PREMEDICATION is giving someone a drug before the dentist attempts to perform any clinical procedure to tranquillize the person so that they may cooperate during treatment. The goals of premedication are to allay apprehension or fearful anxiety and prevent any attempt to hamper or resist treatment. Therefore, the judicious use of premedication agents can be substantially beneficial, especially when the patient is a child.
Every dental professional knows that children as patients present a challenge when drugs are required during the course of dental treatment. Special consideration should be given to the route of administration (mouth or injection), selection of appropriate agents, and correct dosage for optimal effect.
Although not a substitute for psychological management techniques, preoperative sedation, when used with certain medications, can significantly expand the range of patients that can be treated in the office environment. The patient should remain conscious and responsive to commands with intact protective laryngeal reflexes (cough). An ideal agent should be efficacious at a level of dosage that minimally alters vital signs and allows for rapid recovery with a low prevalence of adverse reactions.
While the so-called “laughing gas” nitrous oxide is among the best premedication agents, most dentists using preoperative sedation in children prefer the oral route of administration. This method has been shown to be largely effective, even though variability in absorption is sometimes observed. The major advantage of the oral route is that it is an innocuous delivery system that is less likely to be perceived by the child as threatening or suspicious.
Chloral hydrate sold under the brand name of Notec is the oldest drug of hypnotic groups. It closely resembles a barbiturate. The drug is available as syrup and the child can take two spoonfuls 45 minutes before the dental appointment. A major drawback to the use of chloral hydrate is that no specific antidote is currently available to reverse any adverse effects should they occur. Side effects are minor and the taste is frequently reported to be objectionable.
Hydrazine has historically been one of the most popular sedating agents used in children. Available as Atarax and Vistaril, this drug tranquilises; it prevents vomiting and inflammation and also relaxes the muscles. It comes in tablets of 25mg and 50mg. The suspension and injection are also manufactured.
Recently, diazepam, which is widely prescribed for the control of adult anxiety, has gained popularity for use in the preoperative sedation of children. It has been suggested that a dose the night before and the day of dental appointment are necessary to achieve optimal sedation.
Proethazine is widely used in medicine and dentistry as a comedication for narcotic agents. Other similar drugs are meperidine and alphaprodine.
Parents and guardians should know that it could be dangerous to give a child any premedication agent without the consent and control of the dentist. This article does not provide information such as dosage in relation to the weight of the child, the specific dental procedure to be performed and its relation to the type and dosage of the drug etc. in addition, the mental state (hysterical etc.) age, medical history and clinical status of the child, all must be taken into account before premedication is prescribed.
