Behavioural management is an essential approach for the dental treatment of the anxious child. It is sometimes necessary to supplement this with sedation. The main aim of this study was to compare the effect of three doses of oral midazolam (0.5, 0.75, and 1 mg ⁄ kg) on the sedative state and cooperative behaviour of children during dental treatment.
90 child patients unable to initially unable to tolerate dental treatment under behavioural management and local anaesthesia or in combination with nitrous oxide use were randomised to Groups A, B, and C and received 0.5, 0.75, and 1 mg⁄ kg of oral midazolam, respectively. The researchers measured prospectively, levels of sedation, cooperative behaviour, procedures completion rates, parent satisfaction, and adverse events .
- Sedation scores in B and C were higher than in A. (P < 0.001)
- Cooperation scores (CS) in B and C were higher than in A (P < 0.001).
- Significant increase in completion rates was observed between A and C (P = 0.025).
- Parent satisfaction was greater in B and C compared to A (P < 0.001).
- Adverse events were higher in C (P < 0.05) than in A or B.
The authors concluded
The amount of 0.75 mg⁄ kg oral midazolam appears to be the optimal oral dose in terms of effectiveness, acceptability, and safety for dental treatments in paediatric patients, when administered by an experienced, paediatric anaesthetist.
Somri, M., Parisinos, C. A., Kharouba, J., Cherni, N., Smidt, A., Abu RAS, Z., Darawshi, G. and Gaitini, L. A. (2011), Optimising the dose of oral midazolam sedation for dental procedures in children: a prospective, randomised, and controlled study. International Journal of Paediatric Dentistry. doi: 10.1111/j.1365-263X.2011.01192.x
Sedation in children and young people – NICE December 2010
Conscious Sedation in Dentistry – Scottish Dental Clinical Effectivenes Programme (SDCEP 2006)