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Child BehaviorPhase 4NCT04119180

Sedation Versus Protective Stabilization for Pediatric Dental Treatment

A Phase 4 study testing Ketamine 50 MG/ML, Midazolam Hcl 2Mg/Ml Syrup and Protective stabilization in people with Child Behavior and Dental Caries in Children, run by Universidade Federal de Goias at 2 sites in Brazil.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

There is a lack of evidence on the effectiveness of moderate sedation in pediatric dentistry, compared to protective stabilization, which remains routinely used in the Brazilian context despite moral questions. Read more about this study

Who is it for?
Ages 1 year to 7 yearsHealthy volunteers can take part
Conditions the study is for
Child Behavior, Dental Caries in Children
What is being tested?
Ketamine 50 MG/ML, Midazolam Hcl 2Mg/Ml Syrup and Protective stabilization
Could I receive a placebo?
No, everyone receives an active treatment
How many people
152 participants
Where
2 sitesBrazil
Study dates
30 Jan 2020to 28 Feb 2026
Phase
Phase 4
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 1 year to 7 years
  • All sexes
  • Healthy volunteers accepted
  • Child

Who may be able to join

  • Children presenting cavities that need dental restoration
  • ASA I (healthy) or II (mild and controlled systemic disease - persistent asthma, for example) children (ASA, 2015)
  • Medical history without neurological or cognitive impairment
  • Children who do not use medicines that may impair cognitive functions
  • Children at low risk for airway obstruction (Mallampati less than 2 and / or tonsil hypertrophy occupying less than 50% of the oropharynx) (Mallampati et al., 1985)

Who cannot join

  • Children with positive or definitely positive behavior (Frankl et al. 1962) in the dental examination session
  • Non-attendance at the first intervention appointment after three scheduling attempts
  • Chronic use of systemic corticosteroids

Trial locations and contacts

2 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Patricia C Faria, PhD contact

6232096325

patriciacorreafaria@ufg.br

Luciane R Costa, PhD contact

+556232096325

lsucasas@ufg.br

Brazil2 sites, 1 recruiting
  • Dental School - UFG

    Goiânia, Goiás, 74605220

    Active, not recruiting
  • Dental School - FOUSP

    São Paulo, São Paulo, 05508-000

    Daniela P Raggio, PhD, +55 (11) 30917812, danielar@usp.br

    Daniela P Raggio, PhD

    Recruiting

Other trials in Brazil

About this study

Official title: Sedation Versus Protective Stabilization for Dental Treatment of Children With Caries and Negative Behavior at the Dentist: a Non-randomized Clinical Trial

There is a lack of evidence on the effectiveness of moderate sedation in pediatric dentistry, compared to protective stabilization, which remains routinely used in the Brazilian context despite moral questions. The objective of this prospective nonrandomized clinical trial is to evaluate the effectiveness of the use of moderate sedation, compared to the protective stabilization, in the dental care of children with fear / anxiety and / or dental behavior problem, and associated factors. The study will be carried out in outpatient clinics of the Dental Schools of the Federal University of Goiás (UFG) and University of São Paulo (USP), with the support of professors from King's College London through the partnership CEDACORE - Children Experiencing Dental Anxiety: Collaboration on Research and Education. Participants will be 152 children under 7 years of age with dental caries, who need specialized dental treatment due to a history of non-cooperation with dental care. The interventions to be compared are moderate sedation with oral administration of ketamine and midazolam (UFG) and protective stabilization (USP). The primary endpoint 'behavior / anxiety of the child during treatment will be assessed using the Ohio State University Behavioral Rating Scale. The secondary outcomes are: dental behavioral and anxiety evolution of the child, child' pain during procedure, impact on the quality of life related to oral health, parents and dentists' satisfaction and stress, adverse events for sedated participants, longevity of composite and glass ionomer cement restorations, chronotype and physiological stress of these children. A cost-efficacy analysis will be produced at the end of the study from the perspective of the Sistema Único de Saúde. Additionally, at the end of 36 months, the investigators expect to contribute to the identification of psychosocial aspects related to dental behavior problems in children in early childhood. It is important to highlight the perspective of technological innovation, with the creation of a digital platform that will allow the registration of data related to the dental care of children worldwide and favor analyzes in the methodology of data science.

