Sedation is one of the anxiety control technique used in dentistry. Typically, consideration should be given to the possibility of local anaesthetic techniques with or without conscious sedation. Sedation is most frequently used during extensive procedures, for children who find it difficult to sit still, or for children with dental phobia. There are various types of sedation, including IV sedation, nitrous oxide ("laughing gas"), oral sedatives and general anesthetic. There are many efficient and safe medications available to the dental practitioner for producing conscious sedation. Given the many sedatives that are available, all possessing different degrees of risk and clinical characteristics, careful consideration is needed when deciding on the pharmacologic agents.
Sedation can range from general anesthetics used to put them to sleep to the use of nitrous oxide to calm a child. This is suitable for children with major dental treatment, dental phobia, low pain tolerance, physical handicaps or strong gag reflexes. Procedures like crowns, fillings, bridges, root canals, extractions, cosmetic procedures and periodontal treatments often require sedation. While sedation can improve the patient experience, if performed poorly it has the potential to cause significant harm. Some authorities are of the opinion that patients' protective reflexes are impaired at any level of sedation, and sedation merges into anaesthesia in a continuum of loss of consciousness. Despite its excellent safety record, there remains disquiet about the provision of conscious sedation for dental care. All anaesthetists should fully grasp the definition of 'conscious sedation', and be well versed with the concepts of 'monitored anaesthesia care' and 'deep sedation'. For dental outpatients undergoing conscious sedation, recovery from sedation must be sufficient to allow safe discharge home. This safety measure is required as many researchers have defined "recovery time" as the time until the patient was permitted to return home after the end of dental treatment.
Conscious sedation is a technique in which the use of drugs produces a state of depression of the central nervous system (CNS). This enables dental treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The techniques, as well as the drugs used in providing conscious sedation for dental treatment, should carry a margin of safety wide enough to render loss of consciousness unlikely. There are a few standard techniques: Firstly, the IV sedation using midazolam alone. Secondly, inhalational sedation using nitrous oxide/oxygen. And thirdly is the oral/intranasal benzodiazepine, but only within a strictly defined protocol that requires competence in IV sedation and specific training, especially venous access.
So, therefore, sedation is a technique of anesthesia usually used for children. Though many patients would prefer to have, their dentistry performed with sedation if it were offered to them. It has been prepared for medical and dental practitioners (including anaesthetists) which defines the minimum standard for safe and effective patient care regardless of the clinical setting. It is worth noting that dental sedation is an issue that still needs to be clarified in some regions of the world; the respective roles of physicians and dentists need to be determined to benefit the population.
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