ISSN No: 2582-0559

KNOWLEDGE, ATTITUDE AND PRACTICES OF DENTAL

STUDENTS AND PRACTITIONERS TOWARDS CONSCIOUS

SEDATION - A CROSS-SECTIONAL STUDY

Dr.Vinita Mary. A, Dr. Kesavan. R, Dr. Keerthiga. B, Dr. Neelofar Begum.A , Dr. Sathya.K, Dr. Malleswari.M.D

Department of Public Health Dentistry, Thai Moogambigai Dental College and Hospital, Chennai, Tamil Nadu, India.

Address for Correspondence

Dr. Vinita Mary. A, MDS

Professor and Head,

Department of Public Health Dentistry,

Thai Moogambigai Dental College

and Hospital, Chennai, Tamil

Nadu, India.

Email id: viniebe@gmail.com

ABSTRACT

BACKGROUND:

Dental professionals work effectively and efficiently to

impart  a  positive  behavioral  attitude  towards  dental  treatment  in  children
with  oral  health  care  needs.  The  main  objective  of  sedation  in  pediatric
dentistry  is  to  reduce  fear,  minimize  physical  discomfort  and  control
behavior  for  dental  procedures.  The  present  study  was  carried  out  to
evaluate  the  knowledge,  attitude  and  practices  of  dental  students  and
practitioners towards conscious sedation.

METHODS:

A descriptive cross-sectional survey was conducted among

384  dental  professionals  that  included  undergraduate,  postgraduate  dental
students  and  dental  practitioners  across  Tamil  Nadu,  India.  The  data  was
collected through self-constructed questionnaires consisting of 28 questions
in  English  and  circulated  via  online  platform  on  account  of  COVID-19
pandemic. Every respondent was informed of the purpose of the study and
participation was purely voluntary.

RESULTS:

The mean age of the study participants was found to be 25.99 ±

12.34  years  (mean  ±  S.D)  comprising  of  184  (48%)  males  and  200  (52%)
females.  Majority  of  the  study  participants  acquired  knowledge  about
conscious sedation through dental curriculum only. About 46.1% considered
conscious  sedation  over  general  anesthesia  for  all  dental  procedures  like
restoration,  scaling,  minor  bone  fractures  and  minor  surgeries,  40.1%
preferred  midazolam  and  78.4%  recommend  Nitrous  oxide  sedation  as
effective  technique.  Most  of  the  study  participants  believed  oral  sedation
was  easier  to  administer,  required  less  expertise  and  skill  with  minimal  or
no complication.

CONCLUSION:

This study reveals lacunae in adequate knowledge and

understanding  among  the  practitioners.  The  result  of  this  study  thus
provides  an  insight  on  need  for  strategies  like  incorporating  guidelines  in
dental  curriculum,  organizing  continuing  dental  education  programs  and
workshops  to  provide  knowledge  and  incorporate  positive  attitude  among
the  dental  professionals  to  offer  effective  conscious  sedation  in  children
necessitating oral health care.

KEYWORDS:

Dental anxiety, Midazolam, Pediatric dentistry, general

ORIGINAL ARTICLE

Received:

12.08.2021

First Published:

14.09.2021

Accepted:

11.09.2021

Published:

27.09.2021

Volume No: 8, Issue No: 3

DOI: 1.37841/jidam_2021_V8_I3_01

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

INTRODUCTION:

Management of oral health care needs among children

is a demanding task owing to several factors such as
anxiety, fear associated with anticipation of pain and age-
specific behavioral patterns

1,2

. The process by which dental

health care professionals work effectively and efficiently to
impart positive behavior attitude towards dental treatment
in children is often termed as behavior management

Behavioral modification during dental treatment can be
achieved

non-pharmacological

methods

communication techniques, contingency management,
coping, assimilation, behavioral shaping and modeling
methods

as well as pharmacological methods such as pre-

medications, deep sedations, conscious sedations, general
anesthesia and anxiolytic or minimal sedation methods

