Dental Sedation Research Articles

Are Special Care Dentistry Services Prepared for a Global Disruption in Healthcare? A Call for a Wider Promotion of Dental Conscious Sedation Training.

Recently, calls for prompt and smart reform of dental education and postgraduate training have been made, reflecting the current global healthcare needs and addressing the most common problems faced by dental care providers. Objectives: Herewith, we propose the enhancement of multilevel dental training in dental conscious sedation (DCS), in order to meet the increasing demands associated with current and post-pandemic times. The temporary suspension of general anaesthesia and hospital-based sedation provision in response to coronavirus disease 2019 (COVID-19) revealed the urgent need for more efficient utilization of a variety of forms of DCS. Whilst the global spread of Severe Acute Respiratory Syndrome novel coronavirus (SARS-CoV-2) has particularly challenged dental sedation teams in community services, the appropriate preparation for similar disruptions in future should be undertaken proactively. In response, dental schools and commissioners are obliged to implement innovations in teaching, with the development of new programs supporting trainer–trainee interactions and focusing on practical sedation skills. Conclusions: The joint efforts of educators, healthcare providers, and commissioners, as well as adequate and robust DCS training utilizing a variety of teaching methods, would allow our profession to face the growing demand for pain and anxiety control measures in light of the current situation, which may increase even further over time. Decision makers are urged to consider making training in DCS more accessible, meeting current healthcare demands, and equally providing essential support for the special dental care sector.

Midazolam and its effect on vital signs and behavior in children under conscious sedation in dentistry.

Midazolam is a short acting sedative with small number of adverse effects. Administered orally, it is currently the most common form of conscious sedation in children. The objective of this paper is to describe effect of midazolam administered to children during dental treatment on their vital signs, and to monitor changes in children's behavior. We described values of vital signs and behavior in 418 sedations conducted in 272 children between 1-12 years of age. To achieve the following results, we used data from 272 all first-time sedations. After administration of midazolam arterial blood pressure and blood oxygen saturation decreased by values which were not clinically significant. The heart rate increased, with values staying within the limits of physiological range. The speed of onset of midazolam's clinical effects depends on age and dose. The lower age and dose correlated with the higher behavior score. The effectiveness of midazolam treatment is 97.8 %. Unwillingness of child to receive midazolam is predictor for disruptive behavior during sedation. 1.8 % of all sedation cases showed paradoxical reactions. The administration of midazolam in dose of 0.5 mg per 1 kg of child's body weight is safe and could be recommended for dental treatment in pediatric dentistry.

Sedacja w stomatologii – aktualne wytyczne anestezjologiczne

Introduction. Dental treatment remains a constant concern of children as well as adult patients. Adequate choice of sedation enables dentists to safely carry out medical procedures. Aim. To review current literature concerning anesthetic guidelines for sedation in a dental office. Material and methods. Articles from 3 databases were analyzed: PubMed/Medline, EMBASE and Cochrane Library, for current guidelines on sedation in dentistry. Results. The most current guidelines show that sedation can be applied to any patient in the event in which anxiety or pain prevents practitioners from safely performing medical procedures. In order for the patient to be qualified for treatment under sedation, he must undergo thorough health assessment and physical examination as well as evolution of the possibility of performing the procedure using minimal, moderate or deep sedation. The most common form of sedation applied in dentistry is oral or inhalation minimal sedation, which does not require the presence of an anesthesiologist during the procedure. Patients suffering from severe odontophobia can be successfully sedated with the use of intravenous drug infusions. However, such procedure requires assistance of a trained Anesthesia Care team specialized in life support. Conclusions. Current guidelines enable treating patients with various health conditions and with fear of dental treatment, using varying degrees of sedation. Thanks to trained medical personnel, the application of specific, procedures and an appropriately equipped dental office, sedation of adults as well as children is safe.

Parents' satisfaction with paediatric dental treatment under sedation: A cross-sectional study.

Patient-reported outcomes are under-investigated in the field of paediatric dental sedation. To evaluate the satisfaction of parents/guardians with their children's dental sedation, compare it to the dentist's satisfaction, and identify associated factors. This study was performed with parents/guardians of young children treated under sedation and dentists. Participants' satisfaction was measured using the visual analogue scale (0-100). Child's behaviour was classified using the Ohio State Behavioural Rating Scale. Other information was collected during interviews and from patient charts. The Spearman's, Mann-Whitney and Kruskal-Wallis tests were performed (P<.05). A total of 167 parents/guardians and ten dentists participated in the study. Protective stabilisation and atraumatic restorative treatment (ART) were used in 69.9% and 51.5% appointments, respectively. The parents/guardians (median: 91 [25-75 percentile: 75-96]) and dentists (76 [23-98]) were satisfied. Parental/guardian satisfaction was higher than dentist satisfaction (P≤.001). Parental/guardian satisfaction was positively correlated with quiet child behaviour (r=0.347, P≤.001) and was associated with the non-use of protective stabilisation (P≤.001), no previous toothache (P=.019), and the use of ART (P=.018). The participants were satisfied with treatment under sedation. Parents/guardians were more satisfied, especially, when the child had cooperative behaviour.

