Making patients safe and comfortable for a lifetime of dentistry: frontiers in office-based sedation

Conscious sedation administered in the office setting is one important method for helping people obtain necessary dental care. Patients who may benefit from sedation include the dentally fearful, young children, the behaviorally or medically challenged, and individuals who are undergoing invasive procedures or have problems with gagging or local anesthesia. In-office sedation is effective in reducing apprehension and can improve patient behavior without adversely affecting the patient's physiological status. Mortality and serious morbidity are exceedingly rare in modern practice. Although behavioral strategies are clearly more cost-effective for the patient receiving routine dental care, in-office sedation is usually the least expensive alternative for patients requiring pharmacologic management. Future advances in conscious sedation may include agents and techniques currently thought to be dangerous for nongeneral anesthesia-trained dentists because of their ability to produce rapid changes in anesthetic depth. However, delivery devices such as infusion pumps for drugs like propofol, when coupled with computers to help regulate the infusion rate and monitor the sedative effect, may provide the necessary control for safe administration of propofol and similar drugs by these individuals. A final approach to drug delivery may involve patient-controlled sedation in which the patient self-infuses small boluses incrementally until the desired effect is achieved.