A DOCS Education member seeks the faculty’s assistance:

Hello Dr. Feck. I have a 44-year-old male patient who presented to the office with a blood pressure of 154/108. He was extremely afraid and reported terrible past dental experiences. He reported no allergies. His medications are:

  • Doxycycline hydrate 100 mg
  • Amlodipine Besylate 5-40 mg for high blood pressure

He will take .25 triazolam an hour before treatment and probably another dose when he gets to the office.

He is a social drinker and will not drink for a week before the sedation appointment. He smokes a cigar every once in a while.

Any advice would be appreciated—including your thoughts on the placebo effect—such as how and where to get it.

Thank you!

Dr. Anthony Feck, DOCS Education faculty, offers his advice:

It’s impossible to say whether the patient has uncontrolled hypertension or that the blood pressure reading is the result of anxiety.

It is best to err on the side of safety and have the patient checked out by his PCP before being sedated.

There are no drug interactions to be concerned with here.

From your proposed protocol, it appears you can incrementally dose, so I would recommend the “Golden Protocol” (Incremental Protocol #1) for your patient.

The placebo effect comes from planting an idea in a patient’s mind to achieve an effect rather than getting the effect from a drug. There are many methods to achieve this. In the DOCS Education Oral Sedation Dentistry course, one of the placebo techniques we teach is using crushed up sugarless Life Savers to make patients who don’t really need more medication think they are getting more medication.

Disclaimer

The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.

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The information contained in this, or any case study post in Incisor, should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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