Abstract
Aim: To report on two separate child sedation cohorts; one undergoing propofol intravenous sedation (IVS) and the other, nitrous oxide inhalation sedation (IS) in respect to changes in dental anxiety and subject characteristics. Study design: The age, gender, level of social deprivation and amount of treatment performed and observed patient behaviour during treatment, using the Frankl and a VAS scale, were recorded for each subject. Anxiety questionnaires were completed before and after treatment. These were: — Modified Child Dental Anxiety Scale (MCDAS); Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and two Visual Analogue Scales (VAS). Results and statistics: Participants (36) attended for treatment under IS and 40 attended for treatment under propofol IVS. The IVS cohort was older (p < 0.01), by between 1.9 and 4.1 years and had more treatment [p = 0.015, 95% confidence interval for the difference between the cohort medians was (0, 3) units]. The two cohorts were closely matched in respect to pre-operative anxiety as measured by the MCDAS and CFSS-DS scales. There were significant anxiety reductions within each cohort as measured by three of the scales: — MCDAS, CFSS-DS and VAS (1) (p ≤ 0.001) but no significant change in the VAS (2) scores. When the two cohorts were compared, there was no significant difference in the reduction of the self-reported anxiety for any of the four scales (p > 0.05). The observed behaviour was good for both cohorts. Conclusion: Propofol target-controlled intravenous sedation (TCI) and nitrous oxide inhalation sedation were similarly efficacious at anxiety reduction in referred dentally anxious children. Subjects undergoing propofol IVS were older than those undergoing IS. Propofol TCI may offer the opportunity for more treatment at each visit. Further propofol TCI conscious sedation studies are required.
Similar content being viewed by others
References
Aartman IH, van Everdingen T, Hoogstraten J, Schuurs AH. Self-report measurements of dental anxiety and fear in children: a critical assessment. [Review]. J Dent Child 1998; 65(4): 252–258.
Aitken R. Measurement of feelings using Visual Analogue Scales. Proc Royal Soc Med1969; 62: 989–996.
Arch LM, Humphris GM, Lee GT. Children choosing between general anaesthesia or inhalation sedation for dental extractions: the effect on dental anxiety. Int J Paediatr Dent 2001; 11(1): 41–48.
Blayney MR, Ryan JD, Malins AF. Propofol target-controlled infusions for sedation—a safe technique for the non-anaesthetist? Brit Dent J 2003; 194(8): 450–452.
Busuttil Naudi A, Campbell C, Holt J, Hosey MT. An Inhalation sedation patient profile at a specialist paediatric dental unit. A retrospective survey. Europ Archs Paediatr Dent 2006; 7(2): 106–109.
Control of nitrous oxide in dental operatories. National Institute for Occupational Safety and Health 1994. National Institute for Occupational safety and health (NIOSH) Publication number 94-129. Cincinnati, OH, USA.
Cuthbert MI, Melamed BG. A screening device: children at risk for dental fears and management problems. J Dent Child 1982; 49(6): 432–436.
Frankl SN, Shiere FR, Fogels HR. Should the parent remain with the child in the dental operatory? J Dent Child 1962; 2:150–163.
Girdler NM, Rynn D, Lyne JP, Wilson KE. A prospective randomised controlled study of patient-controlled propofol sedation in phobic dental patients. Anaesthesia 2000; 55(4): 327–333.
Hamid SK, McCann N, McArdle L, Asbury AJ. Comparison of patient-controlled sedation with either methohexitone or propofol. Brit J Anaesth 1996; 77(6): 727–730.
Hosey MT, Blinkhorn AS. An evaluation of four methods of assessing the behaviour of anxious child dental patients. Int J Paediatr Dent 1995; 5(2): 87–95.
Hosey MT. National clinical guidelines. Managing anxious children; the use of conscious sedation in paediatric dentistry. Int J Paediatr Dent 2002;12(50): 354–372.
Hosey MT, Makin A, Jones RM, Gilchrist F, Carruthers M. Propofol intravenous conscious sedation for anxious children in a specialist paediatric dentistry unit. Int J Paediatr Dent 2004; 14(1): 2–8.
Humphris GM, Morrison T, Lindsay SJ. The Modified Dental Anxiety Scale: validation and United Kingdom norms. Community Dent Health 1995; 12(3): 143–150.
Kindler C.H, Harms C, Amsler F et al. The Visual Analogue Scale Allows Effective Measurement of Preoperative Anxiety and Detection of Patients’ Anesthetic Concerns. Anesthesia and Analgesia, 2000; 90(3): 706–712.
Kucukyavuz Z, Cambazoglu M. Effects of low-dose midazolam with propofol in patient-controlled sedation (PCS) for apicectomy. Brit J Oral & Max-facial Surg 2004; 42(3): 215–220.
