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Conscious sedation and its use in management of anxious patients

BDJ Student volume 28, pages 52–54 (2021)Cite this article

By Alisha Amin

Approximately 15% of adults avoid receiving routine dental care due to their dental anxiety.1 In my experience, talking not only to my patients, but also the wider public, dentistry is commonly associated with pain, money or fear and almost always has negative connotations. Dental anxiety can range from low level, presenting with symptoms such as tachycardia, hypertension, sweating, agitation or fidgeting; to high-level dental phobias resulting in complete avoidance of dental settings. Despite its prevalence, many dentists and dental students still find it incredibly difficult managing patients with high level dental anxiety. There are a variety of ways to help patients cope with fear or anxiety, ranging from simply giving a detailed explanation of procedures (tell, show, do) to cognitive behavioural therapy (CBT), hypnotherapy, and sedation. Conscious sedation in particular, if used appropriately, is a reliable anxiolytic which could enable patients with severe dental anxiety to seek elective treatment they would have otherwise never considered. It is a treatment option that, in my opinion, is often overlooked in general practice, where facilities might not be available and referral to secondary or tertiary care not routine and easily forgotten. Currently, only practices that hold sedation contracts with NHS England can provide sedation in primary care (see NHS England's 'Commissioning Standard in Conscious Sedation in Primary Care' for more information).

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References

  1. Milgrom P, Newton J T, Boyle C, Heaton L J, Donaldson N. The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London. Community Dent Oral Epidemiol 2010; 38: 453-459.

  2. Academy of Medical Royal Colleges. Safe Sedation Practice for Healthcare Procedures. London: AoMRC; 2013.

  3. Coulthard P, Bridgman C M, Gough L, Longman L, Pretty I A, Jenner T. Estimating the need for dental sedation. 1. The Indicator of Sedation Need (IOSN) - a novel assessment tool. Br Dent J 2011; 9: 211: E10.

  4. Scottish Dental Clinical Effectiveness Programme. Conscious Sedation in Dentistry, Dental Clinical Guide, Second Edition, June 2012.

  5. Galeotti A, Garret Bernardin A, D'Antò V et al. Inhalation Conscious Sedation with Nitrous Oxide and Oxygen as Alternative to General Anesthesia in Precooperative, Fearful, and Disabled Pediatric Dental Patients: A Large Survey on 688 Working Sessions. Biomed Res Int 2016; 2016: 7289310.

  6. Al Sarheed M A. Intranasal sedatives in paediatric dentistry. Saudi Med J 2016; 37: 948-956.

  7. Standards for conscious Sedation in the Provision of Dental ccre. Report of the Intercollegiate Advisory Committee for Sedation in Dentistry. The dental faculties of the royal colleges of surgeons and the Royal College of Anaesthetists.

  8. Prause A, Wappler F, Scholz J, Bause H, Schulte am Esch J. Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance. Intensive Care Med 2000; 26: 1454-1461.

  9. Hines R L, Marschall K E. Stoelting's Anesthesia and Co-existing disease. 7th edition Elsevier.

  10. Roth D, Pace N L, Lee A et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev 2018; 5: CD008874.

  11. Iyer M S, Pitetti R D, Vitale M. Higher Mallampati Scores Are Not Associated with More Adverse Events During Pediatric Procedural Sedation and Analgesia. West J Emerg Med 2018; 19: 430-436.

  12. Appukuttan D P. Strategies to manage patients with dental anxiety and dental phobia: literature review. Clin Cosmet Investig Dent 2016; 8: 35-50.

  13. Kisely S. No Mental Health without Oral Health. Can J Psychiatry 2016; 61: 277-282.

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  1. King´s College London, Great Maze Pond, SE1 9RT, London, UK

    Alisha Amin

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Correspondence to Alisha Amin.

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Amin, A. Conscious sedation and its use in management of anxious patients. BDJ Student 28, 52–54 (2021). https://doi.org/10.1038/s41406-020-0182-2

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