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Leitch and Girdler (2000) 1 conducted a study in 1998 that looked for the first time at the quantity and quality of dental undergraduate teaching in conscious sedation in the dental schools of the United Kingdom and Ireland. The conclusions were that undergraduate sedation teaching varied considerably across United Kingdom and Irish dental schools. Students at most dental schools were failing to receive adequate hands-on sedation experience, especially in intravenous techniques, and the authors suggested that undergraduate sedation training

The safe and effective use of medications for moderate and deep sedation requires a sound appreciation for pharmacokinetic principles that govern serum concentrations adequate to provide the intended effect. These principles have been presented in a previous continuing education article in this journal. 1 The goal of this article is to address pharmacodynamic principles, including mechanisms of action and the effects that follow. Depending on the provider's level of training, the desired effects range from various levels of sedation to general anesthesia

Moderate and deep sedation is frequently required to manage the apprehensive dental patient. Clinicians and researchers alike continue the search for a “magic potion,” operating within the paradigm that an answer somehow lies in the selection of a perfect drug or drug combination. Suggestions have included a staggering number of single and multiple drug regimens, as well as alternative routes for their administration, including rectal and intranasal. None have achieved universal acceptance because no single drug or combination is suitable for all

Sedation is useful for minor oral surgery because it helps prevent excessive increases in blood pressure and heart rate and reduces mental stress arising from the surgery. 1 – 3 This is a significant benefit for both the patient and the operator. However, if the sedative level goes beyond moderate sedation, airway problems may arise, and deep sedation may also lead to a delay in recovery from sedation. In addition, implant surgery often takes longer than tooth extraction, and maintaining an adequate sedation level for longer procedures can

Moderate oral sedation is utilized by pediatric dentists to provide dental care for children who are unable to cooperate during in-office dental procedures. 1 Studies have evaluated the intraoperative safety and effectiveness of sedation medications commonly used in pediatric dentistry by investigating patient parameters such as oxygen saturation, respiratory rate, blood pressure, and patient behavior during the course of the sedation. 2 – 7 However, little is known about the effects of sedation medications used in pediatric dentistry

Dental caries is the most common chronic disease of childhood. By kindergarten, 40% of children are affected by early childhood caries. 1 A portion of these young patients need pharmacologic intervention to complete dental treatment. 2 When a patient has behavior problems that can't be resolved solely using communicative techniques, and general anesthesia can be avoided, conscious sedation may be beneficial. The decision to use sedation for treatment of early childhood caries includes consideration of the amount and difficulty of dental

The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory

A thorough and focused assessment of the airway prior to the planned administration of moderate sedation or deep sedation/general anesthesia (GA) is of vital importance. Over the years, studies of closed claims have focused on the association of respiratory and airway issues with mortality and severe morbidity in hospital and off-site locations. 1 – 3 The Closed Claims Project of the American Society of Anesthesiologist (ASA) evaluated adverse anesthetic outcomes obtained from the closed claim files of 35 U.S. liability insurance companies

Nitrous oxide inhalation sedation (N 2 O/O 2 ) is commonly employed to improve cooperation for pediatric dental procedures. The clinical efficacy of nitrous oxide is sufficient and predictable in most cases. However, there are children for whom nitrous oxide fails to provide adequate levels of sedation. For example, Burnweit et al found that N 2 O/O 2 effectively facilitated minor surgical procedures for greater than 95% of their pediatric patients, and Soldani et al reported similar results for pediatric patients receiving orthodontic

contribute to the development of skeletal muscle wasting, osteoporosis, ischemic heart disease, anemia, diabetes, and metabolic symptoms. 27 SEDATION AND GENERAL ANESTHESIA CONCERNS IN COPD PATIENTS: PREOPERATIVE PERIOD COPD is a common condition that presents multiple challenges for dental sedation and general anesthesia (GA) providers. Increased risk of perioperative pulmonary complications (PPCs) is compounded by the fact that many dental anesthetics are administered in the office-based setting. It is the responsibility of the