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Pediatric dental sedation: challenges and opportunities.

Nelson TM, Xu Z - Clin Cosmet Investig Dent (2015)

Bottom Line: This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety.To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety.While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA.

ABSTRACT
High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

No MeSH data available.


Related in: MedlinePlus

Nitrous oxide nasal hood modified for use with an end-tidal carbon dioxide sampling line.
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f1-ccide-7-097: Nitrous oxide nasal hood modified for use with an end-tidal carbon dioxide sampling line.

Mentions: In response to growing safety concerns, EtCO2 monitoring is now used increasingly in ambulatory settings17,18,20,25 (Figure 1). Professional association guidelines reflect this trend, and the American Society of Anesthesiologists has amended its standards for basic anesthetic monitoring to require EtCO2 for moderate or deep sedation.25 In dentistry, perhaps the most widely recognized professional sedation guidelines come from the American Dental Association. For children 12 years of age and under, the American Dental Association recognizes the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAP/AAPD) guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Both the American Dental Association and the AAP/AAPD guidelines suggest that EtCO2 monitoring may be used to evaluate respiration; however, it is not currently required for moderate sedation.16,26 In the USA, each state has unique requirements for a dentist to perform sedation. States vary considerably regarding training standards, required continuing education, and advanced life support credentials required to maintain a sedation permit.27 Similarly, there is no nationally recognized government standard for monitoring of dental patients during sedated procedures. However, some states have begun to mandate the use of EtCO2 monitors for dental sedation. Given this trend, it is possible that in the future EtCO2 monitoring will become the standard for sedated patients in dental offices and health care facilities.


Pediatric dental sedation: challenges and opportunities.

Nelson TM, Xu Z - Clin Cosmet Investig Dent (2015)

Nitrous oxide nasal hood modified for use with an end-tidal carbon dioxide sampling line.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4555969&req=5

f1-ccide-7-097: Nitrous oxide nasal hood modified for use with an end-tidal carbon dioxide sampling line.
Mentions: In response to growing safety concerns, EtCO2 monitoring is now used increasingly in ambulatory settings17,18,20,25 (Figure 1). Professional association guidelines reflect this trend, and the American Society of Anesthesiologists has amended its standards for basic anesthetic monitoring to require EtCO2 for moderate or deep sedation.25 In dentistry, perhaps the most widely recognized professional sedation guidelines come from the American Dental Association. For children 12 years of age and under, the American Dental Association recognizes the American Academy of Pediatrics/American Academy of Pediatric Dentistry (AAP/AAPD) guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures. Both the American Dental Association and the AAP/AAPD guidelines suggest that EtCO2 monitoring may be used to evaluate respiration; however, it is not currently required for moderate sedation.16,26 In the USA, each state has unique requirements for a dentist to perform sedation. States vary considerably regarding training standards, required continuing education, and advanced life support credentials required to maintain a sedation permit.27 Similarly, there is no nationally recognized government standard for monitoring of dental patients during sedated procedures. However, some states have begun to mandate the use of EtCO2 monitors for dental sedation. Given this trend, it is possible that in the future EtCO2 monitoring will become the standard for sedated patients in dental offices and health care facilities.

Bottom Line: This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety.To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety.While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Dentistry, University of Washington, Seattle, WA, USA.

ABSTRACT
High levels of dental caries, challenging child behavior, and parent expectations support a need for sedation in pediatric dentistry. This paper reviews modern developments in pediatric sedation with a focus on implementing techniques to enhance success and patient safety. In recent years, sedation for dental procedures has been implicated in a disproportionate number of cases that resulted in death or permanent neurologic damage. The youngest children and those with more complicated medical backgrounds appear to be at greatest risk. To reduce complications, practitioners and regulatory bodies have supported a renewed focus on health care quality and safety. Implementation of high fidelity simulation training and improvements in patient monitoring, including end-tidal carbon dioxide, are becoming recognized as a new standard for sedated patients in dental offices and health care facilities. Safe and appropriate case selection and appropriate dosing for overweight children is also paramount. Oral sedation has been the mainstay of pediatric dental sedation; however, today practitioners are administering modern drugs in new ways with high levels of success. Employing contemporary transmucosal administration devices increases patient acceptance and sedation predictability. While recently there have been many positive developments in sedation technology, it is now thought that medications used in sedation and anesthesia may have adverse effects on the developing brain. The evidence for this is not definitive, but we suggest that practitioners recognize this developing area and counsel patients accordingly. Finally, there is a clear trend of increased use of ambulatory anesthesia services for pediatric dentistry. Today, parents and practitioners have become accustomed to children receiving general anesthesia in the outpatient setting. As a result of these changes, it is possible that dental providers will abandon the practice of personally administering large amounts of sedation to patients, and focus instead on careful case selection for lighter in-office sedation techniques.

No MeSH data available.


Related in: MedlinePlus