5, 6

The  AAPD  (American  Academy  of  Pediatric  Dentistry)
recommends  use  of  general  anesthesia  or  conscious
sedation  techniques  in  acute  anxiety  situation,  extensive
dental  rehabilitation  procedure  of  longer  duration,  severe
treatment  procedural  situations,  extremely  uncooperative
child behavior, and an immature cognitive pattern in a child
or  in  case  of  children  with  physical  or  physiological
impairments

7,8

. Thus the main objective of sedation in

pediatric dentistry is to reduce fear, minimize physical
discomfort and control behavior for dental procedures.

General anesthesia is preferred in children less than 4

years  of  age,  patients  with  special  health  care  needs,
medically  compromised  conditions  including  respiratory
illness,  hepatic  and  renal  diseases,  epilepsy  and  with
communicating incapability. However, the major drawback
of  this  technique  includes  prolonged  unconsciousness,
depressed  vital  signs  and  protective  reflexes  and  need  for
specific  equipment  and  well  trained  anesthetic  team

9, 10, 11

In order to overcome these serious complications, conscious
sedation was introduced to perform high quality dental care
treatment  with  use  of  drugs  that  produce  a  state  of  CNS
(Central nervous system) depression with maintained verbal
contact  through  the  entire  treatment  period  of  sedation.
Conscious  sedation  is  commonly  preferred  to  reduce
anxiety,  increase  pain  threshold,  to  maintain  stable  vitals
and reflexes and  to achieve  mood alteration. It is indicated
in  patients  with  severe  dental  anxiety  and  phobia,  stress
inducing medical conditions, children lacking psychological
or emotional  maturity requiring prolonged traumatic dental
procedures

12, 13

but contraindicated in uncooperative and

medically compromised children

14, 15

. It is highly suggested

that  pediatric  dental  professionals  and  dental  students
should  have  a  comprehensive  theoretical  knowledge  on
anatomic  and  physiological  differences  in  children,

prerequisites  for  conscious  sedation  with  some  practical
understanding  of  patient  selection,  assessment  and
preparation  with  familiarity  towards  various  sedation
techniques  such  as  inhalation,  oral,  intramuscular,  sub-
mucosal  and  several  other  recommended  modes  of
administration  as  required.  Thus,  the  present  study  was
carried out to evaluate the knowledge, attitude and practices
of  undergraduate  and  post  graduate  dental  students  and
dental practitioners towards conscious sedation.

METHODOLOGY:

A cross-sectional questionnaire survey was conducted

among 384 dental professionals that included undergraduate
and postgraduate dental students and dental practitioners
across Tamil Nadu, India.

ETHICAL CLEARANCE

The study was conducted following the Helsinki

declaration as revised in 2013. The protocol was submitted
to the ethical committee before the start of the study and
approval was obtained from Institutional Review Board.

QUESTIONNAIRE DEVELOPMENT:

The required information was collected through

published  scientific  articles  pertaining  to  the  study  and
specially  designed  structured  questionnaire,  comprising  of
28 questions divided into 2 sections was prepared. The first
section was used to record the demographic details such as
age,  gender,  qualification  and  year  of  study/experience  of
practice.  The  second  section  consisted  a  combination  of
selected  responses  to  certain  questions  and  also  few  close
ended  questions  (Yes  /  No/  don’t  know)  related  to
knowledge,  attitude  and  practices  towards  conscious
sedation.

SAMPLING METHODOLOGY AND DATA

COLLECTION

A non-probabilistic convenient sampling methodology

was  used  to  recruit  the  participants  for  the  present  study.
Since  this  study  was  conducted  during  COVID-19
Pandemic  lockdown  period,  online  Google  forms  were
generated  and  distributed  through  social  media  platforms.
The  questionnaire  encompassed  a  separate  section  which
explained the nature and purpose of the study along with an
informed consent  form.  The respondents  were requested to
provide appropriate answers and were assured of anonymity
and  confidentiality.  The  filled  questionnaire  was  collected
and evaluated.

