Increasing awareness about the importance of preventive dental care among low-income families has been considered to be key to overcoming nonfinancial access to care barriers for children. The purpose of this randomized, controlled trial was to measure the impact of postcard mailings on dental utilization by low-income children through a dental society program designed to increase access to dental care.
Five thousand eight hundred and seven low-income 2- to 4-year-olds were randomly assigned to 1 of 3 groups: (1) Group 1 (N=2,014) received postcards containing information on how to enroll in the Yakima County Access to Baby and Child Dentistry program; (2) Group 2 (N=2,014) received the enrollment information as well as additional information on the availability of fluoride varnish and the need to visit the dentist by the age of 1-year-old; and (3) Group 3 (N=1,779) did not receive postcards.
Preventive services utilization rates were not different among the groups: 61% for Group 1, 62% for Group 2, and 60% for Group 3, although rates were high for a Medicaid population.
Postcard mailings did not significantly increase utilization of preventive dental services. Other strategies to increase utilization of preventive oral health measures are needed.
access to dental care; Medicaid; child; RCT
In this study, we compared preventive dental utilization through visits to a pediatric dentist (PD) vs. visits to a general dentist (GD) among Medicaid-enrolled children in New Hampshire (n=12,964). Dental claims were analyzed using conditional logistic regression models. After adjusting for covariates, children seen by a PD were 51% more likely to have received fluoride treatment, 26% more likely to have had at least two dental examinations, and 19% more likely to have received a sealant than children seen by a GD. Overall, our results suggest that children seen by a PD were more likely to have received preventive services than those seen by a GD. Because Medicaid-enrolled children are at increased risk for poor oral health, policies should be enacted to ensure that high-risk children receive appropriate and regular prevention-oriented dental care.
dental Medicaid program; health care disparities; dental care for children; preventive dentistry; access to health care; pediatric dentistry; utilization
To describe the strategies--based on the social triad concept of a partnership of researchers, school personnel and community-- employed to recruit low-income, minority parent/caregivers of kindergarten children into a school-based tooth decay prevention trial in the United States.
The study site was an urban school district with five elementary schools. Recruitment was carried out once each year for three years. Recruitment involved strategies at the school district, school, classroom, and student-parent level. A coalition of researchers, school personnel and community individuals was established for communication and recruitment. Outreach workers from the community were hired to promote, recruit, and disseminate oral health information. Study promotion included both print materials (logos, flyers, pictorial story boards) and presentations at school and community events.
The School District Superintendent and administrators approved the study, and all five school principals and kindergarten teachers participated. All children within the classrooms were eligible: the overall participation rate of was 86% (580/672). Community outreach workers actively facilitated the recruitment and participants were recruited at open house for parent-teacher meeting (37% of all participants), sending letters and consent forms home (31%), at a prearranged convenient time during drop off and pick up of the child at their respective schools (30%), curriculum nights and health fairs (2%).
Utilizing the social triad concept led to success in planning and carrying out the recruitment of predominantly minority school children with high participation rates.
randomized clinical trial (RCT); recruitment; school children; minority participation
There is growing interest in the use of diammine silver fluoride (DSF) as a topical agent to treat dentin hypersensitivity and dental caries as gauged by increasing published research from many parts of the world. While DSF has been available in various formulations for many years, most of its pharmacokinetic aspects within the therapeutic concentration range have never been fully characterized.
This preliminary study determined the applied doses (3 teeth treated), maximum serum concentrations, and time to maximum serum concentration for fluoride and silver in 6 adults over 4 h. Fluoride was determined using the indirect diffusion method with a fluoride selective electrode, and silver was determined using inductively coupled plasma-mass spectrometry. The mean amount of DSF solution applied to the 3 teeth was 7.57 mg (6.04 μL).
Over the 4 hour observation period, the mean maximum serum concentrations were 1.86 μmol/L for fluoride and 206 nmol/L for silver. These maximums were reached 3.0 h and 2.5 h for fluoride and silver, respectively.
Fluoride exposure was below the U.S. Environmental Protection Agency (EPA) oral reference dose. Silver exposure exceeded the EPA oral reference dose for cumulative daily exposure over a lifetime, but for occasional use was well below concentrations associated with toxicity. This preliminary study suggests that serum concentrations of fluoride and silver after topical application of DSF should pose little toxicity risk when used in adults.
