Tarja Kaakko

Psychiatric Diagnoses Among Self-Referred Dental Injection Phobics

In order to determine the psychiatric characteristics of people with dental injection phobia. 118 dental injection phobics were systematically assessed using a structured clinical interview and a written questionnaire. Fifty-four percent of subjects had a current Axis I diagnosis other than dental injection phobia, mainly anxiety, mood or adjustment disorder, and 68.6% of subjects had an additional lifetime Axis I diagnosis. Subjects with additional current Axis I diagnoses reported higher dental anxiety, greater severity of injection fear cognitions, and poorer relationships with dental professionals, than did subjects without any or with past Axis I diagnoses. Further investigation is needed to explore the treatment possibilities for patients with and without additional current diagnoses.

A Randomized Clinical Trial of Triazolam in 3- to 5-year-olds

Triazolam has shown promise as a sedative agent for use in pediatric dentistry. However, the efficacy of triazolam has not been previously examined in a placebo-controlled study. The present clinical trial used a two-group, randomized, double-blind study design to compare the efficacy of oral triazolam with that of a placebo. The primary hypothesis tested was that triazolam would reduce negative behaviors of pediatric dental patients compared with a placebo. A secondary hypothesis was that triazolam would increase the efficiency of dental treatment by reducing the need for time-consuming behavior management by the pediatric dentist. The subjects were 54 3- to 5-year-old children, randomly assigned to the drug and placebo groups. The active drug, 0.03 mg/kg triazolam (Halcion®), or lactose placebo was given orally 30 min before dental treatment. Behavior management techniques commonly used in pediatric dentistry were used during dental treatment. A single pediatric dentist provided all of the dental treatment. The procedure included an inferior block anesthesia and careful attention to anesthesia effectiveness. All sessions were video-taped and the tapes coded for child and dentist behaviors by an independent observer. There were no statistically significant differences between the groups with respect to completion of dental treatment. There were no significant differences found in either the total time or the percent of time that the subjects exhibited disruptive movements, verbal or non-verbal distress. The total use of time in the dental chair was slightly higher in the placebo than in the drug group due to more time spent preparing the child. Contrary to preliminary reports in the literature, this investigation found little or no improvement in child behavior when triazolam was used as a sedative compared with a placebo. However, triazolam did shorten the length of dental treatment, primarily by reducing dentist time in preparing the child for the dental procedure (e.g., establishing rapport and shaping behavior).

Pharmacokinetics and clinical effects of sublingual triazolam in pediatric dental patients.

The purpose of this investigation was to describe the pharmacokinetics of sublingual triazolam in children. Nine healthy children (64–98 months old) received 0.25 or 0.375 mg of sublingual triazolam before dental treatment. Plasma triazolam concentrations were measured by gas chromatography/ mass spectrometry and analyzed by noncompartmental methods. The peak concentration was 4.9 ± 2.0 ng/mL (mean ± SD), time to peak was 75 ± 32 minutes, the elimination half-life was 91 ± 32 minutes, and apparent clearance was 17.6 ± 8.8 mL · kg −1 · min −1 . Children were tested for gait ataxia, amnesia, and diplopia during a screening session and again after triazolam. Ninety minutes after drug administration, seven of nine children demonstrated ataxia, and three of nine demonstrated amnesia. Peak triazolam concentrations were similar in children with or without ataxia, but they were significantly higher in children with amnesia compared with those without amnesia. Six children demonstrated diplopia 30 and 120 minutes after triazolam; however, peak triazolam concentrations were similar in both groups. Sublingual administration was an acceptable alternative route of triazolam delivery in children.

Temporal information reduces children's pain reports during a multiple-trial cold pressor procedure*

An experiment was conducted to determine whether providing children with information about the time remaining in each of 9 cold pressor trials would modify their pain reports. The study design included an experimental group and 2 control groups. The experimental group was given visual information about time remaining in each cold pressor trial using cartoon images presented on a computer screen. Control groups viewed either no images or randomly presented images. Temporal information reduced childrens self-reported pain during short (10 to 15 s) duration cold pressor trials, but did not increase the number of trials completed. This study suggests that providing time-remaining information during brief clinical procedures may decrease childrens discomfort.