title: Moderate sedation helps improve future behavior in pediatric dental patients - a prospective study.
abstract: There is little evidence on the long-term effects of pharmacological management in children undergoing dental treatment. This study aimed to assess children's behavior in consecutive dental sessions following oral rehabilitation using different pharmacological regimens for behavioral control. Participants were preschoolers who were previously treated for caries under one of the following: no sedative, oral sedation with midazolam, oral sedation with midazolam/ketamine, or general anesthesia. The children's behavior in the follow-up sessions was assessed using the Ohio State University Behavioral Rating Scale (OSUBRS); higher scores represented less cooperative behavior (range 5-20). Follow-up assessments were conducted on 50 children under four years old for up to 29 months. Data were analyzed by the Friedman/Wilcoxon tests and Cox regression model. OSUBRS mean (standard deviation) scores for the whole sample decreased from 11.9 (5.4) before treatment to 6.8 (3.2) at the final recall session (p < 0.001). Moderate sedation with midazolam (OR 2.9, 95%CI 1.2-6.9) or midazolam/ketamine (OR 4.3, 95%CI 1.6-11.4) improved children's future behavior. The general anesthesia group (n = 4) had a small sample size and the results should be considered with caution. Although invasive dental treatment negatively affected the child's behavior in the dental chair, they became more cooperative over time. Moderately sedated children showed better prospective behavior than those in the non-sedation group.
authors: Universidade Federal de Goiás - UFG, Health Sciences Graduate Program, Goiânia, Goiás, Brazil.
authors: Denise Espíndola
authors: DE
authors: Antunes
authors: Universidade Federal de Goiás - UFG, Dentistry Graduate Program, Goiânia, Goiás, Brazil.
authors: Karolline Alves
authors: KA
authors: Viana
authors: Universidade Federal de Goiás - UFG, School of Medicine, Department of Pediatrics, Goiânia, Goiás, Brazil.
authors: Paulo Sucasas
authors: PS
authors: Costa
authors: Universidade Federal de Goiás - UFG, School of Dentistry, Division of Pediatric Dentistry, Goiânia, Goiás, Brazil.
authors: Luciane Rezende
authors: LR
authors: Costa
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000379:methods; D000778:Anesthetics, Dissociative / Q000627:therapeutic use; D002652:Child Behavior / Q000187:drug effects*; D002675:Child, Preschool; D016292:Procedural Sedation / Q000379:methods*; D016854:Dental Anxiety / Q000517:prevention & control; D019140:Dental Care for Children / Q000379:methods*; D003731:Dental Caries / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007649:Ketamine / Q000627:therapeutic use; D008297:Male; D008874:Midazolam / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000778:Anesthetics, Dissociative; D006993:Hypnotics and Sedatives; D007649:Ketamine; D008874:Midazolam