Maximum cumulative doses of sedation medications for in-office use

The AGD acknowledges that dentists may need an additional permit to perform the procedure described in this article. Many states require dental practitioners to have additional or advanced training in order to perform enteral sedation. In some states, practitioners must have an i.v./conscious sedation permit before they are allowed to titrate (dose) oral medication. The ADA does not believe that oral medication can be titrated (dosed) without an i.v. sedation license. The AGD has adopted and published a white paper on sedation issues, which appeared in the September-October 2006 issue of General Dentistry. The AGD encourages continuing education in sedation modalities for general dentists. Oral conscious sedation (OCS) is an increasingly common practice in dentistry and is at the forefront of evolving state regulations. At the center of the OCS controversy is the oral titration of medications. Most medications available for OCS are used in an "off-label" manner and have no determined maximum recommended dosage for that purpose. This article proposes cumulative maximum dosing guidelines for in-office OCS, with an emphasis on triazolam.