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

STATISTICAL ANALYSIS

The data was analyzed using Statistical Package for

Social Sciences, IBM Corporation, SPSS Inc., Chicago, IL,
USA  Version  21  software  package  (SPSS).  Descriptive
analysis  with  frequency,  percentage,  mean  and  standard
deviation  was  computed.  Pearson  Chi-square  test  and
Fisher’s  Exact  test  was  used  to  assess  the  level  of
significance at p<.05.

RESULTS

The age of the participants in the present study ranged

between  19  to  50  years  with  a  mean  age  of  25.99  ±  12.34
years  (mean  ±  S.D)  comprising  of  184(48%)  males    and
200(52%) females.  Among the study participants,  89(23%)
were  BDS  practitioners,  55(14%)  were  MDS  practitioners,
178(47%)  were  UG  students  and  62(16%)  were  PG
students.  Around  70(18%)  were  studying  in  third  year,  45
(12%)  were  studying  in  final  year,  83(22%)  were  interns,
61(16%) were Post-graduate students, 80(21%) were dental
practitioners  under  5  years  of  experience,  31(8%)  were
practitioners  with  5-10  years  of  experience,  and  14(3%)
were  practitioners  with  more  than  10years  of  experience.
The  demographic  details  of  the  study  participants  is  given
in table 1.

Demographic

character

AGE

MEAN

25.99

12.339

N (%)

GENDER

MALE

184(48%)

FEMALE

200 (52%)

QUALIFICATION

BDS

89(23%)

MDS

55(14%)

UG STUDENTS

178(47%)

PG STUDENTS

62(16%)

YEAR OF STUDY
/ EXPERIENCE
OF PRACTICE

THIRD YEAR

70(18%)

FINAL YEAR

45(12%)

INTERN

83(22%)

POST GRADUATE

61(16%)

DENTAL
PRACTIONERS UNDER
5 EXPERIENCE

80(21%)

5-10 YEARS OF
EXPERIENCE

31(8%)

MORE THEN 10 YEARS
OF EXPERIENCE

14(3%)

Table 1: Demographic details of the study participants

When the genders were compared, it was observed that

there  were  differences  with  respect  to  conscious  sedation
seminar  attendance  and  monitoring  of  intravenous
conscious  sedation  and  these  differences  were  statistically
significant (p<0.05) (Table 2 (a) and (b)).

The comparison of knowledge about conscious

sedation  based  on  educational  qualification  among  the
participants  revealed  that  there  was  statistically  significant
differences  for  source  of  learning,  alternative  names,
frequently  used  technique  in  dentistry,  the  fastest  acting
drug,  stage  of  conscious  sedation  for  performing  dental
treatment,  indication,  duration,  period  of  pre-operative
fasting  and  complications  of  conscious  sedation  (p<0.05)
(Table 2 (a) and (b)).

Question

Options

Total
n(%)

Gender

value

Qualification

value

Males
n (%)

Females

n (%)

BDS

n (%)

MDS

n (%)

UG student

n (%)

PG student

n (%)

How did you
learn about
conscious
sedation

Seminar

118(30.7%)

55(29.9%)

63(31.5%)

0.725

29(32.6%)

16(29.1%)

56(31.5%)

17(27.4%)

0.025

Dental
curriculum

195(50.8%)

95(51.1%)

100(50.0%)

54(60.7%)

30(54.4%)

77(43.3%)

34(54.8%)

Colleague

58(15.1%)

26(14.1%)

32(16.0%)

4(4.5%)

9(16.4%)

35(19.7%)

10(16.1%)

Don't know

13(3.4%)

8(4.3%)

5(2.5%)

2(2.2%)

0(0.0%)

10(5.6%)

1(1.6%)

Have you
attended any
seminar
regarding
conscious
sedation

Yes

219(57.0%)

115(62.5%)

104(52.0%)

