Manley MC, Skelly AM, Hamilton AG. Dental treatment for people with challenging behaviour: general anaesthesia or sedation?. Br Dent J. 2000; 188:358-360 https://doi.org/10.1038/sj.bdj.4800480
McGeown D, Stapleton S, Nunn J. A cost analysis estimation of a single episode of comprehensive dental treatment under general anaesthesia for adults with disabilities. Br Dent J. 2018; 224:442-446 https://doi.org/10.1038/sj.bdj.2018.124
Armfield JM. How do we measure dental fear and what are we measuring anyway?. Oral Health Prev Dent. 2010; 8:107-115
Halai T, Naqvi A, Steel C, Koshal S. Complications of conscious sedation: causes and management. Dent Update. 2017; 44:1034-1040
British Society for Disability and Oral Health. The provision of oral health care under general anaesthesia in special care dentistry: a professional consensus statement. 2009. http://www.bsdh.org/documents/BSDH_GA_in_SCD_2009.pdf (accessed July 2021)
Venchard GR, Thomson PJ, Boys R. Improved sedation for oral surgery by combining nitrous oxide and intravenous midazolam: a randomized, controlled trial. Int J Oral Maxillofac Surg. 2006; 35:522-527 https://doi.org/10.1016/j.ijom.2005.11.003
Sivaramakrishnan G, Sridharan K. Nitrous oxide and midazolam sedation: a systematic review and meta-analysis. Anesth Prog. 2017; 64:59-65 https://doi.org/10.2344/anpr-63-03-06
Averley PA, Girdler NM, Bond S A randomised controlled trial of paediatric conscious sedation for dental treatment using intravenous midazolam combined with inhaled nitrous oxide or nitrous oxide/sevoflurane. Anaesthesia. 2004; 59:844-852 https://doi.org/10.1111/j.1365-2044.2004.03805.x
Lipp M, Dick W, Daublander M Effects of an intravenous sedation technique with simultaneous administration of nitrous oxide in dental surgical operations. Anesth Prog. 1989; 36:164-168
Milgrom P, Beirne OR, Fiset L The safety and efficacy of outpatient midazolam intravenous sedation for oral surgery with and without fentanyl. Anesth Prog. 1993; 40:57-62
An alternative sedation option for special care patients: combined inhalation sedation with nitrous oxide and oxygen and intravenous sedation with midazolam
An alternative sedation option for special care patients: combined inhalation sedation with nitrous oxide and oxygen and intravenous sedation with midazolam Stephanie Fenesan Sadie Hughes Neha Patel Dental Update 2024 48:7, 707-709.
Authors
StephanieFenesan
BDS, BSc(Hons), AKC, MSc, MSCD RCS Ed
Specialty Trainee in Special Care Dentistry, Department of Sedation and Special Care Dentistry, Guy's Dental Institute, Guys and St Thomas' NHS Foundation Trust
Specialist in Special Care Dentistry, Hertfordshire Special Care Dental Service, Hertfordshire NHS Community Trust, Hoddesdon Health Centre, Hoddesdon, Hertfordshire
This article highlights an alternative sedation technique by providing inhalation sedation with nitrous oxide and oxygen alongside intravenous sedation with midazolam as an additional option for patients within special care dentistry. Two case reports are described, as well as a short overview of the available literature on this technique and the indications, advantages and disadvantages. This technique should be considered alongside other sedation techniques. As with all treatment for which sedation is provided, each case needs to be considered on an individual basis and the most appropriate option selected following discussion with the patient.
CPD/Clinical Relevance: Although single sedation techniques provide a good level of sedation to facilitate dental treatment for the majority of patients, it is desirable to have an awareness of alternative sedation options that may be available for patients.
Article
Conscious sedation has become indispensable in the dental management of patients in special care dentistry. Special care dentistry includes the provision of dental treatment for those who are unable to accept routine dental care due to physical, intellectual, medical, emotional, sensory, mental or social impairment, or a combination of these factors.1 These factors can make it difficult for patients to accept dental treatment without additional anxiety management techniques, such as behaviour management techniques, conscious sedation or general anaesthesia (GA).
The Intercollegiate Advisory Committee for Sedation in Dentistry (IACSD) defines conscious sedation as: ‘A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.’2 While this principle is applicable to most patients, it is with the caveat that for some special care patients, verbal contact might not be the primary form of communication.
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