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Intranasal Dexmedetomidine for Severe Dental Anxiety: a Randomized Trial

Primary Purpose

Dental Anxiety

Status
Not yet recruiting
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Dexmedetomidine
Sponsored by
Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Dental Anxiety focused on measuring Dexmedetomidine, Intranasal, Randomized controlled trial

Eligibility Criteria

18 Years - 65 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Fully understand the purpose and significance of this trial, voluntarily participate in this clinical trial, and voluntarily sign an informed consent form;
  2. Age 18 to 65 years old, regardless of gender;
  3. Diagnosed by a dentist and needs dental treatment;
  4. Can be immediately arranged for dental treatment after being evaluated by the clinician as having no contraindications;
  5. Graded as severe dental anxious (obtained using the MDAS modified dental anxiety scale);
  6. After controlling the symptoms of infection if with symptoms of acute/systemic infection, and can be arranged immediately after meeting the indications for dental treatments;
  7. BMI is 18.5 kg/m2~25 kg/m2;
  8. After resting for 30 min, the SBP < 180 mmHg, the DBP < 110 mmHg, and the 60≤HR ≤ 120 bpm;
  9. For women who have not been menopausal or who have been under 1 year of menopause, a pregnancy test (blood or urine pregnancy test) should be performed during the screening period, and then the study and administration should be carried out after the pregnancy test is negative during the screening period.

Exclusion Criteria:

  1. Subjects who are not considered by the researcher to be suitable for nasal drops (such as severe rhinitis, nasal malformations, etc.);
  2. Subjects with a history of severe arrhythmias such as type II or above AV block or a history of cardiac insufficiency;
  3. Subjects with a history of myocardial infarction or unstable angina in the 6 months before the screening period;
  4. Subjects with a history of ischemic stroke or transient ischemic attack (TIA);
  5. Subjects with poor blood pressure control after drug therapy (hypertension: SBP≥180 mmHg, and/or DBP≥110 mmHg, or hypotension: SBP <90 mmHg and/or DBP≤50 mmHg);
  6. Subjects with psychiatric disorders (such as schizophrenia, anxiety, depression, etc.) and cognitive dysfunction, or have a history of epilepsy, or previous abuse of psychotropic drugs and narcotic drugs;
  7. Subjects with a history of difficult airway disease or possibility, such as obstructive sleep apnea syndrome;
  8. Randomly, within 1 year of random, a history of drug abuse, a history of drug abuse and a history of alcohol abuse, i.e., a subject who drank more than 2 units of alcohol per day on average (1 unit = 360 ml of beer or 45 ml of liquor or 150 ml of wine with an alcohol content of 40%);
  9. Subjects who received selective alpha2-adrenoceptor agonists or antagonists within 14 days of randomization;
  10. Those who are allergic to dexmedetomidine hydrochloride or items used in stomatology;
  11. Pregnant or nursing women;
  12. Those who have a birth plan within 30 days before the screening period and half a year after the end of the trial, and are unwilling or unable to take effective contraception measures;
  13. Other circumstances in which the investigator determines that the subject is not suitable to participate in this study.

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm 3

    Arm Type

    Experimental

    Experimental

    Experimental

    Arm Label

    0.8 μg/kg intranasal dexmedetomidine

    1.5 μg/kg intranasal dexmedetomidine

    2.0 μg/kg intranasal dexmedetomidine

    Arm Description

    Intranasal administration of 0.8 μg/kg dexmedetomidine

    Intranasal administration of 1.5 μg/kg dexmedetomidine

    Intranasal administration of 2.0 μg/kg dexmedetomidine

    Outcomes

    Primary Outcome Measures

    Change of MDAS score
    Dental anxious score will be accessed by modified dental anxiety scale (MDAS), and the change of MDAS score will be calculated as the scores right after dental treatments minus the initial score before intervention.

    Secondary Outcome Measures

    Change of plasma cortisol concentration
    The change of plasma cortisol concentration will be calculated as the values right after dental treatments minus the initial values before intervention.
    Change of NTI score
    The depth of sedation will be accessed by NTI score using Narcotrend, and the change of NTI score will be calculated as the score right after dental treatments minus the initial score before intervention.
    Change of OAA/S score
    OAA/S score will be accessed by observer's assessment of alertness/sedation scale (OAA/S), which also represent the depth of sedation, and the change of OAA/S score will be calculated as the score right after dental treatments minus the initial score before intervention.
    Change of blood pressure (BP)
    BP will be continuously accessed using an electrocardiogram monitor throughout the whole clinical process. BP value will be converted into mean arterial pressure (MAP) for comparison using the formula: MAP = (SBP + 2 × DBP)/3. Then the change of BP was presented as ΔMAP, which was calculated as the MAP at the point with the highest SBP minus the initial MAP right before the procedure.
    Change of heart rate (HR)
    HR will be continuously accessed using an electrocardiogram monitor throughout the whole clinical process. Change of HR equaled the corresponding HR of the highest SBP subtracted by the initial HR.
    Pain score
    Pain score will be obtained via visual analogue scale (MDAS) for the subject to fill.
    Percentage of thinking feasible of intranasal dexmedetomidine by participants
    The feasibility of intranasal dexmedetomidine will be assessed through semistructured questionnaires. Items includes the reasons for nonparticipation; the acceptability of the trial and intranasal dexmedetomidine to participants; and the experience of the patients, the clinician performing the procedure, and the nursing staff taking care for patients during the study. The patients and clinic staffs filled the questionnaires right after the extraction process under our instruction. The outcome of the questionnaires was analyzed through counting and reported as a percentage (%).

