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The article by Neuhäuser et al focuses on recommendations for administering analgesia-sedation in painful procedures in children and adolescents. One serious and common item needs to be added to the list of indications (Box 2 in the article): dental treatment in anxious patients—in particular, in uncooperative children.

Most dental and dental-surgical procedures (for example, tooth extractions) can be performed without any problems under local anesthesia. However, this is usually insufficient in patients with exaggerated phobias of dental treatment (dental phobia, oral phobia) or children. Anxiety is usually caused by several coinciding factors—such as particularly traumatic childhood experiences at the dentist’s (“dental trauma”). Further, mere reports of dentist’s visits may trigger phobias (1). The more experienced the dentist and the practice team are in dealing with (young) anxious patients, the better the patient will feel (2). Analgesia-sedation provides an additional, gentle instrument for administering diagnostic measures or necessary dental treatment in a calm and relaxed state (3). However, in some children, or in patients with extreme phobias, a general anesthetic will be required so as not to endanger the treatment result by overly strong phobic reactions or having to interrupt the treatment session. The indication for general anesthesia and how it should be administered will need to be discussed with the parents, the pediatrician or primary care physician, and the anesthesiologist. Whereas analgesia-sedation or general anesthesia should be given in order to enable successful local treatment in dental procedures, causative treatment of chronic phobias additionally requires psychological and psychosomatic approaches.

DOI: 10.3238/arztebl.2010.0784c

Dr. med. dent. Silke Shah

Dr. med. Sanjai M. Shah

Im Kießling 14

64665 Alsbach, Germany

sanjai_shah@web.de

1.
Smith PA, Freeman R: Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care. Int J Paediatr Dent 2010; 20(1): 50–8.
2.
Slovin M, Falagario-Wassermann J: Special needs of anxious and phobic dental patients. Dent Clin North Am. 2009; 53(2): 207–19, viii.
3.
Zebuhr Y: Analgosedierung in der Zahnheilkunde – Bewährte Konzepte und neue Entwicklungen. Bayerisches Zahnärzteblatt 2007; 11: 50–2.
4.
Neuhäuser C, Wagner B, Heckmann M, Wiegand MA, Zimmer KP: Analgesia and sedation for painful interventions in children and adolescents. Dtsch Arztebl Int 2010; 107(14): 241–7.
1.Smith PA, Freeman R: Remembering and repeating childhood dental treatment experiences: parents, their children, and barriers to dental care. Int J Paediatr Dent 2010; 20(1): 50–8.
2.Slovin M, Falagario-Wassermann J: Special needs of anxious and phobic dental patients. Dent Clin North Am. 2009; 53(2): 207–19, viii.
3.Zebuhr Y: Analgosedierung in der Zahnheilkunde – Bewährte Konzepte und neue Entwicklungen. Bayerisches Zahnärzteblatt 2007; 11: 50–2.
4.Neuhäuser C, Wagner B, Heckmann M, Wiegand MA, Zimmer KP: Analgesia and sedation for painful interventions in children and adolescents. Dtsch Arztebl Int 2010; 107(14): 241–7.