0.038

53(59.6%)

44(80.0%)

81(45.5%)

41(66.1%)

0.000

165(43.0%)

69(37.5%)

96(48.0%)

36(40.4%)

11(20.0%)

97(54.5%)

21(33.9)

What are the
other names for
conscious
sedation

Sleep
dentistry

118(30.7%)

57(14.8%)

61(30.5%)

0.714

27(30.3%)

5(9.1%)

73(41.0%)

13(21.0%)

0.000

Twilight
sleep

69(18.0%)

37(20.1%)

32(16.0%)

18(20.2%)

9(16.4%)

23(12.9%)

19(300.6%)

Both a and b

172(44.8%)

78(42.4%)

94(47.0%)

39(43.8%)

41(74.5%)

65(36.5%)

27(43.5%)

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

Don’t know

25(6.5%)

12(6.5%)

13(6.5%)

5(5.6%)

0(0.0%)

17(9.6%)

3(4.8%)

Have you
undergone
conscious
sedation
yoursel1f
for your dental
procedure

Yes

133(34.6%)

77(41.8%)

56(28.0%)

0.004

33(37.1%)

8(14.5%)

58(32.6%)

34(54.8%)

0.000

251(65.4%)

107(58.2%)

144(72.0%)

56(62.9%)

47(85.5%)

120(67.4%)

28(45.2%)

Which technique
of conscious
sedation is used
in dentistry

Oral

86(22.4%)

34(18.5%)

52(26.0%)

0.493

15(16.9%)

4(7.3%)

58(32.6%)

9(14.5%)

0.000

Intravenous

172(44.8%)

88(47.8%)

84(42.0%)

36(40.4%)

30(54.5%)

72(40.4%)

34(54.8%)

Inhalation

79(20.6%)

39(21.2%)

40(20.0%)

26(29.2%)

17(30.9%)

26(14.6%)

10(16.1%)

Intramuscula
r

30(7.8%)

14(7.6 %)

16 (8.0%)

9 (10.1%)

4 (7.3%)

10(5.6%)

7(11.3%)

Don’t know

17(4.4%)

9(4.9%)

8(4.0%)

3(3.4%)

0(0.0%)

12(6.7%)

2(3.2%)

At which stage of
conscious
sedation dental
procedures are
carried out

Minimal

169(44.0%)

82(44.6%)

87(43.5%)

0.336

46(51.7%)

21(38.2%)

79(44.4%)

23(37.1%)

0.074

Moderate

167(43.5%)

75(40.8%)

92(46.0%)

35(39.3%)

28(50.9%)

70(39.3%)

34(54.8%)

Deep

34(8.9%)

21(11.4%)

13(6.5%)

7(7.9%)

6(10.9%)

17(9.6%)

4(6.5%)

Don’t know

14(3.6%)

6(3.3%)

8(4.0%)

1(1.1%)

0( 0.0%)

12(6.7%)

1(1.6%)

For which all
procedures
conscious
sedation can be
used

General
dentistry
such as
restoration
&scaling

80(20.8%)

43(23.4%)

37(18.5%)

0.267

18(20.2%)

5(9.1%)

37(20.8%)

20(32.3%)

0.002

Minor
surgery

74(19.3%)

35(19.0%)

39(19.5%)

14(15.7%)

5(9.1%)

38(21.3%)

17(27.4%)

Minor bone
fracture

37(9.6%)

20(10.9%)

17(8.5%)

10(11.2%)

7(12.7%)

18(10.1%)

2(3.2%)

All the above

177(46.1%)

82(44.6%)

95(47.5%)

46(51.7%)

37(67.3%)

74(41.6%)

20(32.3%)

Don’t know

16(4.2%)

4(2.2%)

12(6.0%)

1(1.1%)

1(1.8%)

11(6.2%)

3(4.8%)

Conscious
sedation in dental
practice can be
given by

Anesthetist

151(39.3%)

71(38.6%)