    Full Information

    First Posted
    August 2, 2022
    Last Updated
    November 1, 2022
    Sponsor
    Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
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    1. Study Identification

    Unique Protocol Identification Number
    NCT05500261
    Brief Title
    Intranasal Dexmedetomidine for Severe Dental Anxiety: a Randomized Trial
    Official Title
    The Anxiolytic Effect of Intranasal Dexmedetomidine for Severely Anxious Patients in Dental Treatments
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    July 2022
    Overall Recruitment Status
    Not yet recruiting
    Study Start Date
    November 1, 2022 (Anticipated)
    Primary Completion Date
    July 23, 2023 (Anticipated)
    Study Completion Date
    July 23, 2023 (Anticipated)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Sponsor
    Name of the Sponsor
    Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University

    4. Oversight

    Studies a U.S. FDA-regulated Drug Product
    No
    Studies a U.S. FDA-regulated Device Product
    No
    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    Patients with dental anxiety only develop anxiety and fear about dental treatments. Patients with severe dental anxiety have difficulty cooperating with dental treatments, and can only complete dental treatments through general anesthesia, or even abandon treatments. Dexmedetomidine is a potent, highly selective α2-adrenoceptor agonist, which provides good anxiolytic, sedative and analgesic effects and is commonly used in anesthesiology and intensive care medicine departments, routinely intravenously. In recent years, intranasal administration of dexmedetomidine has also been reported for pediatric dentistry and adult alveolar surgery, showing good sedative and analgesic effects. However, these studies have problems such as single surgical types, small sample size, and few indicators analyzed. Therefore, the evaluation of intranasal administration of dexmedetomidine is still not comprehensive enough. Besides, the anxiolytic effect of dexmedetomidine for dental anxiety has not been reported yet. This project plans to carry out a randomized, double-blinded, placebo-controlled, two-stage clinical trial. We will firstly explore a reasonable dose, and secondly verify it with placebo as the control. We plan to measure the object indicators, including the NTI value, plasma cortisol, interleukin-6, blood pressure and heart rate, and to assess the subjective indicators using scales and questionnaires, thus comprehensively evaluating the effectiveness, safety and feasibility of the anxiolytic effect of intranasal dexmedetomidine for severe dental anxious patients, and preliminary exploring its mechanism additionally. We intend to help severe dental anxious patients completing dental treatments.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Dental Anxiety
    Keywords
    Dexmedetomidine, Intranasal, Randomized controlled trial

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Parallel Assignment
    Masking
    ParticipantCare ProviderInvestigatorOutcomes Assessor
    Allocation
    Randomized
    Enrollment
    30 (Anticipated)

