EVERY dental professional knows that children, as patients, present a challenge when drugs are required during dental treatment. Although not commonly practised in Guyana, special consideration should be given to the route of administration (oral or by injection), the selection of appropriate agents and the correct dosage for optimal effect.
Premedication is the act of giving someone a drug before the dentist attempts to perform any clinical procedure, to tranquillise 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. The judicious use of a premedicating agent can therefore be substantially beneficial, especially when the patient is a child.
Although not a substitute for psychological management techniques, preoperative sedation, when used with certain medications, can significantly expand the range of patients who can be treated in the office environment. A tried-and-true technique I often use is to hold the cotton with forceps (pliers) and place it over the affected tooth a few times. Obviously, the child observes that nothing is happening and will therefore allow me to do that repeatedly. On my fifth attempt, I perform the extraction.
The patient should remain conscious and responsive to commands, with the protective laryngeal reflexes (coughing) intact. An ideal agent should be effective at a dose that minimally alters vital signs and allows rapid recovery, with a low rate 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 is largely effective, although absorption can vary. The major advantage of the oral route is that it is an innocuous delivery system that the child is less likely to perceive as threatening or suspicious.
Chloral hydrate, sold under the brand name Noctec, is the oldest drug of the hypnotic group. It closely resembles a barbiturate. The drug is available as a 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.
Hydroxyzine has historically been one of the most popular sedating agents used in children. Available as Atarax and Vistaril, this drug tranquillises, prevents vomiting and inflammation, and relaxes the muscles. It comes in 25 mg and 50 mg tablets. Suspensions and injections 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 doses on the night before and the day of the dental appointment are necessary to achieve optimal sedation. This even works well with adults.
Promethazine is widely used in medicine and dentistry as a co-medication 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 supervision of the dentist. This article does not provide information such as the dosage in relation to the child’s weight, the specific dental procedure to be performed and its relationship to the type and dosage of the drug, etc. In addition, the child’s mental state (hysteria, etc.), age, medical history and clinical status must all be taken into account before premedication is prescribed.
