Use of restraint and management style as parameters for defining sedation success: a survey of pediatric dentists.

Views of what constitutes a successful sedation diff er extremely between clinicians. To date, literature has not been off ered which clarifi es or defi nes what constitutes success when sedative techniques are chosen to manage severely apprehensive and challenging child dental patients. With few exceptions, research methods have been employed which incorporate: (1) confounding drug comparisons; (2) poorly defi ned patient selection criteria; and (3) ambiguous defi nitions of success. There are no clear distinctions to be found in the existing literature which identify when a particular regimen demonstrates effi cacy. Many tools and scales of measurement to assess pediatric sedation have been used in sedation studies. The behavioral research literature is replete with methods that off er detailed and complex mechanisms in which to assess effi cacy and success of a given intervention. Such composite indices have included various: (1) self-report measures; (2) behavioral observation ratings; and (3) physiologic parameters. The scales developed in the medical literature emphasize the safety and sedation level of the child undergoing medical procedures with little reference to the child’s behavior. Scales used in studies dealing with pediatric dental sedation have additional components that measure: (1) safety of the sedation; and (2) the child’s movement; (3) crying; and (4) physical resistance. Among those found in the dental literature are the: (1) Houpt scale; (2) Venham scale; (3) Ohio State University Behavior Rating Scale; (4) Ramsay Sedation Score; (5) North Carolina Behavior Rating Scale; and (6) others, including modifi ed versions of these scales. The Houpt scale was found to be used most frequently among studies that were scientifi cally qualifi ed to be included in the Cochrane review and which met the strict inclusion criteria of that study. Twenty-six diff erent types of measurement scales were used among the 53 studies; 47% utilized the Houpt scale or a modifi cation of it in their study. The Houpt scale measures: (1) sleep; (2) movement; (3) crying; and (4) overall behavior. This scale, however, may consider a sedation in which a papoose board was used throughout treatment as successful. Indeed, in the review of 53 studies, 49% used papoose boards. In contrast, a tool was devised emphasizing the importance of the lack of physical resistance of the sedated child during treatment. Assessment of effi cacy and sedation success was defi ned and developed by Nathan based on the patient’s movements and consequent need to be restrained. Under optimal circumstances, effi cacy and success of a sedation regimen 1Dr. Vargas is associate professor, Department of Pediatric Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa; 2Dr. Nathan is adjunct professor, Department of Pediatric Dentistry, University of Iowa, and associate professor, Department of Surgery, Norhwestern University Medical School, Chicago, Ill; Dr. Qian is senior research assistant, Social Sciences, Department of Preventive and Community Dentistry, University of Iowa College of Dentistry; Dr. Kupietzky is a pediatric dentist in private practice, Jerusalem, Israel, and visiting professor, Department of Pediatric Dentistry, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, NJ. Correspond with Dr. Kupietzky at drkup@netvision.net.il Abstract: Purpose: The purpose of this study was to identify factors that may infl uence current American Academy of Pediatric Dentistry (AAPD) members’ defi nitions of a successful oral sedation. Methods: Surveys were electronically mailed to all AAPD members with registered e-mail addresses, and printed surveys were sent via postal mail to all other members. The survey included: (1) items on demographic variables; and (2) questions on sedation methods and defi nition of success. Results: The following response rates were recorded: (1) electronic survey=26%; (2) printed=45%; and (3) diplomate=53%. The majority of members (55%) characterized their patient management style as being authoritarian. Sixty-seven percent agreed that the need to employ restraints when using sedation does not necessarily indicate that sedation is inadequate or unacceptable. When asked if such a sedation outcome could be defi ned as being successful, however, the agreement dropped to 47%. When defi ned as optimal, the respondents’ agreement was further reduced to 36%. Conclusions: The practitioner’s management style and use of restraint signifi cantly infl uence how a dentist defi nes a successful sedation. (Pediatr Dent 2007;29:220-7)