PDS511- Literature review-2019-20
Table II: Summary of all the studies included in the literature review
Reference: The aim of the study
To investigate if parental
(E. Angeles background affects
Martinez Mier acceptance of behavior
et al., 2019) guidance techniques
(Al Zoubi L et To investigate the parental
acceptance of advanced
al., 2019) behavior management
techniques used in pediatric
dentistry in normal and in
emergency situations in
Germany
(Alkandari et 1- Investigate the attitude ofcross-sectional Not
al., 2016) dentists in Kuwait toward the survey
use of nitrous oxide sedation
as a behavior management
technique (BMT) for
pediatric patients and
assess their training in
nitrous oxide sedation
2- Assessed parents
knowledge of and attitude
Study design Date of Site of Sample size Sample criteria Methodology applied in Results/ outcomes [could be
data recruitment the Intervention/ control divided to two rows for
recruit group cases vs. controls]
ment
Cohort study Not community centers in 142 parents Inclusion criteria: be A video tape was digitized Hispanic parents rated VC most
mentioned Indianapolis, parents of a child under and loaded onto a tablet acceptable, followed by TSD,
Indiana University age eighteen, be over age device and used to show PR, and pharmacologic
School of Dentistry 18 themselves, and be of the different techniques: techniques.
Hispanic ethnicity, non- (AR), (GA), (N2O), (OP),
Hispanic Black, or White (TDS), (VC) and (PR) Black and white parents rated
TSD, followed by N2O, as
No exclusion criteria most acceptable, and AR and PR
as least favorable
cross- July 2016 1-University of 136 parents Inclusion criteria are Parents bringing their The acceptance of all advanced
sectional study -December Greifswald parenthood, literacy and children for dental care BMT was significantly higher
2016 2-University of Berlin enthusiasm to participate answered a questionnaire on when the treatment was urgent.
3- University of the acceptance of four
Leipzig Exclusion criteria are advanced BMT. Nitrous oxide sedation was rated
4-University of parents of children with as the most acceptable technique in
Dresden special both normal and emergency
5-University of Mainz health care needs situation.
Passive restraint was the least
acceptable technique in both
normal and emergency
situation.
Parents: Parents: Parents: Analysis, and presentation Parents: more than half of
mentioned 1- The Kuwait 400 precoded 1-Parenthood of the of results were performed parents (66%) in this study
University Dental questionnaires accompanying child using statistical software, would accept nitrous oxide
Center. 2-Literacy for the Statistical Package for sedation as a BMT for their
2- Pediatric dental Dentist: questionnaire Social Sciences (SPSS) children if it was
clinics at the 280 precoded 3-Minimum age of 21 version 20. recommended by the treating
specialty dental questionnaires years dentist. In addition, a similar
centers. percentage of them would
Dentist: prefer nitrous oxide over
1- Valid dental license. general anesthesia if both
2- Currently residing and
 toward the use of nitrous 3-Pediatric dental practicing in Kuwait. were suggested by the
oxide as a BMT clinics at the 3-Minimum age of 21 years. treating dentist. A significant
for their children general 4-Treating pediatric patients. declining trend in parental
practice dental acceptance was noticed with
centers increasing age of parents.
4-4 Private clinics Parental education also
advertising for showed a significant
pediatric dental association with their
care. acceptance of this sedation
technique.
Dentist: Gender had a significant
1- Kuwait University association, as mothers
Dental Center. accepted this BMT slightly
2- Specialty dental more compared to fathers.
centers
3- 5 Randomly Dentist:
selected polyclinics, The willingness of the
1 from each of the dentists to use nitrous oxide
residential areas in sedation
which the specialty increased with higher numbers
centers were of uncooperative patients
located. being treated . Moreover, the
4- 5 Randomly dentists who had been trained
selected private to use nitrous oxide sedation
dental clinics were more willing to utilize it.
advertising for
pediatric dental
care.

