the dentist's approach to management. If a parent is sat outside and hears their 3-year-
old child start to cry in the surgery, events associated with the child's distress can
easily be misinterpreted. Also, studies have shown that many parents would wish to
be present during dental treatment, especially at the child's first visit. Having said
this, in the absence of any convincing evidence one way or the other, having the
parent present during the treatment of preschool children remains a matter of
individual choice.
7.7.3 Sedation
Sedation will not necessarily convert an uncooperative child into a co-operative one.
However, it can help to alleviate anxiety, improve a child's tolerance of invasive
procedures, and increase the child's ability to cope with prolonged treatment. Several
routes of administration are available and of these, two are generally suitable for
outpatient use: inhalation and oral. Intravenous sedation is unsuitable for preschool
children.
Key Points
- Whether or not the parent is present does not seem to have a great effect on the
child's behaviour in the surgery. - Very young children are probably more settled when the parent is present.
- Parents should be encouraged to adopt the role of 'silent helper'.
Inhalation sedation with nitrous oxide and oxygen produces both sedation and
analgesia. The reader is referred to 296HChapter 4 for a full review of this technique. The
technique works most effectively on children who wish to co-operate, but are too
anxious to do so. Its use for preschool children is limited to those who are able to
tolerate the nasal hood, but where this can be achieved, the technique is often
effective.
Orally administered sedation has the advantage that, once administered, no further
active co-operation of the child is required for the drug to take effect. However, unlike
inhalation or intravenous sedation, it is impossible to titrate the dose of the drug to the
patient's response, which results in some variation in effect from one patient to
another.
Over the years, many agents have been advocated for use in dentistry as oral sedative
agents, and none of these are ideal. In studies, most of the more popular agents
produce a successful outcome in 60-70% of cases. For this reason, some workers,
especially in the United States of America, advocate combinations of oral drugs,
sometimes supplemented with inhaled nitrous oxide and oxygen, in order to achieve a
more reliable result. However, administering multiple sedation drugs does not fall
within the definition of 'simple dental sedation', where only a single sedative drug
should be used. Many authorities consider such 'poly-pharmacy' to carry an increased
risk and discourage the practice.
Of the orally administered sedation agents available, the most useful for preschool
children are the chloral derivatives and some of the benzodiazepines.
Chloral derivatives