The effect of Temperament on Outcomes of Opioid and Non-Opioid Pediatric Dental Sedation

Abstract

Background: Procedural sedation is frequently used to safely and effectively complete pediatric dental treatment. However, there is no standard regimen or patient assessment used among pediatric dentists and sedation outcomes vary widely. Purpose: The primary objective of this randomized trial was to assess the effects of oral sedation using midazolam and hydroxyzine with and without meperidine on sedation outcomes in pediatric dental patients. The secondary objective was to assess the relationship between child temperament and sedation outcomes. Methods: This pilot study recruited 37 children between the ages of 3-7 years who met study eligibility criteria and were planned to undergo dental treatment with oral sedation at the University of Washington Center for Pediatric Dentistry. The children were randomly assigned to receive a regimen of midazolam and hydroxyzine with or without meperidine. Parents completed the Child Behavior Questionnaire Short Form (CBQ-SF) to assess temperament. Results: There were no significant differences in sedation outcome with age, sex, insurance status, sedation regimen, isolation method, or duration of procedure. In general, children with high pre-operative Frankl behavioral ratings were more likely to have successful sedation outcomes. Children who displayed high soothability experienced higher rates of success, and this effect was more pronounced in the non-opioid regimen group. Conclusions: Overall, there was a low rate of success in this study and a relatively small sample size. However, the results suggest that pre-procedure behavior and the temperament characteristic of soothability may warrant more exploration as predictors of sedation success.