Clinical trials registration
Acute pain; Tooth; Medical device; Topical agent; Pharmacology; Toxicology
Dental fear may be the most common reason for referral for intravenous sedation. Intravenous sedation offers many patients an opportunity to obtain needed dental care. However, intravenous sedation also has costs and may not help patients overcome their fear. Given a sample of 518 dentally-fearful patients in the USA presenting for dental care, this study examined the variables which predicted receiving intravenous sedation or not. About one-fifth of the patients received intravenous sedation, while the others received only cognitive behavioural therapy. Having more carious teeth, higher dental fear, more negative beliefs about dentists, lifetime diagnoses of panic disorder and/or generalized anxiety disorder, fewer existing coping skills, and a lower desire to cope with the dental situation were each predictive of having intravenous sedation. When the variables were considered simultaneously, only lower desire to cope contributed uniquely to the prediction. In a setting where psychological treatment for dental fear is available, patients’ desire to cope with their fear was the most important factor in determining whether they received intravenous sedation or not.
Oral health is essential to overall health in the prenatal period. Pregnancy is not a time to delay dental care. Several studies have shown an association between periodontal disease and poor pregnancy outcomes including preterm birth. Interventions to provide periodontal treatment to pregnant women yield inconsistent results regarding preterm birth but have established the safety of periodontal therapy during pregnancy. Postpartum, women in poor dental health readily transmit the tooth decay pathogen Streptococcus mutans from their saliva to their infants resulting in increased risk of early childhood caries. Preventive services and treatment for acute problems should be recommended, fears allayed, and women referred. Dental x-rays may be performed safely with the use of appropriate shielding. Non-emergent interventions are best provided between 14 and 20 weeks of gestation for comfort and optimal fetal safety. Most gravid women do not seek dental care. Increased interprofessional communication to encourage dentists to treat pregnant women will reduce the number of women without care. In states where it is available, Medicaid coverage of dental services for pregnant women is typically allowed during pregnancy and for two months postpartum. Women’s health providers should understand the importance of protecting oral health during pregnancy and educate their patients accordingly.
Surveys over 20 years have documented worsening in the dental health of preschoolers. Healthy People 2010 Midcourse Review reports the country moving away from oral health goals for young children; the slip is 57%. Exacerbating this is the inability of Medicaid to provide for those in need. Most children receive examinations only: few receive comprehensive care. We urge Head Start grantees to adopt a new approach to oral health goals and in this paper offer: (1) a review of the problem and premises preventing a solution; (2) a proposal that Head Start adopt a public health perspective; and (3) specific roles staff and dental personnel can take to mount aggressive strategies to arrest tooth decay at the grantee site.
oral health; preschool children; Head Start; tooth decay
To investigate whether the relationship between dental anxiety and referral for treatment under sedation is explained by attendance patterns and oral health.
Structural Equation Modeling was used on the covariance matrix of the covariates to test hypothesized inter-relationships. Subsequently, we modeled the probability of referral for treatment under sedation with a multiple logistic regression taking into account inter-relationships between the independent variables.
A direct significant association of referral with dental anxiety and attendance patterns was detected but not with oral health status. However, oral health and anxiety were highly correlated. Also signaled were correlations between age and education and between gender and bad past experience.
Referral for treatment under sedation appears to be motivated by both fear and irregular patterns of attendance. Coupled with behavioral treatments to address dental fear and attendance, sedation can part of comprehensive care where curative treatments are long or unpleasant for patients.
dental anxiety; structural equation modeling; logistic regression; utilization; sedation
The purpose of the study was to understand US dentists’ attitudes, knowledge, and practices regarding dental care for pregnant women and to determine the impact of recent papers on oral health and pregnancy and guidelines disseminated widely.
In 2006–2007, the investigators conducted a mailed survey of all 1,604 general dentists in Oregon; 55.2% responded). Structural equation modeling was used to estimate associations between dentists’ attitudes toward providing care to pregnant women, dentists’ knowledge about the safety of dental procedures, and dentists’ current practice patterns.
Dentist’s perceived barriers have the strongest direct effect on current practice and might be the most important factor deterring dentists from providing care to pregnant patients. Five attitudes (perceived barriers) were associated with providing less dental services: time, economic, skills, dental staff resistance, and peer pressure. The final model shows a good fit with a chi-square of 38.286 (p = .12, n=772, df = 52) and a Bentler-Bonett Normed Fit index of .98, CFI = .993. The Root Mean Square Error of Approximation is .02.
