Effectiveness of Nitrous Oxide Inhalation Sedation Utilising Two Distinctive Gas Dissemination Systems in Paediatric Patients Undergoing Pulp Therapy: A Non-randomised, Split-mouth, Crossover Clinical Trial

Abstract

Introduction: The success of any dental treatment fundamentally predicated on completing procedures with minimal discomfort and optimal patient cooperation. However, achieving this goal becomes particularly challenging in paediatric patients, whose behaviour is often influenced by a myriad of factors, including fear, anxiety and the unfamiliarity of the dental environment. While non pharmacological behaviour guidance techniques play a pivotal role in managing such challenges, there are instances where they prove insufficient, necessitating the utilisation of pharmacological behaviour management strategies such as Conscious Sedation (CS). Aim: To evaluate and compare the effectiveness of Nitrous Oxide Inhalation Sedation (NOIS) utilising two distinctive gas dissemination systems, the Matrx Porter and the Consed machines, in paediatric patients undergoing pulp therapy. The focus is on assessing patient behaviour, pain perception, and sedation outcomes. Materials and Methods: This non-randomised, split-mouth, crossover clinical trial conducted in the Department of Paediatric and Preventive Dentistry at Saveetha Dental College and Hospital in Chennai, Tamil Nadu, India from June 2022 to August 2022 employed 80 healthy but anxious children, aged 4 to 8 years, who required multiple treatments involving local anaesthetic administration across two consecutive appointments. Informed consent was acquired from their parents to perform a procedure under NOIS. The participants were sedated using the Consed machine (Group-A) during the first visit and the Matrx machine (Group-B) during the subsequent visit. Differences in pain were measured using the Modified Wong Baker’s pain rating scale, and sedation was assessed using the Ramsay sedation scale during local anaesthetic administration, behaviour using Frankl’s behaviour rating scale was assessed before the start of treatment and during local anaesthetic administration. Statistical analysis, performed with the Mann-Whitney test, evaluated pain, behaviour, and sedation levels in children undergoing dental treatment with two distinct gas distribution systems. Results: The mean age of the children included in the present study was 7.3±1.212 years. The study found significant differences in behaviour scores between the two groups at two time points: during local anaesthetic administration (p=0.039) and after completion of treatment (p=0.048). Specifically, during local anaesthetic administration, Group-B showed a higher proportion of children exhibiting improved behaviour compared to Group-A. However, no statistically significant differences were observed in pain scores during local anaesthetic administration (p=0.089) or sedation scores (p=0.074) between the Consed (Group-A) and Matrx (Group-B) machines. Conclusion: There were no observed alterations in the sedation levels of children who underwent NOIS, regardless of whether it was administered by the Consed or Matrx machine.

Keywords

• behaviour management
• conscious sedation
• paediatric dental patients