Under the guidance and supervision of oral surgeons at my AEGD, I am to complete the program with the requirements for obtaining a moderate conscious sedation license in dentistry. As we know, there are many patients that experience anxiety and stress when it comes to visiting the dentist, let alone having surgical procedures completed. Thus, a form of sedation can be appealing to them and extremely helpful for both the patient and dentist to feel comfortable in completing the treatment.
In my residency, we have discussed the different methods of achieving conscious sedation, such as orally and intravenously. We are completing our cases with IV access and administration of midazolam and fentanyl. IV access allows for titration of the medication, easier reversal, and a line is already started should any other medication need to be given in the event of a medical emergency. While oral administration may be easier for a nervous patient to handle, it is not as controlled.
The oral surgeons in my program have made it clear that when it comes to sedation, it’s not about how MUCH you can give, it’s about how little you can give and still get the work done comfortably. This is a very important point to understand because more meds means more likely to experience unwanted side effects, such as respiratory depression and other medical emergencies. Being selective in what patients you treat with sedation is critical to your success and comfort. We are only offering IV sedation to ASA I and II patients with Mallampati I and II, who are not obese and can withstand the treatment. This is a lesson in setting yourself up for success, not failure.
We began offering IV sedation after becoming ACLS-certified. The clinic has Criticare monitors that measure blood pressure, heart rate, heart rhythms and oxygen saturation. Our first 10 sedations are partnered, where one resident performs the sedation and the other is doing the dental procedure. After these 10, we will be required to complete at least 15 cases of sedation and treatment on our own. In the end, we have a review with our oral surgeons about the details of sedation and the management of medical emergencies. After clearing that, we have to get a final sign-off by the oral surgeon that says they recommend us for a moderate conscious sedation license.
I am curious to know how many AGD members are using sedation in their practices, and if that sedation is oral and/or IV. When I’ve browsed area websites online that state they offer sedation dentistry, they seem to just be offering it as a pill. I hope to get comfortable enough with IV sedation managing medical emergencies that I will be able to offer this to my patients in my future practice.
Katie Divine, DDS