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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

A presedation checklist.13Note: The ASA classification system is a health-grading system used commonly by medical and dental providers. ASA I = healthy, ASA II = mild systemic disease.Abbreviations: Hx, history; Tx, treatment; M, male; F, female; ASA, American Society of Anesthesiologists.
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f3-ccide-7-097: A presedation checklist.13Note: The ASA classification system is a health-grading system used commonly by medical and dental providers. ASA I = healthy, ASA II = mild systemic disease.Abbreviations: Hx, history; Tx, treatment; M, male; F, female; ASA, American Society of Anesthesiologists.

Mentions: The greatest successes are achieved by focusing on safety before the sedation appointment. Preparation begins with appropriate case selection. Using a standard form for presedation, patient assessment helps eliminate guesswork (Figure 3). Appropriate assessment includes patient medical history, physical examination (including targeted airway assessment), and assignment of an American Society of Anesthesiologists score.51,52 Similarly, in-office sedation should be limited to healthy children. Healthy children and those with mild systemic disease (American Society of Anesthesiologists score I and II) can generally be cared for safely and effectively in the dental clinic. Complicated medical conditions including heart disease, obstructive sleep apnea, and obesity have been shown to increase sedation risk and the chances of failed sedation.53 These factors must be considered carefully when selecting the sedation regimen and venue.


Pediatric dental sedation: challenges and opportunities.

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

A presedation checklist.13Note: The ASA classification system is a health-grading system used commonly by medical and dental providers. ASA I = healthy, ASA II = mild systemic disease.Abbreviations: Hx, history; Tx, treatment; M, male; F, female; ASA, American Society of Anesthesiologists.
© Copyright Policy
Related In: Results  -  Collection

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

f3-ccide-7-097: A presedation checklist.13Note: The ASA classification system is a health-grading system used commonly by medical and dental providers. ASA I = healthy, ASA II = mild systemic disease.Abbreviations: Hx, history; Tx, treatment; M, male; F, female; ASA, American Society of Anesthesiologists.
Mentions: The greatest successes are achieved by focusing on safety before the sedation appointment. Preparation begins with appropriate case selection. Using a standard form for presedation, patient assessment helps eliminate guesswork (Figure 3). Appropriate assessment includes patient medical history, physical examination (including targeted airway assessment), and assignment of an American Society of Anesthesiologists score.51,52 Similarly, in-office sedation should be limited to healthy children. Healthy children and those with mild systemic disease (American Society of Anesthesiologists score I and II) can generally be cared for safely and effectively in the dental clinic. Complicated medical conditions including heart disease, obstructive sleep apnea, and obesity have been shown to increase sedation risk and the chances of failed sedation.53 These factors must be considered carefully when selecting the sedation regimen and venue.

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