Findings suggest attitudes are significant determinants of accurate knowledge and current practice. Multi-dimensional approaches are needed to increase access to dental care and protect the oral health of women during pregnancy. Despite current clinical recommendations to deliver all necessary care to pregnant patients during 1st, 2nd, and 3rd trimesters, dentists’ knowledge of the appropriateness of procedures continues to lag the state of the art in dental science.
This communication examines the combined effect of topical PVP-iodine plus fluoride varnish in prevention of tooth decay in erupting first permanent molars in an on-going public health program.
The evaluation employed a retrospective cohort design with two groups of children 60–83 months. Cohort 1 (2004–05) received three times per school year topical fluoride varnish, and Cohort 2 (2008–09) received topical application of 10% PVP-iodine followed at each visit with topical fluoride varnish. The children were examined clinically at the beginning and end of the school year.
The proportion of children with caries-free first permanent molars in Cohort 2 (PVP-iodine plus fluoride varnish) was .883 and was greater than that in Cohort 1 (varnish), which was .785 (Chi-square=1.000E1, df 1, p<.002).
This evaluation of an on-going dental public health program adds evidence that topical antiseptics applied at the same time as fluoride varnish are more effective than varnish alone. Randomized trials are needed.
Retrospective Cohort Study; Oral Health; Fluoride; Fluoride Varnish; PVP-iodine; Children; Dental Caries
To address dental workforce shortages in underserved areas in the United States, some States have enacted legislation to make it easier for foreign dental school graduates to become licensed dentists. However, the extent to which foreign dental school graduates will solve the problem of dental workforce shortages is poorly understood. Furthermore, the potential impact that foreign-trained dentists have on improving access to dental care for vulnerable patients living in dental Health Professional Shortage Areas (HPSAs) and those enrolled in public insurance programs, such as Medicaid, is unknown. The objective of this paper is to provide a preliminary understanding of the practice behaviors of foreign-trained dentists. The authors used Washington State as a case study to identify the potential impact foreign dental school graduates have on improving access to dental care for vulnerable populations. The following hypotheses were tested: a) among all newly licensed dentists, foreign-trained dentists are more likely to participate in the Medicaid program than U.S.-trained dentists; and b) among newly licensed dentists who participated in the Medicaid program, foreign-trained dentists are more likely to practice in dental HPSAs than U.S.-trained dentists.
The authors used dental license and Medicaid license data to compare the proportions of newly licensed, foreign- and U.S.-trained dentists who participated in the Medicaid program and the proportions that practiced in a dental HPSA.
Using bivariate analyses, the authors found that a significantly lower proportion of foreign-trained dentists participated in the Medicaid program than U.S.-trained dentists (12.9% and 22.8%, respectively; P = 0.011). Among newly licensed dentists who participated in the Medicaid program, there was no significant difference in the proportions of foreign- and U.S.-trained dentists who practiced in a dental HPSA (P = 0.683).
Legislation that makes it easier for foreign-trained dentists to obtain licensure is unlikely to address dental workforce shortages or improve access to dental care for vulnerable populations in the United States. Licensing foreign dental school graduates in the United States also has ethical implications for the dental workforces in other countries.
This paper addresses a number of areas related to how effectively science and technology have met Healthy People 2010 goals for tooth decay prevention. In every area mentioned, it appears that science and technology are falling short of these goals. Earlier assessments identified water fluoridation as one of the greatest public health accomplishments of the last century. Yet, failure to complete needed clinical and translational research has shortchanged the caries prevention agenda that incomplete at a critical juncture.
Science has firmly established the transmissible nature of tooth decay. However, there is evidence that tooth decay in young children is increasing although progress has been made in other age groups. Studies of risk assessment have not been translated into improved practice. Antiseptics, chlorhexidine varnish, and PVP-iodine may have value, but definitive trials are needed. Fluorides remain the most effective agents, but are not widely disseminated to the most needy. Fluoride varnish provides a relatively effective topical preventive for very young children, yet definitive trials have not been conducted. Silver diammine fluoride also has potential but requires study in the US. Data support effectiveness and safety of xylitol, but adoption is not widespread. Dental sealants remain a mainstay of public policy, yet after decades of research, widespread use has not occurred.
We conclude that research has established the public health burden of tooth decay, but insufficient research addresses the problems identified in the Surgeon General's Report. Transfer of technology from studies to implementation is needed to prevent tooth decay among children. This should involve translational research and implementation of scientific and technological advances into practice.
