Comparison of transmucosal midazolam with inhalation sedation for dental extractions in children. A randomized, cross-over, clinical trial.
BACKGROUND
The transmucosal route for conscious sedation in children has been reported widely in the field of medicine, but less so in dental patients. The aim of this study was to evaluate the efficacy and safety profile of midazolam (0.2 mg/kg) administered by the buccal transmucosal route, in comparison with nitrous oxide/oxygen inhalation sedation, for orthodontic extractions in 10-16-year-old dental patients.


METHODS
Each patient attended for two visits and was randomly allocated to receive buccal midazolam (0.2 mg/kg) or nitrous oxide/oxygen titrated to 30%/70% at the first visit, the alternative being used at the second visit. The patients' vital signs, sedation levels and behavioural scores were recorded throughout. Post-operatively, side-effects, recall of the visit and satisfaction levels were recorded via questionnaire.


RESULTS
Thirty-six patients, with a mean age of 12.9 years, completed both arms of the trial. The maximum level of sedation was achieved with buccal midazolam in a mean time of 14.42 min, compared with 7.05 min with inhalation sedation. The vital signs with both types of sedation remained within acceptable limits and the reported side-effects were of no clinical significance. Buccal midazolam was found to be acceptable by 65.7%. Only 28.6% of cases preferred this technique, the main disadvantage being the taste of the solution.


CONCLUSIONS
Buccal midazolam sedation (0.2 mg/kg) seems to be equally as safe and effective as nitrous oxide/oxygen for the extraction of premolar teeth in anxious children. However, further research is required to refine the midazolam vehicle to improve acceptability.
Wilson
K E
KE
Department of Sedation, Newcastle University School of Dental Sciences and Dental Hospital, Newcastle upon Tyne, UK. katherine.wilson@ncl.ac.uk
Welbury
R R
RR
Girdler
N M
NM
D000293:Adolescent; D000704:Analysis of Variance; D000766:Anesthesia, Dental / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D018592:Cross-Over Studies; D016854:Dental Anxiety / Q000517:prevention & control; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D009609:Nitrous Oxide; D017060:Patient Satisfaction; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods / Q000706:statistics & numerical data; D014081:Tooth Extraction
D018685:Anesthetics, Inhalation; D006993:Hypnotics and Sedatives; D009609:Nitrous Oxide; D008874:Midazolam