Conscious sedation for dentistry: risk management and patient selection

Despite the many advances in pain control that have expanded our abilities to perform a wide range of dental treatment in a pain-free environment, many adult dental patients still have a great deal of fear about treatmentevoked pain. Discussions about conscious sedation, and possibly general anesthesia, seem to be appropriate in developing treatment plans for this population of fearful patients. Are there other adult populations that also may benefit from sedation during dental treatment? For example, what about the developmentally disabled adult who is unable to cooperate with the dental treatment team, thus decreasing the efficiency and safety of delivering dental treatment? Or what about the adult with a medical history of angina that can be precipitated by moderately stressful events like intraoral injections of local anesthesia? These two examples should suggest that there are other patient populations that would also benefit from sedation during dental treatment. Given the unpleasant nature of many dental procedures, one could argue that sedation is used too little in the practice of dentistry. In contrast, many disciplines of medicine use some sort of sedation when performing procedures that can be considered simple and less stressful when compared with many dental procedures. There are clearly several situations in which local anesthesia alone may be insufficient to deliver dental treatment. In some cases the use of parenteral sedation (ie, intramuscular and intravascular) or general anesthesia may be among the pharmacologic methods for consideration as treatment adjuncts. Advanced clinical training and licensing is