title: An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study.
abstract: BACKGROUND
  Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH.
  
  
  METHODS
  A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded.
  
  
  RESULTS
  The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar.
  
  
  CONCLUSIONS
  There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping.
authors.affiliation: Private Practice Limited to Endodontics, San Jose, California.
authors.forename: Madhavi
authors.initials: M
authors.lastname: Setty
authors.affiliation: Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio. Electronic address: tom1mont@netscape.net.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Montagnese
authors.affiliation: Department of Oral and Maxillofacial Surgery, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Dale
authors.initials: D
authors.lastname: Baur
authors.affiliation: Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Anita
authors.initials: A
authors.lastname: Aminoshariae
authors.affiliation: Department of Endodontics, School of Dental Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Andre
authors.initials: A
authors.lastname: Mickel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local; D001249:Asthma / Q000150:complications; D001714:Bipolar Disorder / Q000150:complications; D002648:Child; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D016854:Dental Anxiety / Q000150:complications; D004499:Education, Dental, Graduate; D004708:Endodontics / Q000193:education; D005260:Female; D005683:Gagging / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009339:Needles; D010517:Periodontics / Q000193:education; D010698:Phobic Disorders / Q000523:psychology; D012189:Retrospective Studies; D013039:Specialties, Dental / Q000193:education*; D013515:Surgery, Oral / Q000193:education; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives
keywords: Claustrophobia; dental anxiety; endodontics; gag reflex; moderate sedation; monitoring; oral surgery; periodontics