Sedation for dental procedures

Abstract

Control of pain and anxiety is fundamental to the practice of dentistry. Patients who have a fear of dental treatment and those who are faced with the prospect of an unpleasant or distressing procedure, rightfully expect that the option of conscious sedation should be available. A satisfactory assessment visit is crucial to the success of subsequent treatment. The planned dentistry must be appropriate and realistically achievable under sedation. Inhaled nitrous oxide (relative analgesia), intravenous, oral and intranasal midazolam are effective for most patients and have an exemplary safety record in dentistry. For moderately anxious adults and children, titrated nitrous oxide has excellent anxiolytic, sedative and analgesic properties with little depression of myocardial function or ventilation. Induction and recovery are rapid. Midazolam is well suited to sedation for dentistry. For intravenous administration, a titration technique ensures the optimum level of sedation for each individual. Midazolam produces a period of acute detachment for 20–30 minutes followed by a state of relaxation for a further hour or so. Most patients have little or no recollection of the operative procedure. Since some degree of respiratory depression is seen in all patients, pulse oximetry is essential. Conscious sedation techniques are appropriate, safe and successful for most fit, cooperative dental patients. However, a more flexible approach may be needed for individuals presenting special medical or behavioural challenges. These patients are better managed in specialist centres with appropriate staff and facilities.