    8. Arms, Groups, and Interventions

    Arm Title
    0.8 μg/kg intranasal dexmedetomidine
    Arm Type
    Experimental
    Arm Description
    Intranasal administration of 0.8 μg/kg dexmedetomidine
    Arm Title
    1.5 μg/kg intranasal dexmedetomidine
    Arm Type
    Experimental
    Arm Description
    Intranasal administration of 1.5 μg/kg dexmedetomidine
    Arm Title
    2.0 μg/kg intranasal dexmedetomidine
    Arm Type
    Experimental
    Arm Description
    Intranasal administration of 2.0 μg/kg dexmedetomidine
    Intervention Type
    Drug
    Intervention Name(s)
    Dexmedetomidine
    Other Intervention Name(s)
    intranasal, randomized controlled trial, dental anxiety
    Intervention Description
    intranasal administration of dexmedetomidine
    Primary Outcome Measure Information:
    Title
    Change of MDAS score
    Description
    Dental anxious score will be accessed by modified dental anxiety scale (MDAS), and the change of MDAS score will be calculated as the scores right after dental treatments minus the initial score before intervention.
    Time Frame
    Change from baseline MDAS score right after finishing dental treatments, an average of 30 minutes
    Secondary Outcome Measure Information:
    Title
    Change of plasma cortisol concentration
    Description
    The change of plasma cortisol concentration will be calculated as the values right after dental treatments minus the initial values before intervention.
    Time Frame
    Change from baseline plasma cortisol concentration right after finishing dental treatments, an average of 30 minutes
    Title
    Change of NTI score
    Description
    The depth of sedation will be accessed by NTI score using Narcotrend, and the change of NTI score will be calculated as the score right after dental treatments minus the initial score before intervention.
    Time Frame
    Change from baseline NTI score right after finishing dental treatments, an average of 30 minutes
    Title
    Change of OAA/S score
    Description
    OAA/S score will be accessed by observer's assessment of alertness/sedation scale (OAA/S), which also represent the depth of sedation, and the change of OAA/S score will be calculated as the score right after dental treatments minus the initial score before intervention.
    Time Frame
    Change from baseline OAA/S score right after finishing dental treatments, an average of 30 minutes
    Title
    Change of blood pressure (BP)
    Description
    BP will be continuously accessed using an electrocardiogram monitor throughout the whole clinical process. BP value will be converted into mean arterial pressure (MAP) for comparison using the formula: MAP = (SBP + 2 × DBP)/3. Then the change of BP was presented as ΔMAP, which was calculated as the MAP at the point with the highest SBP minus the initial MAP right before the procedure.
    Time Frame
    Change from baseline BP right after finishing dental treatments, an average of 30 minutes.
    Title
    Change of heart rate (HR)
    Description
    HR will be continuously accessed using an electrocardiogram monitor throughout the whole clinical process. Change of HR equaled the corresponding HR of the highest SBP subtracted by the initial HR.
    Time Frame
    Change from baseline HR right after finishing dental treatments, an average of 30 minutes.
    Title
    Pain score
    Description
    Pain score will be obtained via visual analogue scale (MDAS) for the subject to fill.
    Time Frame
    Through the completion of dental treatments, an average of 30 minutes.
    Title
    Percentage of thinking feasible of intranasal dexmedetomidine by participants
    Description
    The feasibility of intranasal dexmedetomidine will be assessed through semistructured questionnaires. Items includes the reasons for nonparticipation; the acceptability of the trial and intranasal dexmedetomidine to participants; and the experience of the patients, the clinician performing the procedure, and the nursing staff taking care for patients during the study. The patients and clinic staffs filled the questionnaires right after the extraction process under our instruction. The outcome of the questionnaires was analyzed through counting and reported as a percentage (%).
    Time Frame
    Through the completion of dental treatments, an average of 30 minutes.

