1. Department of Neuroscience, Reproductive and Oral Sciences, Section of Paediatric Dentistry, “Federico II” University, Naples, Italy.
Division of Dentistry and Orthodontics, “Bambino Gesù” Pediatric Hospital, Rome, Italy.
The use of conscious sedation as an alternative to general anesthesia in pediatric dental patients.
T. Cantile, A. Garret Bernardin, V. D'Anto, G. F. Ferrazzano, A. Galeotti.

2. CONSCIOUS SEDATION IN PAEDIATRIC DENTISTRY
Conscious sedation is a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation, allowing patients to maintain: protective reflexes, patent airway independently.
Nitrous oxide (N2O) is a colorless and virtually odorless gas with a faint, sweet smell. It is an effective analgesic/anxiolytic agent causing central nervous system (CNS) depression and euphoria with little effect on the respiratory system.
American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on appropriate use of nitrous oxide for pediatric dental patients. Pediatr Dent ;27(7 Suppl):107-9.
Emmanouil DE, Quock RM. Advances in understanding the actions of nitrous oxide. Anesth Prog 2007 Spring;54(1):9-18.

3. CONSCIOUS SEDATION To guard the patient’s safety and welfare.
To minimize physical discomfort and pain.
To control anxiety, minimize psychological trauma.
To maximize the potential for amnesia.
To control behaviour and movement to allow the safe completion of the procedure.
To return the patient to a state in which safe discharge from medical supervision is possible.
American Academy of Pediatric Dentistry, 2011.

4. AIM OF THE STUDY OUTCOME MEASURES
To evaluate the effectiveness and the tolerability of the nitrous oxide sedation during dental treatment in very young or anxious children and in children with intellectual disability as an alternative to general anesthesia.
Successful completion of the intended dental treatment with the patient co-operative and responsive to verbal commands.
Patient behavior during treatment using the modified Venham scale.
Adverse events.

5. MATERIALS AND METHODS Data elaborated: children average age;
472 children treated under conscious sedation.
688 working sections performed.
Heart rate, oxygen saturation and blood pressure monitored.
Before discharge, assessment of the patient's physical status and alertness.
Data elaborated:
children average age;
percentage of successful sessions in relation to the gender;
overall success / failure;
percentage of successful sessions (healthy/disabled children);
percentage of adverse effects;
number of treated teeth and kind of dental procedure undertaken;
level of cooperation, using the modified Venham scale.

6. MATERIALS AND METHODS - Modified Venham scale
Modified Venham score
Time intervals
0 relaxed
1 concerned
2 tense
3 reluctant
4 very disturbed
5 out of control
TC: At first contact with the dentist
T0: At the start of the induction
T1: At the end of the induction
T2: During the first injection of local anaesthesia
T3:During dental treatment

7. in relation to the gender
RESULTS
Successful sessions
in relation to the gender
Age distribution
58.7 % aged 4 to 6 years old
72.1 % younger than 8 years

8. RESULTS - Overall success / failure
success at the first appointment: 86,3%
success at the second appointment: 90,7%

9. RESULTS - Success / failure in relation to healthy and disabled children
Healthy patients = 87.4%
Disabled patients = 75%

10. RESULTS - Adverse effects

11. RESULTS
Level of cooperation
Dental treatment undertaken

12. THANK YOU FOR YOUR ATTENTION
Conclusions
The use of conscious sedation with nitrous oxide resulted in successful completion of dental treatment in 86. 3% of cases.
The evidence from this study suggests that this technique may be an useful alternative to general anesthesia (GA) and could reduce the number of pediatric patients referred to hospitals for GA.
Conscious sedation can be considered safe, practical, and effective both for very young and anxious and for disabled children.
THANK YOU FOR YOUR ATTENTION