure the process. Children are less brave, however, and may not cooperate at all, presenting dentists with a major challenge.

With this in mind, two researchers—a senior lecturer from the Faculty of Dentistry at the University of Western Cape, South Africa, and a paediatric dentist from Sudan—have been studying sedatives in the hope of finding a safe, effective, low-dose solution that reduces the amount of anxiety children experience prior to these types of procedures.

The use of oral sedatives is a common form of sedation in paediatric dentistry but it can be difficult to judge the proper dose.

A new study in the current issue of the journal Anesthesia Progress describes one particular method that may make it easier to safely administer sedatives to children before extracting a tooth.

In the study, 118 South African children aged between four and six years old were recruited, all needing to have a tooth extracted in an emergency dental clinic. A mucosal atomiser—utilized in paediatric hospitals and slowing gaining favour in dental applications—was subsequently used to spray intranasal midazolam, a sedative that is absorbed directly into the bloodstream through the lining of the nose, at doses of 0.3 or 0.5 mg/kg.

The researchers found that all of the children were sedated to some degree, and pulse rate and oxygen saturation levels were within normal ranges. The children who received the larger dose had less anxiety and a better behavior score, and only took a couple of minutes longer to wake up from the sedation.

The only common complaint of the mucosal atomiser was a burning sensation felt when the drug was being sprayed. In these cases, a nurse gave a nasal anesthesia a few minutes before the main sedative. As a result, only nine per cent of children in the study said they felt burning in their nasal cavity.

The researchers concluded that the mucosal atomiser is best for children during short procedures. Additionally, the study showed that either dose of intranasal midazolam is safe and effective; however, the stronger dose caused less anxiety during the procedure, making the child easier to work with.

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2 Comments

  1. In covering this work from overseas, I would have thought mention should be made not only that there is no proprietary preparation of intranasal midazolam available in Australia, but also that administration of midazolam, whether given intranasally or not, is considered conscious sedation and therefore in Australian dental practice, should only be performed by dentists with conscious sedation qualifications. Just because the drug is given via the nose does not make it any safer. So this is not a preparation the average dentist can give “to calm kids in the dental chair”.

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