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    18 Years
    Maximum Age & Unit of Time
    65 Years
    Accepts Healthy Volunteers
    Accepts Healthy Volunteers
    Eligibility Criteria
    Inclusion Criteria: Fully understand the purpose and significance of this trial, voluntarily participate in this clinical trial, and voluntarily sign an informed consent form; Age 18 to 65 years old, regardless of gender; Diagnosed by a dentist and needs dental treatment; Can be immediately arranged for dental treatment after being evaluated by the clinician as having no contraindications; Graded as severe dental anxious (obtained using the MDAS modified dental anxiety scale); After controlling the symptoms of infection if with symptoms of acute/systemic infection, and can be arranged immediately after meeting the indications for dental treatments; BMI is 18.5 kg/m2~25 kg/m2; After resting for 30 min, the SBP < 180 mmHg, the DBP < 110 mmHg, and the 60≤HR ≤ 120 bpm; For women who have not been menopausal or who have been under 1 year of menopause, a pregnancy test (blood or urine pregnancy test) should be performed during the screening period, and then the study and administration should be carried out after the pregnancy test is negative during the screening period. Exclusion Criteria: Subjects who are not considered by the researcher to be suitable for nasal drops (such as severe rhinitis, nasal malformations, etc.); Subjects with a history of severe arrhythmias such as type II or above AV block or a history of cardiac insufficiency; Subjects with a history of myocardial infarction or unstable angina in the 6 months before the screening period; Subjects with a history of ischemic stroke or transient ischemic attack (TIA); Subjects with poor blood pressure control after drug therapy (hypertension: SBP≥180 mmHg, and/or DBP≥110 mmHg, or hypotension: SBP <90 mmHg and/or DBP≤50 mmHg); Subjects with psychiatric disorders (such as schizophrenia, anxiety, depression, etc.) and cognitive dysfunction, or have a history of epilepsy, or previous abuse of psychotropic drugs and narcotic drugs; Subjects with a history of difficult airway disease or possibility, such as obstructive sleep apnea syndrome; Randomly, within 1 year of random, a history of drug abuse, a history of drug abuse and a history of alcohol abuse, i.e., a subject who drank more than 2 units of alcohol per day on average (1 unit = 360 ml of beer or 45 ml of liquor or 150 ml of wine with an alcohol content of 40%); Subjects who received selective alpha2-adrenoceptor agonists or antagonists within 14 days of randomization; Those who are allergic to dexmedetomidine hydrochloride or items used in stomatology; Pregnant or nursing women; Those who have a birth plan within 30 days before the screening period and half a year after the end of the trial, and are unwilling or unable to take effective contraception measures; Other circumstances in which the investigator determines that the subject is not suitable to participate in this study.
    Central Contact Person:
    First Name & Middle Initial & Last Name or Official Title & Degree
    Zeman Qin, Master
    Phone
    15018419746
    Email
    qinzm@mail.sysu.edu.cn
    First Name & Middle Initial & Last Name or Official Title & Degree
    Liushan Ou, Master
    Phone
    020-81332587
    Email
    sysyxllwyh@163.com
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    Zeman Qin, Master
    Organizational Affiliation
    Department of General Dentistry, Sun Yat-sen Memorial Hospital, Sun Yat-sen University
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Plan to Share IPD
    Yes
    IPD Sharing Plan Description
    All of the data will be shared after publication of the paper of this trial
    IPD Sharing Time Frame
    The data will become available after the publication of the paper about this trial
    IPD Sharing Access Criteria
    IPD will be accessed by the Data and Safety Monitoring Committee and all researchers in related fields
    IPD Sharing URL
    http://www.medresman.org.cn
    Citations:
    PubMed Identifier
    31206433
    Citation
    Uusalo P, Guillaume S, Siren S, Manner T, Vilo S, Scheinin M, Saari TI. Pharmacokinetics and Sedative Effects of Intranasal Dexmedetomidine in Ambulatory Pediatric Patients. Anesth Analg. 2020 Apr;130(4):949-957. doi: 10.1213/ANE.0000000000004264.
    Results Reference
    background
    PubMed Identifier
    26233335
    Citation
    Yoo H, Iirola T, Vilo S, Manner T, Aantaa R, Lahtinen M, Scheinin M, Olkkola KT, Jusko WJ. Mechanism-based population pharmacokinetic and pharmacodynamic modeling of intravenous and intranasal dexmedetomidine in healthy subjects. Eur J Clin Pharmacol. 2015 Oct;71(10):1197-207. doi: 10.1007/s00228-015-1913-0. Epub 2015 Aug 2.
    Results Reference
    background
    PubMed Identifier
    11571417
    Citation
    Coursin DB, Coursin DB, Maccioli GA. Dexmedetomidine. Curr Opin Crit Care. 2001 Aug;7(4):221-6. doi: 10.1097/00075198-200108000-00002.
    Results Reference
    background
    PubMed Identifier
    27833345
    Citation
    Shetty SK, Aggarwal G. Efficacy of Intranasal Dexmedetomidine for Conscious Sedation in Patients Undergoing Surgical Removal of Impacted Third Molar: A Double-Blind Split Mouth Study. J Maxillofac Oral Surg. 2016 Dec;15(4):512-516. doi: 10.1007/s12663-016-0889-3. Epub 2016 Apr 21.
    Results Reference
    result
    PubMed Identifier
    23497981
    Citation
    Nooh N, Sheta SA, Abdullah WA, Abdelhalim AA. Intranasal atomized dexmedetomidine for sedation during third molar extraction. Int J Oral Maxillofac Surg. 2013 Jul;42(7):857-62. doi: 10.1016/j.ijom.2013.02.003. Epub 2013 Mar 14.
    Results Reference
    result
    PubMed Identifier
    21685111
    Citation
    Cheung CW, Ng KF, Liu J, Yuen MY, Ho MH, Irwin MG. Analgesic and sedative effects of intranasal dexmedetomidine in third molar surgery under local anaesthesia. Br J Anaesth. 2011 Sep;107(3):430-7. doi: 10.1093/bja/aer164. Epub 2011 Jun 16.
    Results Reference
    result
    PubMed Identifier
    31114165
    Citation
    Liu S, Wang Y, Zhu Y, Yu T, Zhao H. Safety and sedative effect of intranasal dexmedetomidine in mandibular third molar surgery: a systematic review and meta-analysis. Drug Des Devel Ther. 2019 Apr 23;13:1301-1310. doi: 10.2147/DDDT.S194894. eCollection 2019.
    Results Reference
    result
    PubMed Identifier
    26850877
    Citation
    Ryu DS, Lee DW, Choi SC, Oh IH. Sedation Protocol Using Dexmedetomidine for Third Molar Extraction. J Oral Maxillofac Surg. 2016 May;74(5):926.e1-7. doi: 10.1016/j.joms.2015.12.021. Epub 2016 Jan 7.
    Results Reference
    result

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    Intranasal Dexmedetomidine for Severe Dental Anxiety: a Randomized Trial

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