Conscious sedation service for geriatric and special-care dentistry: A health policy brief

Abstract

Background: Geriatric and special care dentistry (GSD) involves oral health care for seniors and individuals with disabilities. Due to ethical issues, finances, waiting times, treatment versatility and so on, conscious sedation (CS) may have a place to optimise the delivery of care. Objectives: This article identifies considerations for implementing CS in GSD services in Singapore. Methods: Taking the form of a health policy brief, this review (a) defines the situation for patients with special-care needs and justified the need for dental CS, (b) makes reference to practices from countries with established dental CS services, (c) states and evaluates available CS techniques for the GSD centre in Singapore and (d) discusses action plans and considerations for implementation. Results: Demographic analysis revealed that 23.8% of the GSD patients could have benefitted from CS, or 44.7% of all patients who required behavioural management. The key advantages of CS included enhanced safety, more teeth saved and a reduction in general anaesthesia wait, amongst others. Conventional dental CS techniques included midazolam via various routes, nitrous oxide and ketamine. To establish a CS service, key points of consideration need to be conceptualised first, such as adequate training, perception of patients and providers, operational costs, facilities and developing guidance specific for oral health professionals. Conclusion: A local CS service will be beneficial for GSD patients in view of the challenges faced. A group of experts and stakeholders is needed to provide practical consensus.

An Ethical Analysis Regarding the COVID-19 Pandemic Impact on Oral Healthcare in Patients with Mental Disorders

“…Pharmacological sedation techniques have been found to increase patient cooperation, create less traumatic therapeutic contexts, and allow for more personalized care. This approach is particularly beneficial for individuals with mild intellectual disability [ 81 , 82 ]. In the current pandemic situation, Alharbi et al have categorized dental treatments into different groups.…”

The challenges of dental care provision in patients with learning disabilities and special requirements during COVID‐19 pandemic

“…This would be particularly useful in the treatment of individuals with mild moderate learning disabilities, young patients with attention deficit hyperactivity disorder and people with dental phobia. [9][10][11] Particularly nowadays, conscious IV sedation, with the use of titrated single-drug short acting benzodiazepines or propofol, seems to be the optimal pharmacological method of anxiety management in dentistry, as an alternative to DGA that is currently very limited. 12 Midazolam, the most common sedative agent for IV technique in SCD demonstrated to be efficient and safe in clinical use in outpatient settings.…”

“…14 However, in general, conscious sedation procedures using IV midazolam have been shown to be safe and effective in patients with intellectual disabilities. 10,11,15 The shortage of hospital staff involved in general anesthesia and/or sedation, as a result of COVID-19 crisis, creates additional problems related to interrupted access to specialist medical support. It is worth noting that the presence of a qualified anesthesiologist is mandatory for IV sedation provision for dental management purpose in a vast majority of countries, with some exemptions.…”

Factors determining the need for general anesthesia to deliver dental treatment for adults with intellectual and developmental disabilities

“…[ 1 ] Furthermore, when treatment does occur, adults with special needs are more likely to have multiple dental extractions than conservative dental treatment with dental fillings. [ 2 ] Although conscious sedation helps to provide dental treatment for many adults who live with IDD,[ 3 ] the need for general anesthesia (GA) to deliver dental care cannot be eliminated. [ 4 ] GA is one of the behavioral management techniques that can be used to deliver dental care for adults who live with severe dental anxiety, IDD, dementia, physical limitations, behavioral disorders, and chronic systemic conditions.…”