Title For Child Patients With Anxiety In The Dental Office, The Use Of Nitrous Oxide Augments The Sedative Effects Of Orally Administered Diazepam
Clinical Question In a child patient undergoing dental treatment, will sedation with nitrous oxide and diazepam, as compared to treatment with diazepam alone, reduce patient anxiety and improve the overall quality of the sedation?
Clinical Bottom Line For child patients with anxiety in the dental office, the use of nitrous oxide augments the sedative effects of orally administered diazepam. The evaluation of the overall sedative effects of the diazepam and nitrous oxide together were better than the sedative effects of diazepam alone.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
8784916Houpt/1996Twenty-four children (mean age of 32 months).Cross Over Study
Key resultsIn this cross over study child patients were evaluated on one visit having been given an oral dose of diazepam and then on another visit they were evaluated having been given the same dose of diazepam in conjunction with nitrous oxide. The effects of sedation with diazepam in conjunction with diazepam were better 56% of the time, worse 13% of the time, and the same 31% of the time. In conclusion, nitrous oxide may slightly increase the sedative effects of diazepam on children but is not done so with the same quality of effects on all children who were tested.
Evidence Search ("Conscious Sedation"[Mesh] AND "Nitrous Oxide"[Mesh]) AND "Diazepam"[Mesh] AND "humans"[MeSH Terms]
Comments on
The Evidence
This cross over study had the one group of children treated on two occasions with differing sedation techniques. There was a greater than 80% completion rate with the children being treated the same with the two variations of sedation. There was adequate follow up in the study with adequate compliance. The study was not double blind.
Applicability While the results of this study do show that the effects of sedation are more effective with the combination of nitrous oxide and diazepam, it does also state that the effects are not uniform on all of the children being tested, which should lead to more research being performed. The strength of this study would not be one to lead me to believe that the combination with nitrous oxide would be the better option in all cases, but in cases where the child patient has severe anxiety and dental work cannot be performed on the child with diazepam alone, the combination of nitrous oxide with diazepam could be a good option to provide a deeper level of sedation in order to perform dental treatment.
Specialty (General Dentistry) (Pediatric Dentistry) (Dental Hygiene) (Behavioral Science)
Keywords dental anxiety, children, nitrous oxide, diazepam
ID# 2422
Date of submission 04/03/2013
E-mail gonzalezcc@livemail.uthscsa.edu
Author Christina Gonzalez
Co-author(s) e-mail
Faculty mentor Ernest Valdez, DDS
Faculty mentor e-mail valdeze@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available