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ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

Sedation in Dentistry

Categories: Anesthesia and Sedation, Health and Medical Topics

Author(s): Stanley F. Malamed, DDS

Course Type: Self-instruction journal and web based activity

Target Audience: Dental Assistants, Dental Hygienist, Dentists from novice to advanced

Educational Objectives

On completion of this program, the student should be able to:
1. Define iatrosedation and give three specific examples
2. Name the three levels of sedation and describe their differences
3. List the standard-of-care monitoring parameters for minimal and moderate sedation
4. Describe the protocol for an oral sedation appointment
5. Describe the protocol for an inhalation sedation appointment
6. Discuss the management of a CNS-depressant (benzodiazepine or opioid) overdose


Odontophobia (fear of dentistry) is a real problem. In a 2015 American Dental Association (ADA) survey of patients who had not visited a dentist within the last 12 months, fear of dentistry (22%) was second only to cost (59%). The goal of sedation is to relax an apprehensive or fearful dental patient. Recognized levels of sedation are minimal, moderate, and deep. Sedation techniques include iatrosedation and pharmacosedation. Pharmacosedation administration routes include oral, intramuscular (IM), intranasal (IN), inhalation, and intravenous (IV). Dental boards regulate sedation use, with permit requirements varying state to state. Monitoring during sedation is critical to patient safety. Pulse oximetry, with appropriate alarms, is standard of care during all levels of sedation, and end-tidal CO2 monitoring is standard of care in moderate and deep sedation. Inhalation sedation (N2O-O2) remains the most commonly used sedation technique followed by oral sedation.
Parenteral techniques of moderate sedation are less frequent. Deep sedation and general anesthesia, which require more intensive training, primarily are used by oral surgeons and dentist anesthesiologists.
Inhalation sedation, considered minimal sedation when no other central nervous system (CNS)-depressant drugs are administered, possesses significant advantages (including rapid onset, complete recovery [in most patients], and the ability to titrate) over enteral and other parenteral sedation routes.The most commonly used drugs in both oral and parenteral minimal and moderate sedation are benzodiazepines (triazolam, midazolam) and opioids (fentanyl, meperidine, hydromorphone).
Complications, including overdose, can arise whenever drugs are administered. Managing sedation overdose invokes the concept of “rescue,” the ability “to rescue a patient who enters a state of sedation beyond which is intended.” Management involves use of the emergency algorithm: P_C_A_B_D (Position, Circulation, Airway, Breathing, Definitive care).

ADA Credits: 2 | AGD Credits: 2 | Cost: $29.00

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