Aim. To evaluate the effectiveness and the tolerability of the nitrous oxide sedation for dental treatment on a large pediatric sample constituting precooperative, fearful, and disabled patients.Methods. 472 noncooperating patients (aged 4 to 17) were treated under conscious sedation. The following data were calculated: average age; gender distribution; success/failure; adverse effects; number of treatments; kind of dental procedure undertaken; number of dental procedures for each working session; number of working sessions for each patient; differences between males and females and between healthy and disabled patients in relation to success; success in relation to age; and level of cooperation using Venham score.Results. 688 conscious sedations were carried out. The success was 86.3%. Adverse effects occurred in 2.5%. 1317 dental procedures were performed. In relation to the success, there was a statistically significant difference between healthy and disabled patients. Sex and age were not significant factors for the success. Venham score was higher at the first contact with the dentist than during the treatment.Conclusions. Inhalation conscious sedation represented an effective and safe method to obtain cooperation, even in very young patients, and it could reduce the number of pediatric patients referred to hospitals for general anesthesia.

(1) Background: the variety of autism spectrum disorder makes the definition of guidelines for dental care a challenging task. The aim of this review was to evaluate the literature concerning the use of conscious sedation for dental treatments in pediatric autistic patients. (2) Methods: we searched MEDLINE/PubMed, EMBASE, Cochrane databases in order to identify pertinent studies. The search strategy was based on these areas of interest: autistic spectrum disorder, pediatric patients, dentistry, tranquilizing agents, and conscious sedation. (3) Results: the search yielded 177 non-duplicated articles, of which 24 articles were retrieved for full text review, and 2 were found to address our review aim. The first paper was a retrospective study that included 83 autistic patients sedated either with an oral premedication combined with nitrous oxide/oxygen inhalation or with nitrous oxide/oxygen inhalation alone; the second article was a prospective trial on the effectiveness of 0.3 mg/kg of oral diazepam with 0.5 mg/kg of oral midazolam in 13 sedated uncooperative autistic patients. (4) Conclusions: this review highlights the insufficiency of studies that can provide concrete indications for the dental treatment in conscious sedation of pediatric patients with autism. New studies are needed to better define the appropriate drugs, dosages, sedation level and evaluate patient cooperation.

Sedation with nitrous oxide (N₂O) has been widely used as a viable alternative to general anesthesia to perform dental treatments in uncooperative or anxious children. The purpose of this retrospective study is to assess if repeated sedations with N₂O can improve collaboration of uncooperative children. The medical records of 650 children, aged between 3 and 14 years, who underwent at least two sedations, were consulted. Differences in the Venham score during the first sedation and subsequent sedations were collected. After removal incomplete records, 577 children’s records (309 males and 268 females) were analyzed. The Venham score decreased both during each sedation and with repeated sedations (p < 0.01 for both comparisons). In particular, a significant reduction of the Venham score was observed at the first contact with the dentist, with a mean score ranging from 1.56 ± 1.46 to 1.16 ± 1.37, comparing the first and the second sedation, and from 1.65 ± 1.43 to 1.06 ± 1.30, comparing the first with the third sedation (p < 0.01). The reduction in the Venham score was recorded in both healthy and physically impaired patients, and it was significantly greater in older children than in younger children (p < 0.01). In conclusion, uncooperative children with or without physical impairments can be successfully treated with N₂O sedation in order to increase their confidence in dental procedures.

Background/Objectives: Dental anxiety represents a major challenge in paediatric dentistry and is a frequent cause of non-cooperative behaviour during dental treatment. Nitrous oxide/oxygen inhalation conscious sedation is widely used to reduce anxiety in children, while audiovisual distraction is a non-pharmacological behavioural technique aimed at diverting attention from stressful stimuli. Evidence regarding the combined effect of these two approaches during dental treatment is still limited. Methods: This randomized crossover clinical trial included 25 paediatric patients aged 4–7 years with dental anxiety and previous failed attempts at conventional dental treatment. Each child underwent two dental treatment sessions under nitrous oxide/oxygen conscious sedation, one with and one without audiovisual distraction. Anxiety and behaviour were assessed using the Modified Venham Scale and the Facial Image Scale (FIS). Vital parameters were recorded before, during, and after sedation. Results: A significant reduction in heart rate over time was observed in both groups (p < 0.05). In children aged 4–5 years, the combined audiovisual distraction and conscious sedation approach was associated with significantly lower heart rate values compared to conscious sedation alone (p < 0.05). No significant differences were found between the two approaches for behavioural scores assessed by the Venham and FIS scales. Conclusions: Although behavioural scores did not differ significantly, audiovisual distraction contributed to greater physiological stability, particularly in terms of heart rate control. This no-pharmacological approach may complement the pharmacological effects of nitrous oxide sedation by enhancing the overall sense of relaxation and comfort during dental care.