SPS Plenary Session | May 20, 2019, 3:15 pm | James Tom, DDS, MS
Delivery of dental sedation is performed by various provider types, thus collaboration between disciplines is essential. Pediatric sedation provided by dentists often depends on the type of training and pediatric exposure received during residency. Pediatric dentists generally provide in-office moderate sedation whereas dental anesthesiologists commonly provide in-office deep sedation and general anesthesia. Oral surgeons fall somewhere in the middle providing moderate and deep sedation to adolescents and occasionally to younger children if qualified to do so.
In-office sedation can be challenging depending on support personnel qualifications, patient considerations, and outfitting of the work environment. Most dental offices do not have a RN, but have unlicensed dental assistants who are trained on dental surgical techniques that do not include assisting with sedation complications. Dental chairs can often articulate in the appropriate position for sedation but rooms can be confining. Dental procedures may use: mouth-oropharyngeal partitions (i.e. rubber dams) which block the oral airway; oral lasers which may interact with oxygen delivered through a nasal hood; or, materials such as crowns which are small in nature and if mishandled due to a wet environment, (i.e. saliva) may become an aspiration risk. The oral airway may be compromised by orthodontic appliances in the child’s mouth or by the child’s anatomy. An example would be a 6 year old child naturally exfoliating loose primary teeth with an orthodontic expander on the palatal vault.
Dental sedation presents a variety of challenges. With the exceptions of bronchoscopy and gastroduodenoscopy, medical sedation often occurs without concern for the procedure obstructing the airway. It is essential to adapt, improvise, and overcome such challenges when delivering sedation at sites remote from a full service health or ambulatory surgical center.