Being tested
Ketamine 50 MG/ML, Midazolam Hcl 2Mg/Ml Syrup, Protective stabilization
Keywords
Dental Anxiety, Dental Caries, Conscious Sedation, Physical Restraint, Cost-Efficacy Analysis
Medical subject headings
Child Behavior, Dental Caries

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ketamine 50 MG/MLDrug

    Also called Ketamin S, Cristalia, São Paulo, Brazil

    Ketamine injectable solution in a concentration of 50.0 mg/mL via oral route; dose of 4.0 mg/kg maximum 100.0 mg

  • Midazolam Hcl 2Mg/Ml SyrupDrug

    Also called Dormire oral solution, Cristalia, Sao Paulo, Brazil

    Midazolam oral solution in a concentration of 2.0 mg/mL via oral route; dose of 0.5 mg/kg, maximum 5.0 mg when associated with ketamine;

  • Protective stabilizationProcedure or surgery

    The legal guardian or accompanying person appointed by the legal guardian should sit in the dental chair with the child and contain leg and arm movements. A dental assistant keeps the child's head contained during care.

Study groups in NCT04119180
Study groupRoleWhat they receive
SedationExperimentalThe child receives sedatives approved for use in an outpatient setting, directed by a doctor, to accomplish the dental treatment.
Receives: Drug: Ketamine 50 MG/ML; Drug: Midazolam Hcl 2Mg/Ml Syrup
ControlOtherThe child does not receive sedatives. As s/he exhibits negative behavior for the dental procedure, s/he will be restrained by a family member and dental team.
Receives: Procedure: Protective stabilization

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Child behavior during the dental treatment

    Children's behavior assessed by OSUBRS (Ohio State University Behavioral Rating Scale) in digital videos recorded during the administration. Scores: 1 - quiet, 2 - cry with movement, 3 - movement without cry; 4 - struggling. The higher the percentage of time of care in which the child behaves quietly, the better their behavior. Measurements for each group will be synthesized as mean (or median) and standard deviation (or interquartile range).

    Measured: Participants will be followed for the duration of the dental session, an expected average of 40 minutes

Secondary outcomes (15)
  1. Progression of child behavior throughout the follow-up

    A 10-centimeter Visual Analogue Scale (VAS) is used by one of the trained/calibrated dentists to measure the child behavior during the dental session (Hosey and Blinkhorn, 2005). The VAS anchors are "negative behavior" (left) and "positive behavior" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to the perceived level of behavior; this is then measured using a ruler to give a score to the nearest millimeter which can vary from 0 to 100). The higher the VAS score, the better the child's behavior assessed by the dentist

    Measured: Baseline (dental examination) plus follow-up sessions at 4, 8, and 12 months post-treatment

  2. Progression of child dental anxiety throughout the follow-up

    Facial Image Scale (Buchanan and Niven, 2002), a row of five faces ranging from "very happy" to "very sad," and numbered from 1 (very happy, most positive response) to 5 (very sad, the most negative).

    Measured: Baseline (dental examination) plus follow-up sessions at 4, 8, and 12 months post-treatment

  3. Impact on oral health-related quality of life and changes after treatment

    The B-ECOHIS is a measure of oral health-related quality of life (OHRQoL) validated in Brazil by Scarpelli et al. (2008) to assess the impact of oral health problems and related treatment on the quality of life of children aged zero to five years and their families. "The ECOHIS consists of 13 questions divided into two main parts: child impact section (part one) and family impact section (part two). The child impact section comprises of four subscales: child symptom, child function, child psychology and child self-image/social interaction. The family impact section contains two subscales: parental distress and family function. The questionnaire is scored using a simple five-point Likert scale with responses ranging from "never" to "very often" (equivalent to a score of 0 and 4, respectively). A total score ranging from zero to 52 is calculated as a simple sum of the responses with higher scores denoting a greater oral health impact and/or poorer OHRQoL." (Martins-Junior et a. 2012).

    Measured: Baseline (dental examination) plus follow-up sessions at 4, 8, and 12 months post-treatment

  4. Parental satisfaction with the intervention

    A 10-centimeter Visual Analogue Scale (VAS) is used by the accompanying adult to measure her/his satisfaction with the child's dental session. The VAS anchors are "no satisfaction" (left) and "extreme satisfaction" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to their level of satisfaction; this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the respondent satisfaction

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  5. Parental stress (anxiety) with the intervention

    A 10-centimeter Visual Analogue Scale (VAS) is used by the accompanying adult to measure her/his perceived stress (anxiety) with the child's dental session. The VAS anchors are "relaxed" (left) and "too nervous" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to their level of stress (anxiety); this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the respondent stress

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  6. Dentist's satisfaction with the intervention

    A 10-centimeter Visual Analogue Scale (VAS) is used by the dentist in charge to measure her/his satisfaction with the child's dental session. The VAS anchors are "no satisfaction" (left) and "extreme satisfaction" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to their level of satisfaction; this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the respondent satisfaction

