A survey of parental attitudes toward sedation of their child.

A questionnaire was sent to parents whose children had been sedated for dental treatment o determine their acceptance of such a treatment modality. Other areas examined were the adequacy of parental information, total recovery time, degree of illness experienced, and the level of patient recall. There was a high level of acceptance of procedures by parents. In a typical pediatric dental practice, treatment for the majority of child patients is provided effectively with the aid of local anesthetics and psychological child management techniques. A small percentage of child patients present greater management difficulty and cannot be treated in this manner. For those children, different forms of behavior management techniques are required. The literature is replete with articles discussing this problem, with recommendations ranging from psychological management to pharmacological management of the uncooperative patient. 1-4 When a dentist recommends sedation, the parents generally agree; however, there is little in the literature which describes parent reaction to this approach. The purpose of this study was to collect information from parents whose children had been sedated for dental treatment. It was felt such information would serve as a means of evaluating treatment techniques from the parents" perspective. Methods and Materials The sample consisted of 41 children (22 males, 19 females) with an age range of 1 year 6 months to 11 years and an average age of 61.3 months (Table 1). All the children were healthy, as determined by a self-administered health questionnaire, and by discussion with 1 or both parents. The decision to use sedation was based on the child’s age (e.g., preschoolers with extensive dental work needed) or demonstrated management problem evidenced by past dental history as well as the authors’ own subjective assessments during the child’s initial examination appointment. The authors’ usual p~rocedure was to see the child for an initial examination visit. At that time, the child’s dental needs were determined, as well as the need for sedation. If the child was to be sedated, the procedure was discussed with the parents and they were provided with a printed instruction sheet which briefly described the procedures, the child’s preoperative preparation (e.g., NPO after midnight), as well as a description of the child’s postoperative course. The child was then reappointed for the sedation and treatment session. All children in this study were sedated with a combination of drugs (Meperidine ®, Promethazine ®, and Chlorpromazine®), ~ in a weight-related dosage. The sedative was administered IM (gluteal area), by a registered nurse approximately 45 rain before the scheduled dental appointment. During treatment, children were placed in a Pediwrap. ® Nitrous oxide was used initially at 30-50% (depending on the level of sedation displayed by the patient) and subsequently was reduced to 10% following administration of the local anesthetic. Every effort was made to complete Table 1. Age Distribution of Child Patients Age Number of Patients 18-24 months 1 25-36 months 10 37-48 months 5 49-60 months 4 61-72 months 7 73-84 months 7 85-96 months 2 97-108 months 2 109-120 months 1 121-132 months 2 206 PARENTAL ATTITUDES TOWARD CHILD SEDATION: E1Badrawy and Riekman Table 2. Questionnaire Please check the appropriate answer: 1. Were you adequately informed about the use of sedation techniques in aiding in the treatment of your child? Yes __ No 2. How long did it take your child to become fully alert following the sedation procedure? less than 1 hour 3 to 4 hours 1 to 2 hours 4 to 5 hours 2 to 3 hours more than 5 hours 3. Was there at any time any evidence of illness (e.g., nausea)? Yes No 4. What does your child recall regarding this experience? No recall Detailed memory Vague memory 5. Do you think that the technique of sedation was effective in allowing your child to receive the needed dental care with minimal psychological trauma? Yes No 6. Would you permit your child to be treated again with this method? Yes No 7. Prior to your child’s sedation, what were some of your concerns (if any) regarding this method of dental care delivery? 8. If you have any comments you wish to add, kindly note them on the back of this sheet. Thank you for your cooperation. the treatment in 1 session if at all possible. This frequently meant anesthetizing 2 or more quadrants. This was accomplished by anesthetizing the quadrants in stages, and by keeping the overall amount of anesthetic solution to three carpules. A rubber dam was used routinely, and the appointments usually lasted 1 hr or less. A self-administered questionnaire (Table 2) was mailed to the parents of 64 children who had undergone dental treatment under sedative medication. The questionnaire was mailed approximately 1 week following the child’s dental appointment. Also included in the mailing was a covering letter and a stamped, self-addressed envelope. Of the 64 questionnaires, 41 were returned (64.1% response rate).