Previous work described the pharmacokinetics and clinical effects of multi-dose sublingual (SL) triazolam (Halcion®). This laboratory study evaluated the hypothesis that incremental dosing of triazolam produces dose-dependent central nervous system (CNS) depression that is profound and long lasting. Forty-nine healthy adults 21–39 years, not receiving dental treatment, were randomly assigned to placebo (n=12), or 1-of-3 triazolam groups (0.25 mg single dose, n=12; 0.5 mg divided between 2 equal doses over 60 minutes, n=12; or 0.75 mg divided among 3 doses over 90 minutes, n=13). Plasma triazolam concentrations were determined. Bispectral index (BIS) and the Observer Assessment of Alertness/Sedation (OAA/S) were used to assess sedation. Plasma triazolam concentrations increased with time in all subjects, with Tmax and Cmax both increasing dose-dependently. Compared to placebo, all dosing paradigms produced dose-dependent BIS suppression and sedation. The single dose of 0.25 mg reached its peak BIS suppression at 90 minutes (81±7) and sedation at 120 minutes (3.6±0.5), and returned to baseline before 360 minutes. In contrast, incremental dosing of 0.5 and 0.75 mg produced profound and long-lasting BIS suppression and sedation that did not plateau until either 180 or 210 minutes measured by BIS (67±14 and 60±16 at 0.5 and 0.75 mg, respectively) and 150 minutes measured by OAA/S (3.2±1.0 and 2.7±0.4 at 0.5 and 0.75 mg, respectively). These data more fully characterize the effects of incremental dosing with SL triazolam and provide additional insight for discharge safety recommendations.
triazolam; sublingual; sedation; BIS; bispectral index; observer assessment of alertness/sedation (OAA/S)
Adolescent dental patients pose a unique challenge to providers, particularly when intravenous sedation is introduced to the treatment plan. Surveys show many adolescents are afraid of the dentist. Five to six per cent overall are fearful of dental injections and may avoid care or have irregular attendance. At the same time, adolescents may assert their independence by refusing to cooperate with providers’ and parents’ requests even while accepting that the goal of better health is reasonable. Successful treatment of – and rapport with – the adolescent dental patient, however, can ensure that adolescents’ oral needs are met. Successful providers recognise that adolescents alternate between childlike and mature coping strategies during the course of dental treatment. Identifying an adolescent’s current coping style can help the dental team select appropriate strategies to help treatment proceed more smoothly for the adolescent and clinical team. Working with adolescents’ individual coping styles, rather than expecting consistently adult behaviour, will ideally help decrease frustration and improve treatment outcome.
A survey was administered to 55 homeless adolescents and young adults aged 14 to 28 years who presented for care at a community health center in Seattle, Washington in 2005. Forty-five valid surveys were analyzed. The aim of the study was to identify factors associated with self-reported oral health. The most common self-reported dental problem was sensitive teeth (52.6%), followed by discolored teeth (48.6%), toothache (38.5%), or a broken tooth (37.8%). Dental problems were associated with lower self-reported oral health, while non-high school graduates, mixed race youths, and methamphetamine users had significantly higher self-reported oral health. Among homeless youths, addressing dental problems with direct dental care may improve self-perceived oral health. The relationships between methamphetamine use and education level, on the one hand, and self-reported oral health, on the other, are complex and may be modified by age.
homeless youth; oral health; health service accessibility; healthcare disparities; community dentistry
Efforts to achieve national objectives for fluoridation, such as Healthy People 2010, and water quality monitoring regulations focus on public water systems and generally overlook the 15% of U.S. households with private wells. Mandated testing of public water systems and new building sites on San Juan Island, Washington revealed naturally occurring fluoride levels up to several times the EPA Maximum Contaminant Level. This study evaluated fluoride concentrations in private wells and estimated the prevalence of dental fluorosis among children to inform local stakeholders.
Primary school children were examined by a dentist for dental fluorosis, parents were surveyed about fluoride exposures, and household drinking water samples were collected to measure and map fluoride concentrations. De-identified data were analyzed using chi-square and Fisher’s exact tests.
18.8% of examined children exhibited mild dental fluorosis, a prevalence similar to national averages. Fluoride concentrations in drinking water were 0.08 to 1.30 mg/L, below levels for health concerns, and generally (94%) below levels recommended for caries prevention. Supplemental sources of fluoride (e.g. tablets) did not account for observed fluorosis.