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  7. Dentist's stress (anxiety) with the intervention

    A 10-centimeter Visual Analogue Scale (VAS) is used by the dentist in charge to measure her/his perceived stress (anxiety) with the child's dental session. The VAS anchors are "relaxed" (left) and "too nervous" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to their level of stress (anxiety); this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the respondent stress

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  8. Child pain reported by the parent

    A 10-centimeter Visual Analogue Scale (VAS) is used by the accompanying child to measure her/his perceived pain in the child undergoing dental treatment. The VAS anchors are "no pain" (left) and "too much pain" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to the perceived level of child's pain; this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the child's pain according to the parent

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  9. Child pain reported by the dentist

    A 10-centimeter Visual Analogue Scale (VAS) is used by the dentist in charge to measure her/his perceived pain in the child undergoing dental treatment. The VAS anchors are "no pain" (left) and "too much pain" (right). At the end of the session, raters mark a point on the 10 cm line to correspond to the perceived level of child's pain; this is then measured using a ruler to give a score to the nearest millimeter, which can vary from 0 to 100. The higher the VAS score, the greater the child's pain according to the dentist

    Measured: At the end of each session from dental examination through the end of the dental treatment, an average of 2 months

  10. Child pain/distress during the dental restoration session

    FLACC Pain Assessment Tool (Faces, Legs, Activity, Cry and Consolability) scored by trained and calibrated observers after watching the videos of the dental treatment. The FLACC is a measurement used to assess pain for children between the ages of 2 months and 7 years. The scale is scored in a range of 0-10 with 0 representing no pain and 10, too much pain. The scale has five criteria, which are each assigned a score of 0, 1 or 2: face, legs, activity, cry and consolability (Merkel et al., 1997).

    Measured: Duration of the dental session, an expected average of 40 minutes

  11. Adverse events during the dental procedure

    Occurrence of adverse events assessed by the Tracking and Reporting Outcomes of Procedural Sedation (TROOPS) (Roback et al. 2018) in the Moderate Sedation Group, or occurrence of bruises or inconsolability in the protective stabilization group

    Measured: Participants will be followed for the duration of the dental session, an expected average of 40 minutes. Sedated patients will also be followed in the recovery room, an expected average of 60 minutes

  12. Number of teeth restored

    Restored teeth count at the end of each session

    Measured: End of each session of dental treatment, an average of 2 months

  13. Longevity of composite resin and glass ionomer cement restorations

    Trained and calibrated observers will follow the criteria for assessing occlusal (Frencken and Holmgren 2001) or occlusal-proximal (Roeleveld et al. 2006) restorations to categorize each restoration as successful or failed

    Measured: At a time point of 5 minutes (average) after the end of the dental procedure, and in the follow-up sessions (4, 8 and 12 months)

  14. Children's stress according to salivary cortisol

    Occurrence of stress during dental procedure, assessed by salivary cortisol in children; the ELISA test will determine changes in cortisol level during dental treatment

    Measured: Change from baseline in the salivary cortisol at an expected average of 40 minutes

  15. Cost analysis

    Cost-efficacy of different sedation protocols according to the methodology of health technologies assessment; the cost of each intervention will be compared

    Measured: An expected average of 15 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Oct 2019
  2. Study start30 Jan 2020
  3. Primary completion28 Feb 2025 (estimated)
  4. Study completion28 Feb 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
152 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04119180
Sponsor's protocol ID
PI03925-2019
Other IDs
424339/2018-8
Status last verified
Dec 2024
First submitted
1 Oct 2019
Last updated
10 Dec 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: All IPD that underlie results in a publication

Publications

  • da Silva GS, Anabuki AA, Viana KA, Correa-Faria P, Moterane MM, Tedesco TK, Costa PS, Hosey MT, Raggio DP, Costa LR; CEDACORE Collaborative Group. Sedation versus protective stabilization for dental treatment of children with caries and challenging behavior at the dentist (CHOOSE): a study protocol for a non-randomized clinical trial. BMC Oral Health. 2021 May 12;21(1):256. doi: 10.1186/s12903-021-01594-0.

    PubMed 33980232

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Ketamine 50 MG/ML, Midazolam Hcl 2Mg/Ml Syrup and Protective stabilization in people with Child Behavior and Dental Caries in Children, run by Universidade Federal de Goias at 2 sites in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 10 Dec 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Patricia C Faria, PhD (6232096325, patriciacorreafaria@ufg.br), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Child behavior during the dental treatment (time frame: Participants will be followed for the duration of the dental session, an expected average of 40 minutes). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04119180, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Dec 2024.

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