Clinical Significance
Patients who cannot be managed with basic sedation techniques were able to receive needed treatment with the use of advanced techniques and did not require general anesthesia. Patient
Conscious sedation can be divided into basic or advanced approaches (Table 1). The medical and dental professions vary widely in their opinions concerning when advanced techniques should be used. Some believe that anything other than basic techniques is equivalent to using general anesthesia and should be banned from clinical practice or limited to use in a hospital setting. Alternatively, some believe the routine use of advanced conscious sedation techniques is the only reliable method because
Four patients required propofol intravenously (IV) to attain the level of sedation necessary for dental treatment. One was taking long-term erythromycin to control acne and had a severe needle phobia, so oral sedation with temazepam was attempted. However, the sedation level was insufficient, so propofol was used, allowing the administration of local anesthetics in both upper and the lower right quadrants. The patient, a 14-year-old girl, was then able to complete multiple restorative
All five of the patients who received a combination of opioids and midazolam appeared to have reached an adequate level of sedation with midazolam alone but when treatment was begun, the patients' level of anxiolysis was insufficient to accomplish the needed treatment. A man, 17, was anxious about all aspects of dental treatment, particularly intraoral injections and tooth preparation. He required multiple intracoronal restorations in all four quadrants, so a combination of fentanyl and
Most adults who require dental interventions can be managed with a combination of nitrous oxide and oxygen or with midazolam via the route most appropriate for that individual patient. Failing these methods, advanced conscious sedation can be used successfully in the majority of cases. Clinical Significance Patients who cannot be managed with basic sedation techniques were able to receive needed treatment with the use of advanced techniques and did not require general anesthesia. Patient
Table 3
Robb N: The role of alternative (advanced) conscious sedation techniques in dentistry for adult patients: A series of cases. Br Dent J 216:223-227, 2014
Reprints available from N Robb, Reader in Restorative Dentistry, School of Oral & Dental Sciences, Univ of Bristol, Lower Maudlin St, Bristol, BS1 2LY; e-mail: [email protected]