80(40.0%)

0.983

33(37.1%)

32(58.2%)

55(30.9%)

31(50.0%)

0.000

Dentist

95(24.7%)

45(24.5%)

50(25.0%)

22(24.7%)

3(5.5%)

51(28.7%)

19(30.6%)

Both a and b

126(32.8%)

62(33.7%)

64(32.0%)

34(38.2%)

18(32.7%)

64(36.0%)

10(16.1%)

Don’t know

12(3.1%)

6(3.3%)

6(3.0%)

0(0.0%)

2(3.6%)

8(4.5%)

2(3.2%)

In which of the
conditions
conscious
sedation is
indicated

Mild to
moderate
dental
anxiety

179(46.6%)

84(45.9%)

950(47.5%)

0.886

45(50.6%)

29(52.7%)

87(48.9%)

18(29.0%)

0.009

Moderate to
severe dental
anxiety

139(36.2%)

70(38.0%)

69(34.5%)

29(32.6%)

19(34.5%)

55(30.9%)

36(58.1%)

Severe dental
anxiety

45(11.7%)

21(11.4%)

24(12.0%)

11(12.4%)

7(12.7%)

21(11.8%)

6(9.7%)

Don’t know

21(5.5%)

9(4.9%)

12(6.0%)

4(4.5%)

0(0.0%)

15(8.4%)

2(3.2%)

Under which age
conscious
sedation is
contraindicated

Below 6
months

218(56.8%)

108(58.7%)

110(55.0%)

0.247

56(62.9%)

35(63.6%)

100(56.2%)

27(43.5%)

0.025

Below 10
months

70(18.2%)

36(20.7%)

32(16.0%)

16(18.0%)

13(23.6%)

26(14.6%)

15(24.2%)

Below 1 year

65(16.9%)

25(13.6%)

40(20.0%)

13(14.6%)

7(12.7%)

30(16.9%)

15(24.2%)

Don’t know

31(8.1%)

13(7.1%)

18(9.0%)

4(4.5%)

0(0.0%)

22(12.4%)

5(8.1%)

In which of the
conditions
conscious
sedation is
contraindicated

Extreme
anxiety

250(65.1%)

119(64.7%)

131(65.5%)

0.184

65(73.0%)

40(72.7%)

110(61.8%)

35(56.5%)

0.002

Needle
phobia

56(14.6%)

27(14.7%)

29(14.5%)

16(18.0%)

8(14.5%)

17(9.6%)

15(24.2%)

Traumatic
procedure in
uncooperativ
e patient

50(13.0%)

29(15.8%)

21(10.5%)

6(6.7%)

6(10.9%)

29(16.3%)

9(14.5%)

Don’t know

28(7.3%)

9(4.9%)

19(9.5%)

2(2.2%)

1(1.8%)

22(12.4%)

3(4.8%)

Table2 (a).Comparison of Knowledge and Practice of Conscious Sedation among Genders and Qualification

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

Question

Options

Total
n(%)

Gender

value

Qualification

value

Males

n (%)

Females

n (%)

BDS

n (%)

MDS n

(%)

student

n (%)

PG student

n (%)

intravenous

conscious sedation
monitored
continuously

Yes

237(61.7%)

114(62.0%)

123(61.5%)

0.005

66(74.2%)

37(67.3%)

97(54.5%)

37(59.7%)

0.000

76(19.8%)

46(25.0%)

30(15.0%)

13(14.6%)

16(29.1%)

30(16.9%)

17(27.4%)

Don’t know

71(18.5%)

24(13.0%)

47(23.5%)

10(11.2%)

2(3.6%)

51(28.7%)

8(12.9%)

Do you know the
armamentarium
used in conscious
sedation

Yes

240(62.5%)

118(64.1%)

122(61.0%)

0.527

56(62.9%)

41(74.5%)

96(53.9%)

47(75.8%)

0.003

144(37.5%)

66(35.9%)

78(39.0%)

33(37.1%)