Results provided community stakeholders with valuable information to support decision-making regarding fluoride levels in drinking water. Previously available information suggested potential for excessive fluoride exposure, however, these study results indicated low fluoride levels were more common. The approach used in this case study suggests a simple method of assessing the scope of fluoridation needs in communities where private water sources are common, allowing for better informed decision-making with regard to future fluoridation efforts.
Community Health Planning Fluorosis; Dental Health; Environmental Water
Extensive research and clinical experience have demonstrated the usefulness of sedation in helping fearful patients receive dental treatment, particularly when they have urgent treatment needs. In addition, the efficacy of behavioural programmes for managing dental fears is well established. While often these two approaches are seen as oppositional, our work in Seattle, Morgantown and at King’s College London Dental Institute demonstrates the complementarity of the two approaches. Using the example of two compounds, one very familiar, propranolol, and one that has recently become of interest, D-cycloserine, we wish to illustrate the manner in which these medications can be used to enhance behavioural approaches to managing dental anxiety.
Dental services during pregnancy can improve maternal oral health, reduce mother-child transmission of cariogenic bacteria, and create opportunities for anticipatory guidance. This study aimed to understand why low-income women did or did not utilize dental services in a pilot program to promote dental visits during pregnancy in Klamath County, Oregon.
Sixty women were contacted and 51 participated in semi-structured telephone interviews regarding utilization of dental services during pregnancy. Women were selected randomly from the pilot program: 45 women (88%) utilized dental services and six did not. Transcripts were content analyzed using a mixed method qualitative approach - grounded theory and Stages of Change model - to identify themes and sub-themes.
Most women overcame stress or dentally-related barriers to use care. Stressors included poor domestic relationships, personal finances, and employment. Dentally-related factors included perception of dental experience, attitude toward dental providers, importance/valuing of oral health, perceived ability to pay for care, time constraints, dental providers’ and office staff attitudes toward clients.
Identifying barriers that prevent low-income women from taking action to access dental care during pregnancy provides information essential for enhancing public-private health programs to promote dental visits, reduce mother-child transmission, and provide guidance to new mothers.
Oral Health Disparities; Dental Services; Utilization; Pregnancy; Medicaid
Frequent consumption of simple carbohydrates, primarily in the form of dietary sugars is significantly associated with increased dental caries risk. Malnutrition (under or over nutrition) in children is often a consequence of inappropriate infant and childhood feeding practices and dietary behaviors associated with limited access to fresh, nutrient dense foods substituting instead, high-energy low cost and nutrient poor sugary and fatty foods. Lack of availability of quality food stores in rural and poor neighborhoods, food insecurity, and changing dietary beliefs resulting from acculturation including changes in traditional ethnic eating behaviors, can further deter healthful eating and increase risk for Early Childhood Caries and obesity.
America is witnessing substantial increases in children and ethnic minorities living in poverty, widening the gap in oral health disparities noted in the Surgeon General's Report, Oral Health in America. Dental and other care providers can educate and counsel pregnant women, parents and families to promote healthy eating behaviors and should advocate for governmental policies and programs that decrease parental financial and educational barriers to achieving healthy diets. For families living in poverty, however, greater efforts are needed to facilitate access to affordable healthy foods, particularly in urban and rural neighborhoods in order to effect positive changes in children's diets and advance the oral components of general health.
Diet and pediatric caries
A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid) in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies.
As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County.
Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93). The mean (SD) number of teeth with any decay was .75 (2.5) in the test population and 1.6 (2.5) in the comparison population (t = 2.08, p = .04).
The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.
To evaluate the effectiveness of a xylitol pediatric topical oral syrup to reduce the incidence of dental caries of very young children.
Randomized, double-blinded, controlled trial.
Communities in the Republic of the Marshall Islands.
108 children aged 9 to 15 months were screened and 100 were enrolled.
Children were randomized and parents administered topical oral xylitol syrup two times (Xyl-2X, two xylitol 4.00 g/dose + one sorbitol dose) or three times (Xyl-3X, three xylitol 2.67 g/dose) per day (total 8 g) or control (one xylitol 2.67 g/dose + two sorbitol dose).
The outcome end-point of the study was the number of decayed primary teeth.
