Cochrane · intervention · CD003877
Sedation of children undergoing dental treatment
Ashley, PF, Chaudhary, M, Lourenço‐Matharu, L · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
19
current version
GRADE rated
17
No studies
1
Included studies
50
as reported
No studies 1 · 5.3%Ungraded 1 · 5.3%Very low 15 · 78.9%Low 1 · 5.3%Moderate 1 · 5.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents aged 0 to 16 years (including children with specific medical or behavioural problems) having simple restorative treatment with local anaesthesia (e.g. fillings, stainless steel crowns), simple extractions or management of dental trauma; children having complex surgical procedures excluded | Studies from 16 countries (greatest proportion USA, n=12, 24%); age 1 to 16 years (>=39 studies all subjects 6 or under); mean age approx 4.8 years; mean 74 participants per study; 3704 in total |
| Intervention | Any sedative agent via any route of administration that can be administered by a dentist, anaesthetist, sedationist or dental auxiliary in an outpatient/dental office setting; studies inducing deep sedation excluded | Chloral hydrate (n=3); Chloral hydrate + hydroxyzine (n=6); Chloral hydrate + hydroxyzine + midazolam (n=1); Chloral hydrate + promethazine (n=1); Dexmedetomidine (n=2); Diazepam (n=1); Hydroxyzine (n=3); Ketamine (n=7); Ketamine + promethazine (n=1); Ketamine + midazolam (n=3); Ketamine + midazolam + sevoflurane (n=1); Melatonin (n=1); Meperidine (n=1); Meperidine + promethazine (n=2); Midazolam (n=27); Midazolam + acetaminophen (n=1); Midazolam + fentanyl (n=1); Midazolam + hydroxyzine (n=1); Midazolam + nitrous oxide/oxygen (n=1); Midazolam + ketamine (n=5); Midazolam + sevoflurane + nitrous oxide/oxygen (n=2); Midazolam + tramadol (n=1); Nitrous oxide/oxygen (n=5); Promethazine (n=1); Propofol (n=1); Sevoflurane + nitrous oxide/oxygen (n=1); Sufentanil (n=1); Tramadol (n=1); Triazolam (n=1); Triclofos (n=2); Trimeprazine + methadone (n=1); Trimeprazine + physeptone (n=1); Zolpidem (n=2); Zolpidem + tramadol (n=1) |
| Comparison | Placebo (including no intervention); alternative sedation agent; different dosage of the same agent | Placebo (n=12); No intervention (n=1) |
| Outcomes | Behaviour (primary); Completion of treatment (yes/no); Postoperative anxiety; Adverse events | Behaviour (n=50); Completion of treatment (n=50); Postoperative anxiety (n=50); Adverse events (n=50) |
| Study designs | Randomised controlled trials (including cluster-randomised); quasi-randomised and cross-over trials excluded | Randomised controlled trials |
| Timing | Not reported | Not reported |
Search date: 22 February 2018. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid
Questions and results
Show all 5 versionsChloral hydrate vs Placebo (including no intervention)
Population: Children and adolescents (0 to 16 years) needing dental treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Good or better behaviour | RR 1.33 [0.80, 2.22] 176 [-106, 467] per 1000 | 1 study · 60 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour (Houpt/behavioural score) | SMD 0.69 [0.13, 1.26] | 1 study · 52 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour | Moreira 2013: 0.5 mg/kg midazolam + 3 mg/kg ketamine produced significantly better behaviour than placebo and oral midazolam (P=0.03); not included in meta-analysis / not GRADE-rated. Narrative. | 1 study | Ungraded |
Good or better behaviour | RR 5.33 [1.45, 19.64] 578 [60, 867] per 1000 | 1 study · 60 participants | Low Downgraded: risk of bias, imprecision |
Behaviour (Houpt/behavioural score) | SMD 0.62 [-0.28, 1.53] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour (Houpt/behavioural score) | SMD 1.21 [0.24, 2.18] | 1 study · 20 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour (Houpt/behavioural score) | SMD 1.96 [1.59, 2.33] | 6 studies · 202 participants | Moderate Downgraded: risk of bias |
Midazolam (any mode of delivery) vs Different dosage of the same sedative
Population: Children and adolescents (0 to 16 years) needing dental treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behaviour | Any behavioural score - Midazolam (any mode of delivery): 394 (10 studies); VERY LOW. Insufficient evidence to determine whether any specific dose of intranasal midazolam is effective; weak evidence oral midazolam… | 10 studies · 394 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Hydroxyzine: 30 (1 study); VERY LOW. Insufficient evidence to determine whether any specific dose of hydroxyzine is effective. | 1 study · 30 participants | Very low Downgraded: risk of bias, imprecision |
Intravenous midazolam vs A different sedative agent
Population: Children and adolescents (0 to 16 years) needing dental treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Behaviour | Any behavioural score - Intravenous midazolam versus (other sedatives): 70 (2); VERY LOW | 2 studies · 70 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Ketamine versus (other sedatives): 494 (8); VERY LOW | 8 studies · 494 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Chloral hydrate/promethazine versus (other sedatives): 24 (1); VERY LOW | 1 study · 24 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour | Any behavioural score - Dexmedetomidine versus (other sedatives): 120 (2); VERY LOW | 2 studies · 120 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Chloral hydrate/hydroxyzine versus (other sedatives): 235 (6); VERY LOW | 6 studies · 235 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Rectal midazolam versus (other sedatives): 90 (1); VERY LOW | 1 study · 90 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour | Any behavioural score - Sevoflurane versus (other sedatives): 1140 (3); VERY LOW | 3 studies · 1140 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Behaviour | Any behavioural score - Ketamine/midazolam versus (other sedatives): 27 (1); VERY LOW | 1 study · 27 participants | Very low Downgraded: risk of bias, imprecision |
Behaviour | Any behavioural score - Oral midazolam versus (other sedatives): 654 (7); VERY LOW | 7 studies · 654 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Sedation
Population: Medically compromised children (ASA III+) or children with learning/behavioural difficulties needing dental treatment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Outcome NR | 'Some of the techniques described may be useful in the management of medically compromised patients, but at present there are no studies carried out in these groups.' (Discussion) Explicit evidence gap. | 0 studies | No studies |