Conscious sedation with benzodiazepines in pediatric outpatient dentistry

Background. Children and adolescents suffering from dentophobia and fear of dentists may exhibit destructive behavior during examination and treatment (from anxiety to tantrums). In some cases, they may completely refuse treatment despite severe pain. Effective sedation is important for successful dental treatment. Objective. To improve the quality of treatment of children in outpatient dentistry through sedation with benzodiazepines. Material and methods. The study enrolled 522 children aged 1—6 years (ASA grade I—II) scheduled for therapeutic/surgical dental treatment. For sedation, we used intramuscular midazolam, relanium and sibazon (0.1 mg/kg, 0.15 mg/kg, and 0.2 mg/kg). All children were divided into 2 groups depending on age: 1—3 years and 3—6 years. Within each group, we distinguished 6 subgroups depending on drug and dose. The expected depth of sedation was Ramsay grade II—III. We assessed depth and duration of effective sedation, treatment per a visit, the possibility of therapeutic interventions without anesthesia at subsequent visits, contact with a child during treatment, negative behavioral reactions during treatment and at home, during subsequent visits, immediate and long-term dental complications. Results. Treatment features correlated with age and drugs. Midazolam 0.15 mg/kg was the most effective. This statement is true for both age groups. Higher doses lead to side effects. In both groups, sibazon in any dose did not allow comfortable treatment. Relanium gave a positive effect in older children. Conclusion. Midazolam is the most effective for comfortable treatment. To achieve maximum effect, it is necessary to take into account duration and traumatic nature of the procedure, as well as characteristics of developmental psychology.