Is it Impossible to Replace Chloral Hydrate in Dental Sedation of Pediatric Dentistry in Korea?

Chloral hydrate (CH) has been used in sedation for over 100 years. CH was first synthesized in 1832, the sedative properties were observed in 1861. Because of its easy synthesis, its use was widespread since 1869. There is a record of the use of CH in children as early as 1894. Recently there have been many controversies about safety of CH. Because of the low cost and relatively safe experience CH has still been used for dental sedation in children. After the US FDA recommendation in 2006, US pharmaceutical companies no longer produce commercial CH. However, CH has been used in the form of suspensions prepared from raw materials in many areas of the United States, and reports of adverse events related to death have continued.&lt;br/&gt;CH is the most commonly used drug for sedation in Korea, and there have been some reports of side effects.&lt;br/&gt;Dexmedetomidine, propofol and midazolam were introduced as an alternative for CH. There are various limitations in using them in the pediatric dentistry area and there are many things to consider.&lt;br/&gt;The purpose of this review is to analyze the complications of CH and status of use in Korea, and to introduce alternatives to CH.

QUALITY ACCREDITATION OF DENTAL CLINICS: NEED OF THE HOUR (PART 3) ADDRESSING REQUIREMENTS RELATED TO CARE OF PATIENTS

This is the third article in the series of articles ‘Quality Accreditation of Dental Clinics – Need of the hour’. As described in the first article (Published in JIDA May 2020 issue) there are 10 chapters in NABH standards for Dental Healthcare Service Providers (DHSP). First chapter ‘Access, Assessment &amp; Continuity of Care’ (AAC) was described in JIDA June 2020 issue. ‘Care Of Patients’ (COP) is the second chapter. Addressing accreditation standards and implementing them in day-to-day practices is the primary objective in the preparation of DHSP for accreditation. Involvement of clinical staff is needed to address requirements of this chapter; as this chapter describes the clinical aspects of care for patients under dental treatment. This expects to provide uniform care to all patients. This chapter covers aspects related to legal guidelines, clinical guidelines, emergency services in dental practice, dental laboratory, use of local anaesthesia and sedation in dentistry. Aim of this article was to provide brief idea about the criteria required to fulfill in order to address requirements related to the second chapter of NABH i.e. COP. KEY WORDS: Quality Accreditations, Dental Clinics, NABH, COP

Conscious Sedation in Dentistry: Selecting the Right Patient

In recent years, conscious sedation has grown in popularity as an alternative to general anaesthesia in a primary setting due to its safety and efficiency. It is imperative to carry out a full patient assessment prior to treatment under conscious sedation. Conscious sedation is provided intravenously, by inhalation or oral route. Clinical and physical examination as well as medical, social and mental history play a fundamental role in selecting the right patient. In addition, to optimize safety of patients, it is necessary to follow available guidelines and standards, provide an appropriate environment and adequate staff training. CPD/Clinical Relevance: This article highlights the importance of pre-assessment prior to treatment under conscious sedation. The vast majority of adverse events during sedation occur as a result of inadequate pre-assessment and preparation.

A review of good record keeping for conscious sedation in dentistry

Contemporaneous and thorough record keeping for conscious sedation in dentistry is good clinical practice; it is necessary to ensure patient safety and helps protect patients and clinicians (medicolegally). Clinicians providing a sedation service should be familiar with guidelines and their implementation. Record keeping for conscious sedation in dentistry is a useful audit topic in both primary and secondary care.

