title: Dental anesthesia for patients with special needs.
abstract: To offer individualized dental treatment to certain patients who cannot tolerate dental treatment, sedation or general anesthesia is required. The needs could be either medical, mental, or psychological. The most common indications for sedation or general anesthesia are lack of cooperation, multiple morbidities, and pediatric autism. In adults, cognitive impairment and multiple morbidities are most commonly encountered indications. Because of suboptimal home care, incomplete medical history, poor preoperative management, lack of cooperation, and developmental abnormalities, it is a challenge to prepare anesthesia for patients with special needs. The American Society of Anesthesiology (ASA) has proposed guidelines for office-based anesthesia for ambulatory surgery. In patients with ASA physical status IV and V, sedation or general anesthesia for treatment in the dental office is not recommended. The distinction between sedation levels and general anesthesia is not clear. If intravenous general anesthesia without tracheal intubation is chosen for dental procedures, full cooperation between the dentist, dental assistant, and anesthesiologist is needed. Teamwork between the dentist and healthcare provider is key to achieve safe and successful dental treatment under sedation or general anesthesia in the patient with special needs.
authors.affiliation: Department of Anesthesiology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Wang
authors.forename: I-Hua
authors.initials: IH
authors.lastname: Lin
authors.forename: Chi-Hsiang
authors.initials: CH
authors.lastname: Huang
authors.forename: Shou-Zen
authors.initials: SZ
authors.lastname: Fan
mesh_terms: D000766:Anesthesia, Dental / Q000379:methods*; D000768:Anesthesia, General; D001321:Autistic Disorder / Q000523:psychology; D002547:Cerebral Palsy / Q000523:psychology; D003730:Dental Care for Persons with Disabilities; D004314:Down Syndrome / Q000523:psychology; D004827:Epilepsy / Q000523:psychology; D005239:Fear; D006801:Humans