Leitch JA, Sutcliffe N, Kenny GN. Patient-maintained sedation for oral surgery using a target-controlled infusion of propofol — a pilot study. Brit Dent J 2003; 194(1): 43–45.
Locker D, Liddell A, Dempster L, Shapiro D. Age of onset of dental anxiety. J Dent Res 1999; 78(3): 790–796.
Loyola-Rodriguez JP, Aguilera-Morelos AA, Santos-Diaz MA, et al. Oral rehabilitation under dental general anesthesia, conscious sedation, and conventional techniques in patients affected by cerebral palsy. J Clinic Pediatr Dent 2004; 28(4): 279–284.
Marsh B, White M, Morton N, Kenny GN. Pharmacokinetic model driven infusion of propofol in children. Brit J Anaesthes 1991; 67(1): 41–48.
McLoone P. (1994) Carstairs scores for Scottish postcode sectors from the 1991 census. Glasgow; Public Health Resource Unit, University of Glasgow.
Oei-Lim LB, Vermeulen-Cranch DM, Bouvy-Berends EC. Conscious sedation with propofol in dentistry. Brit Dent J 1991; 170(9): 340–342.
Oei-Lim VL, Kalkman CJ, Makkes PC, Ooms WG, Hoogstraten J. Computer controlled infusion of propofol for conscious sedation in dental treatment. Brit Dent J 1997; 183(6): 204–208.
Oei-Lim VL, White M, Kalkman CJ, et al. Pharmacokinetics of propofol during conscious sedation using target-controlled infusion in anxious patients undergoing dental treatment. Brit J Anaesthes 1998; 80(3): 324–331.
Oei-Lim VL, Kalkman CJ, Makkes PC, Ooms WG. Patient-controlled versus anesthesiologist-controlled conscious sedation with propofol for dental treatment in anxious patients. Anesthesia & Analgesia 1998; 86(5): 967–972.
Rodrigo C, Irwin MG, Yan BS, Wong MH. Patient-controlled sedation with propofol in minor oral surgery. J Oral & Max-facial Surg 2004; 62:[1], 52–56.
Rodrigo MR, Irwin MG, Yan SW, To PC. Patient maintained propofol sedation for dental surgery. Int Dent J 2004; 54(4): 177–181.
Ruiz K, Coldwell SA, Hitchin N, Dresner-Black E. Propofol sedation in general dental practice: the first 100 patients. Dental Update 2000; 27(1): 16–20.
Schuurs AH, Hoogstraten J. Appraisal of dental anxiety and fear questionnaires: a review. Community Dent Oral Epidemiol1993; 21(6): 329–339.
Scottish Dental Clinical Effectiveness Programme (NDAC). Conscious Sedation in Dentistry. May 2006. Dundee
Skipsey IG, Colvin JR, Mackenzie N, Kenny GN. Sedation with propofol during surgery under local blockade. Assessment of a target-controlled infusion system. Anaesthes 1993; 48(3): 210–213.
Stephens AJ, Sapsford DJ, Curzon ME. Intravenous sedation for handicapped dental patients: a clinical trial of midazolam and propofol. Brit Dent J 1993; 175(1): 20–25.
Tan CH, Onsiong MK. Pain on injection of propofol. Anaesthes 1998; 53(5): 468–476.
Veerkamp JS, Gruythuysen RJ, Hoogstraten J, van Amerongen WE. Anxiety reduction with nitrous oxide: a permanent solution? J Dent Child 1995; 62(1): 44–48.
Wehrmann T, Kokabpick S, Lembcke B, Caspary WF, Seifert H. Efficacy and safety of intravenous propofol sedation during routine ERCP: a prospective, controlled study. Gastrointestinal Endoscopy 1999; 49(6): 677–683.
Wilson KE, Welbury RR, Girdler NM. A randomised, controlled, crossover trial of oral midazolam and nitrous oxide for paediatric dental sedation. Anaesthes 2002; 57(9): 860–867.
Wong HM, Humphris GM, Lee GT. Preliminary validation and reliability of the Modified Child Dental Anxiety Scale. Psychological Reports 1998; 83(3 Pt2): 1179–1186.
Zacharias M, Bridgman J, Parkinson R. Two methods of administration of propofol for dental sedation. Brit J Oral & Max-facial Surgery 1998; 36(1): 19–23.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alexopoulos, E., Hope, A., Clark, S.L. et al. A report on dental anxiety levels in children undergoing nitrous oxide inhalation sedation and propofol target controlled infusion intravenous sedation. Eur Arch Paediatr Dent 8, 81–86 (2007). https://doi.org/10.1007/BF03262574
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03262574