Adult Oral Sedation in the Dental Office
Adult Oral Sedation as a part of your dental practice can be a wonderful adjunct to the services you can provide your patients. This article is not meant to provide any training in oral sedation, you are encouraged to take a board approved course.
The ability to treat patients that may otherwise go without proper care can be very rewarding to you, your team and your patients. Currently, in California, a permit acquired through the Dental Board is required. Section 1004 defines adult conscious as any patient over 13 years of age, although I personally only treat patients over the age of 18. This permission is only needed if the dentist is going to administer medication dosages that exceed the FDA daily recommended dose. A dentist can apply for a permit by either submitting 10 board approved sedations completed prior to Dec.. 31, 2005 or having 25 hours of classroom instruction and observation of 1 live patient experience from a board approved CE provider. The right needs to be renewed every 2 years with a minimum of 7 hours of CE in sedation. Proper training of the entire dental team, monitoring equipment, emergency training and equipment is essential.
Typically in our practice, our sedation patients fall into two categories- fear based and time based. Our fear based patients are just as you would think-they usually have some past dental experiences that have kept them form the dental office. It is not uncommon for us to see a patient that has not had a dental visit for 10, 20, 30 years in some cases. Typical concerns are bad childhood experiences, pain during treatment, fear of needles, sounds, smells, difficulty getting numb, gag reflex or bad rapport with the dentist. Time based patients typically have at least some fear but also want to have as few appointments as possible in order to get back to maintenance visit status. Patients with hectic work schedules and frequent business travel are an example of time based patients. The entire dental team must be very skilled, compassionate, well-trained and have excellent communication skills in order to properly handle sedation patients. The patient's heightened fears or needs require that your team go the extra mile to put the patient at ease.
As mentioned before, we treat only patients 18 years of age or older. Generally ASA I or ASA II are good candidates and with advanced training ASA III's can be treated. We consult with every patients Physician prior to treatment. Also, a complete medical history and pre-op vitals are taken. Oral sedation is very safe but there are a few contraindications – pregnancy, allergy to medications used, interaction of some medications that the patient is already taking – I will not go into all of that now. Triazolam is the main medication we use for oral sedation. Triazolam is a benzodiazepine in the sedative-hypnotic family. Amnesia is a normal and much appreciated side effect for my patients. Typically a patient will take a small dose of diazepam at bedtime and we can also supplement the triazolam with hydroxyzine. We also, quite often, supplement the sedation with a low dose of nitrous oxide during the administration of local anesthetic and oral surgery. A typical sedation appointment is 5-6 hours. We can be performing treatment from simple restorative, crown and bridge and periodontal therapy (by one of our trained hygienists) to full mouth reconstruction, endodontic therapy, oral surgery and laser gum treatment. Our patients are regularly monitored with a pulse oximeter / pulse / blood pressure monitor. We do not put our patients to sleep. They are in a relaxed state that allows them to complete their requested treatment. We can communicate with the patient through the appointment as needed. At the conclusion of the appointment, the patient's escort is given post operative instruction and the patient will return home to nap the rest of the afternoon. Patients appreciate the amnesiac effect of the triazolam. I have had patients call the office later that day, upset that they have slept through and missed their appointment only to be told they were in our office from 7:30 am to 1:00 pm.
I hope this give you a brief insight into adult oral sedation and how this can be a wonderful service to provide your patients.