By Charles J. Bohle, DMD Prepared by DOCS Education A woman presented with two chief complaints. She was deeply displeased by the combination of several missing teeth and what she described as an unattractive smile. The 37-year-old patient was otherwise very fit and in excellent health. She was classified as ASA 1 because she reported neither regular medications nor significant medical history. During her first visit the patient received a routine oral examination along with radiographs and a prophylaxis. She indicated that she suffered from an extreme fear of dental procedures and surmised that these likely accrued from a series of traumatic experiences as a child. The oral examination revealed a number of problems. Number 3 indicated a non-painful failing root canal therapy accompanied by chronic periapical disease. Number 13 was previously extracted. Number 19 had a failing aged stainless steel crown, and number 20 was a retained primary tooth with a missing number 30 permanent molar. The patient was also missing her maxillary lateral incisors. A treatment plan was presented to deal with these issues. While assenting to the overall treatment plan, the patient indicated her extreme phobia prevented addressing all of the problems at one time. She elected first to address the esthetic matter posed by the missing maxillary anterior teeth. She chose to do this while receiving oral sedation. Other aspects of the plan proposed to close all diastemas and reshape anterior teeth using Empress crowns on numbers 5, 6, 8, 9 and 11. The goal was further to reshape numbers 6 and 11 to look like lateral incisors and number 5 as a canine. The presedation workup included registering pre-operative blood pressure, heart rate and oxyhemoglobin saturation; these were measured with a pulse oximeter. The patient reviewed pre- and post-operative instructions and provided her written consent. The patient took 5 mg diazepam the night before her appointment. One hour prior to her arrival at the office she took 0.25 mg triazolam. While at the sedation appointment the patient was administered another 0.25 mg triazolam along with 50 mg hydroxyzine sublingually. Although she was resting well, the patient still exhibited anxiety 40 minutes into the appointment. For that reason an additional dose of 0.125 mg triazolam was given. The procedure began shortly following as the patient was well sedated but still fully responsive to verbal commands. Yet another dose of 0.125 mg triazolam was provided 40 minutes later, again based upon the patient’s condition. No further medication was required and the patient comfortably finished the procedures. The next day the patient was contacted and reported a high degree of satisfaction with the effects of the sedation. In fact she declined sedation for the subsequent insert appointment. The inserts were completed with no complications and the patient again expressed great pleasure with the outcome. She has since completed the full treatment plan without using sedation. She proudly proclaims herself to be “cured” from dental phobia.

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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