14(25.5%)

82(46.1%)

15(24.2%)

Which

the

fastest action drug
for

conscious

sedation

Midazolam

154(40.1%)

69(37.5%)

85(42.5%)

0.633

34(38.2%)

20(36.4%)

79(44.4%)

21(33.9%)

0.001

Benzodiazepam

135(35.2%)

70(38.0%)

65(32.5%)

33(37.1%)

25(45.5%)

52(29.2%)

25(40.3%)

Barbiturates

48(12.5%)

24(13.0%)

24(12.0%)

14(15.7%)

7(12.7%)

13(7.3%)

14(22.6%)

Don’t know

47(12.2%)

21(11.4%)

26(13.0%)

8(9.0%)

3(5.5%)

34(19.1%)

2(3.2%)

Which gas is used
for

conscious

sedation

Nitrous oxide

301(78.4%)

141(76.6%)

160(80.0%)

0.354

72(80.9%)

51(92.7%)

139(78.1%)

39(62.9%)

0.000

Carbon dioxide

34(8.9%)

18(9.8%)

16(8.0%)

11(12.4%)

0(0.0%)

11(6.2%)

12(19.4%)

Oxygen

32(8.3%)

19(10.3%)

13(6.5%)

6(6.7%)

2(3.6%)

14(7.9%)

10(16.1%)

Don’t know

17(4.4%)

6(3.3%)

11(5.5%)

0(0.0%)

2(3.6%)

14(7.9%)

1(1.6%)

How long does
conscious sedation
last

2-8 hours

203(52.9%)

99(53.8%)

104(52.0%)

0.094

48(53.9%)

42(76.4%)

84(48.3%)

27(43.5%)

0.000

1-4 hours

106(27.6%)

55(29.9%)

51(25.5%)

30(33.7%)

9(16.4%)

43(24.2%)

24(38.7%)

2-5 hours

37(9.6%)

19(10.3%)

18(9.0%)

6(6.7%)

4(7.3%)

17(9.6%)

10(16.1%)

Don’t know

38(9.9%)

11(6.0%)

27(13.5%)

5(5.6%)

0(0.0%)

32(18.0%)

1(1.6%)

What

the

complications of
conscious sedation

Hypoxia

252(65.6%)

112(60.9%)

140(70.0%)

0.029

60(67.4%)

40(72.7%)

119(66.9%)

33(53.2%)

0.000

Patient retrieval

64(16.7%)

36(9.6%)

28(14.0%)

19(21.3%)

8(14.5%)

17(9.6%)

20(32.3%)

Anxiety

38(9.9%)

22(12.0%)

16(8.0%)

8(9.0%)

6(10.9%)

19(10.7%)

5(8.1%)

Don’t know

30(7.8%)

14(7.6%)

16(8.0%)

2(2.2%)

1(1.8%)

23(12.9%)

4(6.5%)

Is oral sedation
safer than other
modes of sedation

Yes

231(60.2%)

110(59.8%)

121(60.5%)

0.088

59(66.3%)

43(78.2%)

92(51.7%)

37(59.7%)

0.000

79(20.6%)

45(24.5%)

34(17.0%)

14(15.7%)

8(14.5%)

36(20.2%)

21(33.9%)

Don’t know

74(19.3%)

29(15.8%)

45(22.5%)

16(18.0%)

4(7.3%)

50(28.1%)

4(6.5%)

conscious

sedation

safe

during pregnancy

Yes

92(24.0%)

46(25.0%)

46(23.0%)

0.900

30(33.7%)

6(10.9%)

39(21.9%)

17(27.4%)

0.032

249(62.8%)

114(62.0%)

127(63.5%)

51(57.3%)

43(78.2%)

113(63.5%)

34(54.8%)

Don’t know

51(13.3%)

24(13.0%)

27(13.5%)

8(9.0%)

6(10.9%)

26(14.6%)

11(17.7%)

