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Sedation in the Dental Office: An Overview

Course Number: 464

Oral Sedation

Because of convenience, oral sedation is the most common and the most accepted by patients. It is often used for the management of the mild to moderate anxiety and in some cases to assist the patient to have a restful night prior to the appointment. The goal is to produce a lightly sedated, relaxed, more cooperative patient that is easier to manage and not to produce moderate sedation or pain control.

Because of the sedative effect, no matter how mild, it is the responsibility of the dentist to inform the patient of the need of a responsible adult escort to and from the office. Examples of oral sedatives used in dentistry include benzodiazepines such as diazepam (Valium), lorazepam (Ativan), triazolam (Halcion), and midazolam (Versed); and non-benzodiazepines such as zolpidem (Ambien) and zaleplon (Sonata).

  • Advantages Compared to other sedation modalities, the cost of oral sedatives to the patient and the dentist is minimal. There are no special techniques, equipment or injections involved, and the dentist does not require extensive advanced training. Oral sedation can be beneficial to patients with medical conditions such as cardiovascular disease, renal/hepatic diseases, epilepsy and diabetes. Nonetheless, it is always advisable to consult the patient's physician to better understand the patient's medical status. 28

  • Disadvantages One of the major disadvantages of oral sedation is the inability to titrate. Because the drug has to travel through the gastrointestinal tract and the portal hepatic circulation, only a small portion of the drug will reach its site of action. The onset of action (30 minutes to 60 minutes) as well as recovery may be delayed. Relying on patients' compliance, especially providing an escort, may be a problem. Potential common adverse drug effects include nausea and vomiting.

  • Indications Oral sedation alone is mainly used in the management of the mild to moderate dental anxiety. It may also be used or as an adjunct to other methods of sedation for the severely anxious. However, in the latter case, the dentist should have additional advanced sedation training beyond the dental school curriculum.

  • Contraindications Oral sedatives should be avoided if (1) rapid onset of action and titration are desired - in this case inhalation or intravenous sedation would be a better choice; (2) patient has a history of chronic drug use - it is important to explain to the patient the importance of honest disclosure, as sedation may be ineffective in patients with high tolerance to certain drugs; (3) patient has known allergy to the sedative; (4) patient is pregnant or nursing; (5) patient is being treated for depression and bipolar disorders; and (6) patient has acute narrow-angle glaucoma – avoid benzodiazepines.