Case control 2000-2002 The Miami Children’s 145 patients

(Burnweit C et al., This study prospectively Exclusion criteria were The parent assists the child in Pre- and postoperative pain
examines the efficacy Hospital Institutional children who unable to practicing to breath scores in the remaining
2004) children were higher in the
of nitrous oxide analgesia in cooperate, refusing to put through the brightly
children undergoing outpatient on the mask or to breath colored, pleasantly scented abscess group compared
surgical procedures. exclusively through the nurse practitioner titrates the with the other groups The
nose. nitrous oxide, from 20% to pain scores tended to rise
50%, with oxygen. Heart during the procedure in 2
and respiratory rates and groups, probably because
many were completely pain
oxygen saturation are free at the onset. Parental
monitored. satisfaction was 100%.
(Eaton JJ et the objective of this study
was to examine parental
al., 2005)
attitudes toward behavior
management techniques
currently used in pediatric
dentistry.
(Heinrich M et investigated the feasibility and Not mentioned Not
al., 2015) the effectiveness of
N2O/O2 (50:50) as a
sedative analgesic when
performing minor surgical
procedures.
Cross sectional 2005 march- Columbus Children’s 55 parents Exclusion criteria: Parents of (1) tell-show-do
2005 april Hospital dental children presenting for
emergency treatment,
sedation, or general
anesthesia.
Parents of patients treated (6) oral premedication
by others
(LIVOPAN, Linde 210 children Children (ASA 1) were
mentioned Healthcare, included in the study.
Germany) Exclusion criteria were
traumatic brain injuries,
otitis media, bowel
obstruction, gastrointestinal
disorders, or facial
lacerations. , children in
emergency situations
(2) nitrous oxide sedation
(3) passive restraint
(4) voice control
(5) hand over Mouth
(7) active restraint
(8) general anesthesia.
• Assessment of pain
before, during, and after
the intervention through a
self-assessment using the
facescaleof Hicks et al12
with a score of 0 (no pain)
to 10 (strongest pain);
• Evaluation of the child’s
behavior: relaxed and
calm, crying, shows
defensive reactions or
additional restraint
needed
• Inhalation time of the
N2O/O2 (50:50) mixture;
• The lowest oxygen
saturation during the
application of the
The mean parental acceptance
rating was in the acceptable
range for
all behavior management techni
ques examined in this study
except for hand-over-mouth.
General anesthesia was ranked as
the third most acceptable
technique. This high level of
acceptance of general
anesthesia compared to earlier
studies may suggest that
parental acceptance of this
technique is increasing.
A N2O/O2 (50:50) mixture was
administered in 210 children.
Three treatments were
terminated because of lack of
compliance, nausea, or
dizziness. No other side effects
were encountered. During the
intervention, 80.5% of all
patients were pain free, and
81.9% were relaxed and calm. A
higher rate of insufficient pain
control was observed when the
indication was an injection of a
digital block or a reposition of
fractures and dislocations
(S To evaluate the efficacy and RCT 2001 Not mentioned 90 children. Exclusion criteria included Nitrous oxide was OSBD scores reached a
Kanagasundara safety of nitrous oxide for Jun impaired level of administered at a maximum during the
m et al., 2001) children undergoing painful consciousness, variable concentration induction phase with lower
procedures. undrained pneumothorax, of 50±70%to achieve a scores during subsequent
recent middle ear surgery, level of consciousness. phases.
and a difficult airway. two observers were Children over the age of 6
Patients were fasted from trained in the use of showed a lower level of
solids for four hours and OSBD-R until they distress.
clear fluids for two hours obtained a minimum 86% percent of patients
of 90% interobserver had no side effects.
prior to the procedure.
agreement. The incidence of vomiting,
A third observer excitement, and dysphoria
recorded evidence of was 7.8%, 4.4%, and 2%
vomiting, excitement, respectively.
dysphoria, and 8 patients developed
desaturation. ration was oxygen desaturation (SaO2
SaO2 < 95%. This was < 95%), but none developed
chosen as the patients hypoxia, airway obstruction,
were receiving an FiO2 or aspiration.
of 30±50%. Excitement 93 % of patients fulfilled the
was defined as criteria for conscious
uncontrolled laughing or sedation, and 65% had no
hysteria and dysphoria recollection . Mean recovery
was described as time was three minutes
unpleasant dreams. The
level of sedation was
rated on a scale 0±3
(table
1) by noting the
response to touch and
voice during phase 2,3.
The recovery was
recorded as the time
taken from phase 4 to
sitting up on command.