Can you eat or
drink before and
after

conscious

sedation

Yes

173(45.1%)

83(45.1%)

90(45.0%)

0.988

46(51.7%)

30(54.5%)

71(39.9%)

26(41.9%)

0.250

155(40.4%)

74(40.2%)

81(40.5%)

33(37.1%)

21(38.2%)

75(42.1%)

26(41.9%)

Don’t know

56(14.6%)

27(14.7%)

29(14.5%)

10(11.2%)

4(7.3%)

32(18.0%)

10(16.1%)

How many hours
should you not eat
and drink before
conscious sedation

hours

for

fluids

and

hours for solids

184(47.9%)

85(46.2%)

99(49.5%)

0.308

53(59.6%)

24(43.6%)

77(43.3%)

30(48.4%)

0.000

hours

for

fluids

and

hours for solids

106(27.6%)

58(31.5%)

48(24.0%)

21(23.6%)

23(41.8%)

41(23.0%)

21(33.9%)

hours

for

fluids

and

hours for solids

30(7.8%)

15(8.2%)

15(7.5%)

7(7.9%)

3(5.5%)

13(7.3%)

7(11.3%)

Don’t Know

64(16.7%)

26(14.1%)

38(19.0%)

8(9.0%)

5(9.1%)

47(26.4%)

4(6.4%)

Do you aware of
the

crash

cart

equipment

for

conscious sedation

Yes

235(61.2%)

119(64.7%)

116(58.0%)

0.180

53(59.6%)

34(61.8%)

96(53.9%)

52(83.9%)

0.001

149(38.8%)

65(35.3%)

84(42.0%)

36(40.4%)

21(38.2%)

82(46.1%)

10(16.1%)

Table 2 (b) Comparison of Knowledge and Practice of Conscious Sedation among Genders and Qualification

DISCUSSION

Management of pediatric patients during dental

procedures  plays  a  crucial  role  to  establish  ideal
communication,  eliminate  fear  and  anxiety,  build  trust
between the dentist, child, and parent, promote and enhance
child’s  positive  attitude  towards  dental  health  by

successfully  incorporating  behavioral  guidance  thus
providing  quality  oral  health  care.  In  the  present  study  it
was  observed  more  than  half  of  the  study  participants
learned  about  conscious  sedation  (CS)  through  dental
curriculum  (50.8%)  comparable  to  study  by  Thomas  P  et
al

where the majority of the participants were aware of

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

conscious sedation (80.1%) through their curriculum yet
over 69.4% among them also preferred short certified
courses

enhance

their

practice

conscious

sedation

1,3,17,18

It is evident that advanced behavior guidance

techniques  such  as  conscious  sedation,  General  anesthesia
(GA),  and  protective  stabilization  were  commonly  taught
and  practiced  in  postgraduate/masters  pediatric  dental
training programs. A study done by Monisha K et al (90%),
reported that more than half of the pediatric dental surgeons
reported  the  use  of  conscious  sedation  over  GA

comparable  to  the  present  study  where  46.1%  considered
conscious  sedation  over  GA  for  all  dental  procedures  like
restoration,  scaling,  minor  bone  fractures  and  minor
surgeries.  A  higher  prevalence  might  be  attributed  to
observations  done  only  on  dental  professionals  in  the
present  study  whereas  previous  study  involved  parents  as
well  as  other  health  care  professionals  also.    In  contrast,
some  studies  suggest  that  dental  surgeons  working  in
hospitals preferred the utilization of GA

18, 19, 20

In our study, 44.8 % preferred intravenous conscious

sedation over oral sedation which is almost similar to the
study by Tingey et al (49.8%)

but much higher than the

study by Sivakumar N et al (3 %)

. This variation can be

due  to  case  preferences  as  sedation  in  children  is  different
from the sedation methods in adults. Cunha et al stated that
sedation  in  children  is  often  used  to  control  behavior  and
permit  safe  completion  of  the  dental  procedure  and  it
depended on chronological as well as developmental age of
the child

