Anesthesia and Sedation in the Dental Office

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Abstract
Pain is a major factor that brings patients to the dental office, while fear and anxiety about pain are common reasons patients fail to seek dental care. The magnitude of this public health problem is indicated by the fact that there are 35 million Americans who avoid dental treatment until forced into the office with a toothache. The control of pain and anxiety is therefore an essential part of dental practice. To accomplish this objective, various techniques are used, including psychological approaches, local anesthetics, and various types and combinations of sedative and general anesthetic agents. The choice of the most appropriate modality for a particular situation is based on the training, knowledge, and experience of the dentist; the nature, severity, and duration of the procedure; the age and physical and psychological status of the patient; the level of fear and anxiety; and the patient's previous response to pain-control procedures. The use of sedative and anesthetic techniques in the dental office represents a unique situation when compared with their use in the hospital environment. Dental patients are ambulatory and generally in good health, the procedures are usually shorter, the depth of anesthesia or level of sedation is often less, and it is the fear and apprehension of the patient rather than the nature of the procedure that frequently dictates the use of these techniques. These differences often are not clearly understood. As a result, the use of sedation and anesthesia in the dental office has sometimes been unduly criticized. Despite the record of safety that has been established by the dental profession, problems have occurred and questions have been raised regarding the training necessary for the safe and effective use of sedation and general anesthesia, the indications and contraindications for the use of these techniques in different age groups, the appropriate agents to be used to provide the greatest margin of safety, and the proper management and monitoring of the patient. To resolve some of these questions, the National Institute of Dental Research of the National Institutes of Health, along with the Food and Drug Administration and the National Institutes of Health Office of Medical Applications of Research, convened a Consensus Development Conference on Anesthesia and Sedation in the Dental Office from April 22 to 24, 1985. After listening to a series of presentations by experts in the relevant basic and clinical science areas, a consensus panel composed of individuals knowledgeable in medical and dental anesthesiology, oral and maxillofacial surgery, pediatric dentistry, general dentistry, dental education, pharmacology, behavioral science, biostatistics, epidemiology, and the public interest considered all of the material presented and agreed on answers to the following questions: What are the differences between general anesthesia, deep sedation, and conscious sedation? What are the indications and contraindications for the use of general anesthesia and sedation in children, adults, and the geriatric population? What are the appropriate agents and techniques for general anesthesia and sedation? What are the risks associated with the use of general anesthesia and sedation? What facilities, equipment, personnel, and training are needed for managing and monitoring patients? What are the directions for future research?

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