Clinical Significance
Hands OnManaging major neurocognitive disorder
Section snippets
Background
Older patients with major neurocognitive disorders, previously called dementia, can have difficulty accepting dental treatment. Midazolam is a benzodiazepam that is used as premedication in pediatric patients, for oral surgery, and in persons suffering from dental fear. Its usefulness in other groups, such as those with major neurocognitive disorders, is relatively unknown. A population of older dental patients was evaluated for acceptance of treatment after midazolam administration.
Methods
The dental and sedation records of 61 patients sedated with midazolam were examined retrospectively. All had major neurocognitive disorder and had been referred to a special dental care unit in Sweden because of uncooperative behavior. The midazolam was administered as follows: for those less than age 65 years, 0.2 mg/kg body weight; for those age 65 years or older, 0.1 to 0.15 mg/kg body weight. The data collected included dose of midazolam, degree of acceptance of dental treatment (using a
Results
The 39 women's average age was 82 years, and the 22 men had an average age of 75 years. The group overall ranged in age from 62 to 93 years, with an average age of 80 years.
Twenty-seven of the patients exhibited no sedation problems with midazolam, with 26 having just minor adaptations. Dental treatment could not be accomplished in 3 patients.
Average midazolam dose was 0.11 mg/kg of body weight. Five patients received a lower dose, and 6 received a higher dose. Among the low-dose participants,
Conclusions
Midazolam offers the advantages of having a short half-life, which reduces the risk of falls and accidents either at home or during transport to and from the clinic. The agent generally allows at least a brief examination to be done, which helps the dentist to plan any additional treatment. Sedation with midazolam in patients with major neurocognitive disorder helped to improve their treatment acceptance, which has the potential for improving their long-term dental health.
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Rignell L, Mikati M, Wertsén M, et al: Sedation with orally administered midazolam in elderly dental patients with major neurocognitive disorder. Gerodontology 34:299-305, 2017
Reprints available from L Rignell, Clinic of Pedodontics and Special Dental Care, SU/Mölndal, Mölndal, Sweden; e-mail: [email protected]