Young children needing multiple procedures often cannot be manage

Young children needing multiple procedures often cannot be managed using local anaesthesia alone. General anaesthesia (GA) is an alternative but is associated with significant morbidity and expense[1]. Guidelines for the use of GA in paediatric dentistry encourage discussion of alternative treatment options prior to referral for dental GA[2]. Sedation is a possible alternative to GA for behaviour management but evidence in support of its use is weak. In a recent systematic review[3], oral midazolam was identified as being one of the few agents available whose efficacy Nivolumab in vivo in dental procedures for children is supported by evidence. A recently

published guideline from the National Institute for Health and Clinical Excellence suggests that midazolam

could be used for children requiring dental procedures[4]. Midazolam is potentially an ideal sedative agent for paediatric dentistry because it can be administered orally, has anxiolytic and anterograde amnesic effects and is short acting. As with any other drug, there are known side effects, ranging from commonly observed minor effects to rarer but more severe side effects. These may be related to dose, route of administration and the age of the patient. Common side effects include transient desaturations, LY294002 datasheet hiccough, nausea and vomiting, headache, vertigo, enuresis, hypersalivation, hallucinations, Evodiamine dizziness, diplopia and behavioural disinhibition (or paradoxical reaction). Severe side effects

include cardiac arrest, heart rate changes, anaphylaxis, thrombosis, laryngospasm, bronchospasm, respiratory depression and respiratory arrest[5]. Little information is available as to the safety of this drug when used as an oral sedative in children needing dental treatment. Therefore, the aim of this study was to evaluate the side effects and any other adverse outcomes following use of oral midazolam for behaviour management in paediatric dentistry. This study was a review of all published material relating to the safety and side effects of oral midazolam for use in dental procedures. As previously described, a systematic review already exists looking at the efficacy of oral midazolam for children. Although this review and the NICE guidelines do incorporate some assessment of side effects, no formal review of oral midazolam’s side effects in paediatric dental procedures has thus far been carried out. The aforementioned systematic reviews were restricted to randomised controlled clinical trials (RCTs)[6]. Analyses restricted to clinical trials may miss rare but significant outcomes (e.g. mortality); therefore, there is value in carrying out a separate review with a wider range of studies included (such as cohort or case–control studies). To be eligible for inclusion in this review, studies had to meet the following criteria: 1.

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