Effectiveness of Children Experiencing Nitrous Oxide/Oxygen Inhalation Sedation at an Assessment Visit Before Having Treatment

Title: Effectiveness of children experiencing nitrous oxide/oxygen inhalation sedation at an assessment visit before having treatment. Background: Dental anxiety is a common problem, affecting people of all ages, but predominantly children and adolescents. Inhalation sedation (IHS) using nitrous oxide/oxygen (N2O/O2) mixture is a pharmacological behaviour management technique that is widely used to manage dental anxiety in children. It is suggested that the use of an acclimatisation would increase the acceptability and the efficacy of N2O/O2 success. Even though the introductory appointment has been widely proposed, there have not been any studies conducted to measure the effectiveness of this appointment in improving the success of N2O/O2 sedation in children. Aims: This study aimed to investigate the effect of experience of nitrous oxide/oxygen sedation at assessment prior to dental inhalation sedation on children’s anxiety. Methods: The study was a parallel randomised non blinded control clinical trial. Children aged five to fifteen years who were seen at the Leeds Dental Institute for dental treatment under inhalation sedation were recruited on the assessment appointment (1st visit). Both two groups received an assessment appointment, however participants of the study group tried on the mask and the nitrous oxide/oxygen sedation while the ones of the control group tried on the mask without the nitrous oxide/oxygen sedation. Following the assessment appointment, both groups received a second appointment for treatment. Dental anxiety was measured through two different methods. Primarily through the MCDASf questionnaire, which was completed once at the beginning of the assessment visit and twice at the beginning and end of the treatment visit. Secondarily anxiety was measured though the E4 wristband which participants of both groups wore throughout both appointments and recorded their Heart Rate (HR) and Skin Temperature (ST). At the end of the treatment visit, participants and their parents/legal guardians were asked to complete a feedback questionnaire related to the E4 wristband and the experience of N2O/O2 sedation at the assessment visit. -6- Results: Twenty participants were included in the analysis. The control and study groups consisted of 9 and 11 participants respectively with a mean age of 10.35 years. There was no statistically significant difference in the difference of the MCDASf score from the first to the second visit between the two groups. Therefore, our null hypothesis was not rejected. No statistically significant differences were found on children’s dental anxiety levels before and after the treatment session, on the level of acceptance and completion of treatment and on children’s physiological changes between the assessment to the treatment visit between the groups. There were statistically significant reductions of the dental anxiety score of the control group and behavioural score of the study group between the two visits. There was also a minor increase of the mean heart rate of the study group from the assessment to the treatment visit. Conclusion: There was no significant difference in the level of dental anxiety between the children that experience N2O/O2 sedation at the assessment visit with those children that do not and therefore the the null hypothesis, was accepted.