Characteristics of Intravenous Midazolam Sedation with Nitrous Oxide in Pediatric Dental Treatment

Midazolam is a short-acting benzodiazepine that is widely used in pediatric dental sedation. However, its clinical effectiveness as an intravenous sedative agent in children has not been widely documented. A retrospective study was conducted to evaluate the efficacy and safety of intravenous midazolam and nitrous oxide inhalation sedation in pediatric dental treatment.&lt;br/&gt;The subjects were 115 patients (118 cases) who received dental treatment under intravenous midazolam and nitrous oxide inhalation sedation. Demographic factors, general health status, sedation time, midazolam and nitrous oxide dosage, and success rate of sedation were evaluated from electronic medical records.&lt;br/&gt;Behavioral management was the main reason of choosing sedation. Mean duration of sedation was 56.7 minutes for surgical treatment, and 74.4 minutes for restorative treatment. The initial dosage of intravenous midazolam was 0.051 ± 0.019 mg/kg. In 34 cases (28.8%), additional midazolam of 0.036 ± 0.057 mg/kg was delivered during the treatment. The concentration of nitrous oxide was maintained between 40% and 50%. The success rate of sedation was 99% (n = 117). In 1 case, laryngospasm occurred and the patient was reversed with benzodiazepine antagonist, flumazenil.&lt;br/&gt;Intravenous midazolam sedation with nitrous oxide was shown to be clinically effective for the dental treatment in children, if administered by trained personnel and patients are carefully selected in accordance with guidelines.

Quality of available internet information regarding IV sedation for dental treatment.

Aim Evaluate the content and quality of internet information for patients regarding intravenous sedation in dentistry.Methodology Google was queried with predefined search terms that might be chosen by patients wishing to seek information: 'dental IV sedation OR dental intravenous sedation OR dental sedation'. The first hundred search results were identified. Invalid hyperlinks and duplicates were excluded. Providers, format and location of information were extracted. For webpages detailing treatment options, the DISCERN instrument and JAMA benchmark were used to determine the quality of the information provided.Results Of the first hundred search results, 89 webpages met the initial inclusion criteria. A majority (79%) originated from dental providers. Information was commonly presented as patient information leaflets. Of the 78 webpages detailing treatment options, 3% of webpages received a maximum DISCERN score of 5 and 64% a score of 1. No webpages fulfilled all JAMA criteria and 89% met only one criterion. Secondary care providers scored higher in both scales; however, this represents only 5% of the information available.Conclusion The internet is a commonly accessed information resource for patients. The quality of internet information available regarding intravenous sedation in dentistry is suboptimal. There is a need for more high-quality information resources.

Practice of nitrous oxide inhalation sedation in dentistry during and after the COVID-19 pandemic.

Practice of nitrous oxide inhalation sedation in dentistry during and after the COVID-19 pandemic.

Vale Doug Stewart.

It is with great sadness that the Australian Society of Dental Anesthesiology (AusSDA), the Society for Advancement of Anesthesia in Dentistry (SAAD, UK), and the International Federation of Dental Anesthesiology Societies (IFDAS) announce the passing of our friend and colleague Dr Douglas Stewart on May 22, 2020. After cardiac complications, Doug died in the style for which he was known, with his daughters at his side and jazz playing in the background.For 4 decades, Doug was at the forefront of dental sedation education and safety in Australia and the United Kingdom. In 1996, he became the director of the Conscious Sedation and Pain Control Department, University of Sydney, where his passion, enthusiasm, and drive led to increased recognition of conscious sedation as a safe modality of treatment in Australia.His efforts led to the establishment of dental sedation guidelines and protocols in Australia, which were nationally recognized and accepted by health care professionals and the government. His passion for patient safety and evidence-based regulation of sedation in dentistry became internationally renowned during his time with IFDAS, where he served on the IFDAS Council for 2 decades and was president from 2009–2012. In retirement, Doug continued to mentor colleagues and provide courses to dental teams on the diagnosis and management of office medical emergencies.Doug was always the epitome of a man who worked hard and played hard. He was a man of hearty good cheer who brought a smile to all he met. The international community of dental anesthesiology has lost a great friend and leader. Doug will be sorely missed. Our sincere sympathy is extended to his family and loved ones.

Clinical practices and education of intravenous moderate/deep sedation in Japan

Safety and comfort during dental procedures are the key factors for high quality dentistry and fundamentals for patient satisfaction. Systemic managements such as general anesthesia and moderate/deep sedation are widely applied to dental outpatients for safe and comfortable dentistry by dentists in Japan. For intravenous moderate sedation, midazolam, propofol and their combination are common choices for dental outpatients. Sometimes deep sedation is required especially in patients with intellectually disability, severe fear/anxiety or severe gaging reflex. Some of these patients may undergo general anesthesia instead of intravenous sedation. The Japanese Dental Society of Anesthesiology (JDSA) established “Practice Guidelines for Intravenous Conscious Sedation in Dentistry” in 2017, and these guidelines become standard for routine clinical practices. In Japan, dental school has 6-year curriculum. Lectures and preclinical practices are given to 4th grade students and clinical practices are to 5th grade students. They learn wide range of knowledge and skills for systemic management of dental patients. JDSA has two board systems for dental anesthesiologists; Japanese Board of Dental Anesthesiology (JBDA) and Board Certified Dental Anesthesiology Specialist (BCDAS). BCDAS is authorized by the Ministry of Health, Labour and Welfare, Japan since 2006. The author would expect the development of dental anesthesiology field in Russia and the progress of anesthesiology collaboration system in dental and medical field.

