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Consultant and Honorary Senior Lecturer in Special Care Dentistry; Clinical Lead, Department of Sedation and Special Care Dentistry, Guy’s and St Thomas’ NHS Foundation Trust, London
The general features of the movement disorders are outlined and the effects of inhalational sedation with nitrous oxide and oxygen and intravenous sedation, using midazolam, are described. Two case reports of patients with cerebral palsy treated in a community care setting are presented, and the advantages of intravenous and inhalational sedation are explained.
Clinical Relevance: Inhalational sedation (IS) with nitrous oxide and intravenous sedation (IVS) with midazolam can be useful aids to reduce unwanted movements in patients with movement disorders during dental treatment.
Article
The phrase ‘Movement disorders’ describes a wide range of conditions which are neurological in origin and are manifest in individuals as problems with the control of body movement.1 Movement involves a complicated process involving both voluntary and involuntary centres of the brain and any interruption in the system may lead to a movement disorder.
Typically, movement disorders are the result of injury to the basal ganglia of the brain. The damage to the basal ganglia may be progressive, such as seen in neurodegenerative diseases, or may be the result of a cerebral insult. This type of damage tends not to be progressive and may be described as fixed.1 The result of damage to the movement centres of the brain may result in a whole range of movement disorders; movements may be unwanted and exaggerated (such as grimaces/writhing movements) or they may be slow and weak (such as those seen in Parkinson's disease).1,2
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