Seminars on controversial issues. A review of the pharmacological approach to the management of dental anxiety in children.

This paper aims to review the existing literature on the pharmacology of a number of sedative drugs used in the management of dental anxiety in the conscious child patient. Pharmacological agents may be used as a complement to behavioural techniques to assist in the management of anxiety in some paediatric dental patients. Their use may also be especially indicated in children with disabilities. These agents are usually sedative in action and do not, in themselves, eliminate anxiety but merely enhance patient acceptance by reducing arousal and modifying anticipation of danger. The agents used are varied and diverse and include nitrous oxide, benzodiazepines and narcotics. Nitrous oxide has proved to be of particular value but carries a degree of risk for the operating staff. Amongst the benzodiazepines, Midazolam has been used more frequently in recent years. It may be given by a variety of routes, including intra-nasally. Dentists who employ sedative agents and techniques should be familiar with the pharmacology of the agents selected, be cognisant of the risks and benefits of the technique employed and be able to manage any adverse events that may arise through their use.