Oral sedation dentistry is amedical procedure involving the administration ofsedative drugs via anoral route, generally to facilitate a dental procedure and reduce patientsanxiety related to the experience. Oral sedation is one of the available methods of conscious sedation dentistry, along withinhalation sedation (e.g.,nitrous oxide) and consciousintravenous sedation.[citation needed]Benzodiazepines are commonly used, specificallytriazolam.[1] Triazolam is commonly selected for its rapid onset and limited duration of effect.[1] An initial dose is usually taken approximately one hour before the dental appointment.[1] Treatment may include additional dosing on the night proceeding the procedure, to mitigate anxiety-relatedinsomnia.[1] The procedure is generally recognized as safe, with theeffective dosages being below levels sufficient to impairbreathing.[2]
Dental patients with generalized anxiety,belonephobia (fear of needles and sharp instruments), prior dental trauma, or generalized fear of the dentist can take oral medication in order to reduce their anxieties.[3] A variety of single and incremental dose protocols are used to medicate the patient as early as the day before treatment.[4] Medication additionally helps reduce memory or the sights and smells of the dental office to avoid recall of any trauma.[5] The sedative effect allows more dentistry to be completed in fewer appointments as well as allowing complex procedures to be performed in less time.[6]
Drug characteristics must be carefully considered when choosing the appropriate medication. Matching factors, such as where the drug is metabolized and any underlying diseases requires a good medical history and thorough knowledge of the drug's characteristics. All risk factors, individual characteristics, and procedural complexities can be taken into account in order to provide the best drug choice.[citation needed]
Courses in Oral Sedation Dentistry are offered across North America at various dental schools and private organizations. The largest for-profit provider of dental sedation continuing education in North America is theDental Organization for Conscious Sedation. Specialty courses are being taught in pediatric sedation, ACLS, IV Sedation and emergency preparedness.[citation needed] The largest not-for-profit organization that provides educational courses in oral sedation as well as IV sedation and general anesthesia is theAmerican Dental Society of Anesthesiology.[7]
Education and training requirements to administer sedation vary by state. TheADA has set forth general sedation guidelines that have been adopted or modified by many states. There are typically dosing limitations involved withanxiolysis, usually a single dose the day of treatment not to exceed the maximum recommended dose (MRD) of the medication in order to achieve the intended level of sedation. However, these sedation laws vary from state to state. Anxiolysis protocols are designed to treat healthy ASA I & II patients ages 18 and up for one to four hours of treatment. Some states now require a permit even fornitrous oxide administration and/oranxiolysis.[citation needed]
The main advantages of oral sedation[citation needed] versus other sedation methods are:
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