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certain features that may limit its use in some patients and in certain clinical applications. Although this article focuses on the potent volatile agents, a brief description of nitrous oxide will be provided. Nitrous Oxide Of the common inhalational agents used in dentistry, nitrous oxide is the most utilized agent for most dental procedures and surgeries. With an extremely high MAC value (104%), nitrous oxide cannot be utilized as a general anesthetic alone. It is often coadministered with oxygen and the other volatile anesthetics. The gas

, limited cognitive functioning, physical disability, or medical conditions that require deep sedation or general anesthesia to complete dental treatment in a safe and humane fashion. 4 The dental profession has sought to continually develop and improve on previous safety standards in an effort to deliver safe and effective deep sedation and general anesthesia techniques. 5 The American Academy of Pediatric Dentistry (AAPD) endorses in-office use of deep sedation or general anesthesia administered by a trained, credentialed, and licensed pediatric dentist, dental or

Knowledge of reversal agents, or pharmacologic antagonists, is essential for all providers of sedation and general anesthesia. Reversal agents are defined as any drug used to counter the pharmacologic effects of another drug. 1 This article reviews common reversal agents used in contemporary sedation and anesthesia practice for dentistry, specifically flumazenil, naloxone, neostigmine, sugammadex, and phentolamine, and discusses their use in emergency management and routine practice. This article also reviews safety considerations and

used for minimal and moderate enteral sedation in pediatric dentistry. Table 1. Common Pediatric Oral Sedation Medications Table 2. Antihistamine Adjuncts for Oral Sedation CHLORAL HYDRATE Chloral hydrate, a sedative-hypnotic aldehyde compound used in the late 1800s for insomnia, was once the predominant agent for oral sedation in children. Once absorbed by the gastrointestinal (GI) tract, chloral hydrate is metabolized by

% by FPS-R and 40% by PPPM and highest at 2 hours from discharge. This study identifies the high prevalence of postoperative pain in pediatric dentistry after GA and brings to the forefront the need for formalized assessment in the recovery period. In 1998, the World Health Organization named pain as the fifth vital sign, highlighting the importance of its assessment. 33 The early hours exhibit the most pain. Moderate-to-severe pain appears to peak at 2 hours, then reduces in intensity over the 3-day period, a trend which is consistent in morbidity studies

With the recent increase in national attention directed at patient safety involving sedation and anesthesia for dentistry within the office-based environment, organizations inside and outside of dentistry are attempting to collect and evaluate data to improve outcomes and reduce or eliminate untoward events. However, given the general isolated nature of most dental practices, this has proved challenging. Unlike the hospital setting, which can provide abundant opportunity for licensed health care providers to practice in an environment prime

, moderate sedation, deep sedation (DS), or general anesthesia (GA). There is a lack of recent data regarding morbidity and mortality events related to DS/GA for dentistry in Ontario, Canada's most populous province. Specifically, data are lacking for adverse events outside of hospital settings in terms of the number of deaths (mortalities) or severe injuries (morbidities) that occur in dental offices or surgicenters in relation to the number of DS/GAs provided in these ambulatory care settings. Morbidity and mortality reports are fundamental as they provide

INTRODUCTION Fear and anxiety of dentistry are common findings. 1–17 Although related, they differ in that fear may be considered the physiological process that occurs in the body when threatened by danger, whereas anxiety is the anticipation of the possibility of danger and is perceived to be less immediate in nature. 18 19 Their presence in dental patients may lead to avoidance of appropriate care and therefore an impairment of their oral health. 1 9 12 20–22 Fear and anxiety in dentistry have been estimated in various

medical and dental disciplines. Before 2010, all UW and SCH pediatric dental patients requiring GA were treated in the SCH H-OR. Characteristics of patients receiving dental treatment under GA at SCH during 2007-2009 were analyzed in an institutionally approved study and used to support a business proposal for the construction of a dental-specific ASC. 12 In 2010, the UW and SCH opened a dental surgery center, an ASC exclusive to pediatric dentistry, and oral surgery where treatment is provided with GA administered by a privately contracted anesthesiologist

department visits and result in more than 125,000 hospital admissions. 8 An accurate assessment of the impact and prevalence of adverse drug events within the dental profession overall is currently rather difficult to ascertain because of several key factors, which will be discussed shortly. Nevertheless, the analysis, prevention, and management of adverse drug events remain as critical issues that warrant continued attention from medicine and dentistry. ASSESSING THE PROBLEM OF MEDICATION ERRORS AND ADVERSE DRUG EVENTS IN DENTISTRY With the