Dr. Roger Sanger is DOCS Education’s lead instructor for Pediatric Sedation Dentistry and has personally performed over 13,000 pediatric sedation cases. This week he sat down with Incisor to explain why sedation dentistry, if performed by a skilled and responsible doctor, is a safe, dependable and important method of treatment for children with anxiety:

I am a believer that with the proper training and regulatory guidance, a general dentist can perform safe and effective sedation to aid in the dental treatment of children and teens. Proper training must include (among many other subjects) the selection of proper drug(s) and their safe use, and MOST IMPORTANTLY, the proper selection of the child or teen.

The general dentist will never replace the pediatric dentist or the oral surgeon, but they can make dental treatment for many children and teens much more comfortable. Minimal oral conscious sedation performed by trained GPs provides children with a much more pleasant dental experience, thus making them better patients for the rest of their lives. This is because one of the main reasons adults stay away from the dentist today is the fear they had and poor experiences they received as children in dental offices. Eliminate the bad experiences and you eliminate the fear.

What is minimal oral conscious sedation? It is the use of a sedative drug(s) given orally to achieve sedation whereby the child can have a depressed level of consciousness but retain his/her ability to continuously and independently utilize their airway and respond appropriately to physical stimulation and verbal commands. Can one drug do this? Yes. Can two drugs be better? Sometimes. Can nitrous oxide added in provide analgesia? Certainly.

For the majority of cases that a general dentist will encounter in practice where oral conscious minimal sedation will be beneficial, the use of one drug (midazolam is the most popular) given at or below the maximum recommended therapeutic dose (MRTD) with nitrous oxide, oxygen inhalation, analgesia and injectable local anesthesia will suffice. Cases requiring a higher degree of sedation because of patient selection or length of treatment can be referred to the pediatric specialist who may want to achieve moderate sedation.

If one drug is sufficient, why use nitrous oxide or local anesthesia? Nitrous oxide is the safest drug we have to achieve analgesia. Along with injectable local anesthesia, nitrous oxide analgesia will reduce pain sensation thus allowing for a lesser amount of the sedative drug to achieve a better and safer level of minimal sedation.

Why do some states allow a GP to administer a second sedative drug? The second sedative drug (hydroxyzine is the most commonly used) will be synergistic to the first drug thus allowing a lower dose of the first. The second sedative drug is usually for great working time and antiemetic, antihistaminic, antisialologue properties.

I believe that allowing a GP to administer one sedative drug without nitrous would not allow the child or teen to whom the sedation is intended to receive the most comfortable dental treatment. I also believe many states are correct in establishing educational requirements for its regs. I also know that in a child it is AIRWAY, AIRWAY, AIRWAY. Therefore, I encourage states to establish a requirement that any dentist sedating a child be certified by the AHA in PALS (Pediatric Advanced Life Support) and recertified every two years by the AHA. I also feel strongly that the dentist should have a CE requirement for recertification of the sedation regulations by a state.

The four major reasons for complications during dentist administered oral sedation are as follows:

  1. They picked the wrong patient due to physical, mental, medical, drug, etc. compromising conditions. (EDUCATION)
  2. They used an overdose of the sedative drug(s). (EDUCATION)
  3. They used an overdose of the local anesthetic drug(s). (EDUCATION)
  4. They allowed a foreign body to go down the throat by not protecting the airway (no rubber dam or suitable isolation). (EDUCATION).

All these topics should be educational requirements established by the regulations.

Thank you for allowing me to present my opinions. By and large they are supported by the opinions and guidelines of my academy—AAPD and the ADA. I spend most of my time now in Idaho, as I have retired from active clinical practice. I live in Ketchum nine months of the year and California the other three. I hold an inactive dental license in Idaho that I received by reciprocity many years ago. I have never practiced in Idaho nor do I intend to leave retirement. I simply feel that, as a retired dentist, I should obtain an Idaho license. I remain a Life member of ADA, CDA, and my local dental society in California. I am also a life member of AAPD and WSPD/CSPD.

In closing, Dr. Sanger puts it well: It is vital that pediatric sedation dentistry be performed by a skilled and responsible doctor. The key to achieving this level of skill is through intelligent and thorough education. When the proper steps are taken, pediatric sedation can be hugely beneficial for children and help them develop healthy relationships with dentistry all the way into adulthood.

To learn more about Pediatric Sedation Dentistry, Click Here

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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