Due to the high anxiety children feel when they visit the dentist, researchers from the US have turned their attention to the effectiveness and post-treatment effects of sedatives used during dental procedures.

In a study published in the current issue of Anesthesia Progress, a team from the Ohio State University in Columbus, Ohio, investigated three different regimens for the use of midazolam, the most commonly administered paediatric sedative: oral midazolam alone, nasal midazolam, or oral midazolam in combination with other sedative/analgesic medications.

The goal was to find a single sedative or a combination of drugs that would reduce both anxiety and uncooperative behaviour during dental procedures.

The researchers studied a total of 650 cases of sedation that took place over 24 months in a hospital-based paediatric dental clinic. Success rates were determined by procedure completion, behaviour during sedation, sedation effectiveness, and number of teeth treated. Patient demographics were fairly balanced with 333 boys and 317 girls ranging in age.

Although the cases were all relatively short in duration, the results of the study showed that all three regimens had completion rates of over 85 per cent. Oral midazolam alone proved to be the most effective of the three, followed by nasal midazolam, and then the combination of pharmaceuticals.

Complications observed by both clinicians and caregivers were very low with fewer than four per cent of cases reporting post-procedural nausea and vomiting; approximately 62 per cent of these cases involved the combination regimen. Paradoxical reaction, where the sedative caused the opposite effect due to loss of the child´s emotional control, was only present in six per cent of cases and there was no significant difference among the sedation regimens.

Overall, the researchers found that all three regimens were proven to be effective and safe for children undergoing dental procedures.

The researchers noted: "In our study, midazolam in several forms and combinations proved effective and safe with minimal side effects. We can recommend these uses of midazolam for necessary treatment in young children."