Effective and safe pediatric oral conscious sedation: philosophy and practical considerations

Because dental treatment can represent a threatening event for some children, need exists to include sedation within our management arsenal. By definition, pre-cooperative children and those lacking in cooperative ability have immature cognitive skills, a highly restricted range of coping abilities, brief or negligible attention spans, and virtually no experience coping with stress. As result, they can be especially prone to maladaptive responses to anxiety provoking situations. For many of these, traditional non-pharmacologic behavior management strategies may often prove inadequate or inappropriate to overcome resistive or uncooperative behaviors. The importance of intervention with non-aversive techniques that provide a safe, child-oriented environment and timely opportunity in which to encounter and cope with fear-producing situations cannot be dismissed. The use of sedation techniques can frequently serve to obtund interfering and potentially harmful behaviors to safely permit quality care, minimize or eliminate the need for aversive measures, and help bridge the transition for a child lacking cooperative ability to the time when cooperation potential develops.