Enteral sedation: safety, efficacy, and controversy

This article reviews the safety and efficacy of enteral sedation use by dentists to provide an evidence-based perspective on the current controversy associated with the use and training requirements for enteral sedation in dental outpatients. Despite the many benefits to patients and dental practitioners, the administration of anxiolytic agents by the oral, sublingual, or rectal route (collectively referred to as enteral sedation) is controversial and has engendered efforts to limit its use and increase training requirements to levels similar to those for parenteral sedation. Factors contributing to this controversy include the off-label use of sedative-hypnotics for outpatient sedation, idiosyncratic reactions to triazolam, and incremental dosing. Evidence supports the continued need and demand for anesthesia and sedation services to ensure access to care for highly anxious and phobic patients, the very young, and special-needs patients. The published evidence and vast clinical experience for oral sedation with benzodiazepines also supports the safety of administering benzodiazepines for anxiety relief with little evidence of deleterious effects when administered incrementally to patients undergoing a dental procedure or at doses greater than those used for hypnosis. Enteral sedation with benzodiazepines remains a time-tested, safe, and widely used modality that needs to be maintained as part of general practice to ensure adequate access to dental care for the many patients for whom fear of dentistry remains a significant barrier to oral health care.