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Diplomate of the National Dental Board of Anaesthesiologists (USA), Professor of Anaesthesiology and Sedation at University of the Western Cape, and Programme Director of Postgraduate Certificate in Dental Sedation and Pain Management at University College London
Effective pain control is a basic requirement for patients undergoing dental treatment, particularly under conscious sedation as patients are usually nervous. In order to achieve adequate pain management, clinicians must have an understanding of the physiology of pain, the various pain control modalities and be aware of the evidence base relating to analgesia in dentistry. This article focuses on how to provide effective pain control using analgesic drugs for patients undergoing dental conscious sedation, whilst also considering other available pain control modalities.
Clinical Relevance: Dentists have a duty to provide, and patients have a right to expect, adequate and appropriate pain and anxiety control.
Article
The General Dental Council document Maintaining Standards. Guidance to Dentists on Professional and Personal Conduct1 emphasizes the importance of adequate pain and anxiety control by stating that dentists ