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

(Burnweit C et
This study prospectively Case control 2000- The Miami Children’s 145 patients Exclusion criteria five of The parent assists thePre- and postoperative
examines the efficacy 2002 Hospital Institutional the 150 children (3%) child in practicing topain scores in the
al., 2004) of nitrous oxide analgesia were unable to cooperate, breath through the remaining children were
in children undergoing refusing to put on the brightly colored, higher in the abscess
outpatient surgical mask or to breath group compared with the
pleasantly scented nurse
procedures. other groups The pain
exclusively through the practitioner titrates the
nose. nitrous oxide, from scores tended to rise
20% to 50%, with during the procedure in 2
oxygen. Heart and groups, probably because
respiratory rates and many were completely
oxygen saturation are pain free at the onset.
Parental satisfaction was
monitored. 100%.
(Eaton JJ et the objective of this Cross sectional 2005
study was to examine
al., 2005)
parental attitudes toward
behavior management
techniques currently used
in pediatric dentistry.
(Heinrich M et investigated the feasibility Not mentionedNot
al., 2015) and the effectiveness of
N2O/O2 (50:50) as a
sedative analgesic when
performing minor surgical
procedures.
Columbus 55 parents Exclusion criteria Parents (1) tell-show-do The mean parental
march-2005 Children’s Hospital acceptance rating was in the
of children presenting for (2) nitrous oxide sedation
april dental emergency treatment, (3) passive restraint acceptable range for
sedation, or general (4) voice control all behavior management
anesthesia were excluded, (5) hand over Mouth techni ques examined in this
as were parents of study except for hand-over-
(6) oral premedication
patients treated by the (7) active restraint mouth.
authors General anesthesia was
(8) general anesthesia.
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.
(LIVOPAN, Linde 210 children Children (ASA 1) were • Assessment of pain A N2O/O2 (50:50) mixture
mentioned Healthcare, included in the study. before, during, and was administered in 210
Germany) Exclusion criteria were after the intervention children.
traumatic brain injuries, through a self- Three treatments were
otitis media, bowel assessment using the terminated because of lack
obstruction, facescaleof Hicks et of compliance, nausea, or
gastrointestinal disorders, al12 with a score of 0 dizziness. No other side
or facial lacerations. , (no pain) to 10 effects were encountered.
children in emergency (strongest pain); During the intervention,
situations • Evaluation of the 80.5% of all patients were
child’s behavior: pain free, and 81.9% were
relaxed and calm, relaxed and calm. A higher
crying, shows rate of insufficient pain
defensive reactions or control was observed when
additional restraint the indication was an
needed injection of a digital block
• Inhalation time of or a reposition of fractures
the N2O/O2 (50:50) and dislocations
mixture;
• The lowest
oxygen saturation
during the
application of the
(S To evaluate the efficacy RCT 2001 Not mentioned 90 children. Exclusion criteria Nitrous oxide was OSBD scores reached a
Kanagasundar and safety of nitrous Jun included impaired level administered at a variable maximum during the induction
am et al., oxide for children of consciousness, concentration of phase with lower scores during
2001) undergoing painful undrained 50±70%to achieve a level subsequent phases.
procedures. pneumothorax, recent of consciousness. Children over the age of 6
middle ear surgery, two observers were showed a lower level of
and a difficult airway. trained in the use of distress.
Patients were fasted OSBD-R until they 86% percent of patients had
from solids for four obtained a minimum of no side effects.
hours and clear fluids for 90% interobserver The incidence of vomiting,
two hours prior to the agreement. excitement, and dysphoria was
procedure. A third observer recorded 7.8%, 4.4%, and 2%
evidence of vomiting, respectively.
excitement, dysphoria, 8 patients developed oxygen
and desaturation. ration desaturation (SaO2 < 95%), but
was SaO2 < 95%. This was none developed hypoxia,
chosen as the patients airway obstruction, or
were receiving an FiO2 of aspiration.
30±50%. Excitement was 93 % of patients fulfilled the
defined as uncontrolled criteria for conscious sedation,
laughing or hysteria and and 65% had no recollection .
dysphoria was described Mean recovery time was three
as unpleasant dreams. The minutes
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.