1, 18, 23

In this present study, the participants preferred to treat

patients  in  minimal  or  moderate  conscious  sedation  state.
But  few  studies  suggest  that  moderate  sedation  was
comfortable to diagnose and treat uncooperative or anxious
patients,  decreased  the  pain  and  discomfort  compared  to
minimum sedation and also maximized the effectiveness of
amnesia,  and  controlling  the  anxiety,  movement,  and
behavior of the child during dental procedures

23, 24, 25, 26

We observed that 56.8% of the participants considered

that conscious sedation was contraindicated in children
below 6 months of age and with extreme fear and anxiety.
Likewise, Veeramachaneni et al

states that the Council of

European Dentist and AAPD (American association of
Pediatric dentistry) has recommended that this technique of
behavior control should not be administered in severely
compromised patients and in children less than 1 year

In the present study, more than half of the study

participants 78.4% preferred Nitrous oxide sedation which
is similar to study by Sivakumar N et al (72%)

and Wali

et al (73%)

. These studies have shown that care must be

taken when Nitrous oxide sedation is used in addition to
other sedatives where the chances of attaining deep sedation
in a short span of time are relatively high

In the present study, 39.3% preferred that general

anesthetist should be present during conscious sedation
technique. In a study by Thomas P et al

, it was observed

that  the  dentist  experienced  difficulties  in  managing
sedation  in  the  absence  of  anesthesiologists  resulting  in
anxiety  and  forced  and  hasty  completion  of  the  treatment.
However, in presence of anesthesiologists, dentist failed to
experience  such  nervousness  thus  providing  quality  dental
treatment  while  the  anesthesiologists  took  care  of  the  vital
signs  and  related  complications.  Also,  AAPD  recommends
that Pediatric dentists must be well-qualified and skilled for
incorporating specific training in their practice to integrate a
multidisciplinary  team  approach  which  permits  the
recognition of the need of general anesthesia thus providing
a quality oral health care

9,24,27

In the present study, 40.1% recommended midazolam

as a fast acting drug for conscious sedation which is in
contrast to the study by Sivakumar N et al (76%)

. It can be

observed that higher preference of midazolam might be due
to  its  short  duration  of  action  with  potent  anxiolytic  and
anticonvulsant  property  over  other  drugs  such  as  propofol.
Also, midazolam has lower incidence of complications like
nausea,  vomiting  and  prolonged  discharge  time  when
compared to other drugs given orally and/or nasally

28, 29, 30

About 60.2% opted for oral route as the safer mode of

sedation which is similar to study by Perumal K et al
(58%)

. Most of the study participants believed oral

sedatives were easier to administer, required less expertise
and skill, avoided needle usage and adequate sedation was
achieved with minimal or no complications

RECOMMENDATION

It is recommended that dental curriculum should

include  guidelines  and  advanced  sedation  techniques  to
train  the  dental  students  at  the  undergraduate  level.
Subsequently  dental  practitioners  should  be  encouraged  to
attend workshops, continuing dental education programs on
conscious  sedation  technique  by  experts  in  the  field  to
improve their skills and confidence.

Vinita Mary et al:

Knowledge, Attitude And Practices Of Dental Students And Practitioners

Volume No: 8, Issue No: 3

ISSN No: 2582-0559

CONCLUSION

The present clearly shows lacunae in adequate

knowledge, attitude and practices towards conscious
sedation among dental practitioners. One must be also
aware of patient related factors like perceptions, preferences
and

treatment

needs

nonetheless

managing

uncooperative  or  anxious  child  is  always  challenging  that
requires  skill  and  expertise  with  sufficient  knowledge  and
awareness. The results of this study thus provide an insight
on need for strategies to provide knowledge and incorporate
positive  attitude  among  the  Dental  professionals  to  offer
effective  conscious  sedation  in  children  necessitating  oral
health care.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil

CONFLICTS OF INTEREST

There are no conflicts of interest.

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