Inhalational and enteral conscious sedation for the adult dental patient.
There are clearly many safe and effective sedatives available to the dental practitioner for reducing patient fear and improving their level of comfort. Careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to use because they all possess slightly different clinical characteristics and various degrees of risk. Patient selection also is critical when making decisions about sedation because the patient's expectations and general health status factor into keeping the procedure safe. N2O/O2 sedation is an excellent choice for managing the mildly fearful dental patient or when minimal sedation is desirable. Among the sedatives administered enterally, the benzodiazepines are the most commonly used, and for good reason. These drugs are safe, effective, and offer a host of different personalities from which the dentist can choose. If used wisely and thoughtfully, the dentist can tailor the effects and duration of onset and recovery to the needs of the patient and the expected parameters of the appointment. When N2O/O2 sedation is combined with a single enteral sedative, a more profound level of CNS depression is achieved that can be modestly altered by changing the concentration of inhaled nitrous oxide. With these many pharmacologic alternatives, many different dental patient populations can be sedated in a safe, effective manner, thus allowing the delivery of most dental treatments in a setting of reduced psychologic and physiologic stress. These pharmacologic sedatives have truly opened up a wonderful world of possibilities for the comfortable delivery of dental care, and should be integrated into every office's repertoire for delivery of care.
Jackson
Douglass L
DL
Department of Oral Medicine, University of Washington School of Dentistry, B412 Health Sciences Building, Seattle, WA 98195, USA. jacksond@u.washington.edu
Johnson
Barton S
BS
D000280:Administration, Inhalation; D000284:Administration, Oral; D000328:Adult; D000762:Anesthesia Recovery Period; D000766:Anesthesia, Dental / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D014151:Anti-Anxiety Agents / Q000008:administration & dosage; D001569:Benzodiazepines; D002492:Central Nervous System Depressants / Q000008:administration & dosage; D016292:Procedural Sedation / Q000379:methods*; D003657:Decision Making; D016854:Dental Anxiety / Q000517:prevention & control; D006304:Health Status; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D009609:Nitrous Oxide / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D018579:Patient Selection; D012307:Risk Factors; D012449:Safety; D013312:Stress, Physiological / Q000517:prevention & control; D013315:Stress, Psychological / Q000517:prevention & control; D013997:Time Factors
D018685:Anesthetics, Inhalation; D014151:Anti-Anxiety Agents; D002492:Central Nervous System Depressants; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D009609:Nitrous Oxide; D010100:Oxygen