Balancing efficacy and safety in the use of oral sedation in dental outpatients.
BACKGROUND
Concerns about the safety of pediatric oral sedation and the incremental use of triazolam in adults prompted a workshop cosponsored by several professional organizations.


BACKGROUND
There is a strong need and demand for adult and pediatric sedation services. Using oral medication to achieve anxiolysis in adults appears to have a wide margin of safety. Mortality and serious morbidity, however, have been reported with oral conscious sedation, especially in young children. Most serious adverse events are related to potentially avoidable respiratory complications.


CONCLUSIONS
Clinical trials are needed to evaluate oral sedative drugs and combinations, as well as to develop discharge criteria with objective quantifiable measures of home readiness. Courses devoted to airway management should be developed for dentists who provide conscious sedation services. State regulation of enteral administration of sedatives to achieve conscious sedation is needed to ensure safety.


CONCLUSIONS
Safety in outpatient sedation is of paramount concern, with enteral administration of benzodiazepines appearing safe but poorly documented in the office setting. Conscious sedation by the enteral route, including incremental triazolam, necessitates careful patient evaluation, monitoring, documentation, facilities, equipment and personnel as described in American Dental Association and American Academy of Pediatric Dentistry guidelines.
Dionne
Raymond A
RA
Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, USA. dionner@mail.nih.gov
Yagiela
John A
JA
Coté
Charles J
CJ
Donaldson
Mark
M
Edwards
Michael
M
Greenblatt
David J
DJ
Haas
Daniel
D
Malviya
Shobha
S
Milgrom
Peter
P
Moore
Paul A
PA
Shampaine
Guy
G
Silverman
Michael
M
Williams
Roger L
RL
Wilson
Stephen
S
D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects* / Q000379:methods; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D002648:Child; D016292:Procedural Sedation / Q000009:adverse effects* / Q000379:methods; D016854:Dental Anxiety / Q000188:drug therapy; D019140:Dental Care for Children / Q000379:methods*; D006801:Humans; D014229:Triazolam / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics
D014151:Anti-Anxiety Agents; D014229:Triazolam