Ninety-four of 100 children (mean±SD age, 15.0±2.7 months at randomization) with at least one follow-up exam were included in the intent-to-treat analysis. The mean±SD follow-up period was 10.5±2.2 months. Nearly 52% of children in the control condition had tooth decay compared to 40.6% among Xyl-3X and 24.2% among Xyl-2X conditions. The mean±SD number of decayed teeth was 1.9±2.4 for control, 1.0±1.4 for Xyl-3X, and 0.6±1.1 for Xyl-2X condition. Compared to controls, there was significantly fewer decayed teeth in the Xyl-2X (relative risk [RR], 0.30; 95% confidence interval [CI] 0.13, 0.66; P=.003) and Xyl-3X (RR, 0.50; 95% CI 0.26, 0.96; P=0.037) conditions. There was no statistical difference between the two xylitol treatment conditions (P=0.22).
Oral xylitol syrup administered topically two or three times each day at a total dose of 8 g was effective in preventing Early Childhood Caries.
Xylitol; Early childhood caries; Tooth decay; Children; Infants; Preschool; Prevention; Randomized clinical trial
This communication reports an outcomes evaluation of the Pacific Islands Early Childhood Caries Prevention Project.
The evaluation includes children in three conditions: (1) three times per school year topical fluoride varnish; (2) varnish plus twice per day toothbrushing; and (3) intervention 2 plus three times per day xylitol containing gummy bear snacks at school and home visits to encourage parental involvement. For this evaluation, groups 2 and 3 have been combined.
One year after project implementation, mean deft was 10.3 (SD=4.3) teeth for group 1 and 8.2 (SD=4.0) teeth for the combination of groups 2 and 3 (p<.05). Twenty-four percent of group 1 had cavitated lesions in any permanent molar versus 12.8 percent in groups 2 and 3 combined (p>.05).
Evaluation confirms the outcome of a program including both in-school twice-daily toothbrushing with fluoridated toothpaste and frequent applications of fluoride varnish.
Outcomes Evaluation; Oral Health; Fluoride; Fluoride Varnish; Fluoridated Toothpaste; Children; Early Childhood Caries
This report describes the research productivity of the members of the International Association for Dental Research (IADR) Behavioral Sciences and Health Services Research Group and examines personal and professional factors related to greater productivity. The findings from previous studies suggested there might be gender discrimination in opportunities for women faculty. Members on the active membership list for this IADR group were surveyed by email. Most were dentists, and three-quarters had external funding for their research. The primary outcome measure was the number of self-reported published articles in PubMed in the preceding twenty-four months. The mean number of these publications was 4.9 (SD=5.1). Gender and time in research were the best predictors of research productivity of this population. There was no difference in time for research between the men and women in this study. Controlling for gender, the best single predictor of research productivity remained percent time spent in research. Overall, the members of the IADR group spent almost three times as much time in research and were more than twice as productive as faculty members as a whole as described in earlier studies. In view of the current emphasis in many countries on addressing the social and behavioral determinants of oral health disparities, the productivity of this area of dental research is very important. Trends toward clinically oriented, non-research-intensive dental schools in the United States and reductions in time and funding available to conduct research should be of concern.
dental faculty; research; research funding; publishing; productivity; gender
Incremental sublingual triazolam has emerged as a popular sedation technique. Nevertheless, little research has evaluated the technique’s safety or efficacy. Given its popularity, an easily administered rescue strategy is needed.
We conducted an RCT to investigate how intraoral submucosal flumazenil (0.2 mg) attenuates CNS depression produced by incremental sublingual dosing of triazolam (3 doses of 0.25 mg over 90 minutes) in 14 adult subjects. Outcomes were assessed with the Observer Assessment of Alertness/Sedation (OAA/S) scale, BIS and physiological monitoring.
OAA/S and BIS scores increased after flumazenil injection at the 30-minute observation point, but were not sustained. Six hours after the initial dose of triazolam (4 hours after flumazenil or placebo challenge), all could be discharged.
Deep sedation from sequential triazolam is incompletely reversed by a single intraoral injection. Reversal did not persist: discharge was at 360 minutes.
A single intraoral injection of flumazenil at 0.2 mg cannot be used to immediately rescue oversedation with triazolam. A larger dose might be effective. Reversal for discharging the patient early is neither appropriate nor safe.
flumazenil; triazolam; sedation/sublingual; behavior/drug effects; dental anxiety/drug therapy; conscious sedation; patient safety