Safety of chloral hydrate sedation in dental practice for children: an overview.

Chloral hydrate is the oldest and most common sedative drug used in moderate sedation for pediatric dental patients. Hence, the purpose of this article is to review the safety and possible adverse events of this drug when used for pediatric dental treatment. A bibliographic search in PubMed, MEDLINE, Cochrane Library and KMbase, KISS, DBpia, KoreaMed, and RISS databases was performed. Using the keywords “dental sedation,” “chloral hydrate,” and “children or adolescent,” 512 scientific articles were found. Subsequently, 183 studies were individually assessed for their suitability for inclusion in this literature review. Altogether, 24 studies were selected. They included 12 cases of death before, during, or after chloral hydrate sedation for dental treatment, majorly due to dosing error and use of multiple sedatives. Additionally, intraoperative adverse events were mostly respiratory problems such as hypoxia and apnea, but most events were temporary. After treatment, prolonged sedation, including excessive sleep and less activity were the most common postoperative adverse events, and even death cases were reported. Despite the wide acceptance of chloral hydrate as a sedative-hypnotic agent, the risk of adverse events and adequate dose should be of great concern when using it for pediatric dental sedation.

The drugs and application methods in dental sedation

The drugs and application methods in dental sedation

Basic Guide to Dental Sedation Nursing

Basic guide to dental sedation nursing / , Basic guide to dental sedation nursing / , کتابخانه دیجیتال جندی شاپور اهواز

Infection Control in Dental Anesthesiology: A Time for Preliminary Reconsideration of Current Practices.

Relegated to clinical afterthought, the topic of infection control has never taken center stage in our modern dental sedation and anesthesiology practices. Surgical and procedural masks, gloves, gowns, protective eyewear, and appropriate surgical attire have remained de rigueur in both fashion and custom for decades. However, the emergence of certain seminal events throughout health care history has driven mandated changes when practitioners, staff, patients, and the surrounding communities were exposed or put at risk of exposure to infectious disease. Hepatitis, human immunodeficiency virus, and now the global COVID-19 pandemic involving the novel coronavirus SARS-CoV-2, have forced us into rethinking our current practices. This review article will contextualize previous epidemics and their influence on infection control in dental settings, and it will explore the rapid evolution of current modifications to personal protective equipment and infection mitigation practices specific to sedation and anesthesia in dentistry.

Nitrous oxide inhalation sedation in dentistry: An overview of its applications and safety profile.

Nitrous oxide in oxygen (N2O/O2) inhalation sedation is used less commonly by Singapore dentists than their counterparts in the United Kingdom and the United States. Using this technique, trained dentists often perform the dual roles of a sedationist and an operating dentist. This paper describes the mechanism of action of N2O and highlights the modern gas delivery system commonly used in dentistry. The built-in safety features of this unique system helps to ensure that patient-specific therapeutic dosages are effectively and safely administered by dentists. Existing evidence for adverse events and the safety profile of the N2O/O2 inhalation sedation is discussed. Finally, recommendations of equipment, training and techniques for safe N2O/O2 inhalation sedation are provided.

Nitrous Oxide Prior to Intranasal Midazolam for Moderate Dental Sedation in Pediatric Patients

Nitrous Oxide Prior to Intranasal Midazolam for Moderate Dental Sedation in Pediatric Patients

A comparison of the sedation provision of NHS dental services 2014-2016 for local authorities throughout England.

Background Conscious dental sedation is commissioned by NHS England for patients who are unable to accept dental treatment under local anaesthetic and behavioural techniques alone. Dental sedation provided by NHS England is carried out on a referral basis but this can be carried out in a primary or secondary care setting. This paper reports a study carried out to improve NHS dental services by supporting the work of multiple NHS England area teams in reviews of sedation services.Aim The aim of this paper is to identify variations in the provision of sedation services by NHS providers across England and explore possible factors affecting this variation.Method The project makes use of the recently developed NHS Business Services Authority (BSA) national public health data set, which Public Health England has developed in association with the BSA.Results Variations in population experience of sedation in England have been graphically demonstrated using a comprehensive BSA data set which captures all general dental service and public dental service (GDS/PDS) activity for a two-year period. There are wide and significant variations in population experience of sedation across England.Conclusion The variations in population experience of sedation across England are difficult to explain on purely clinical grounds.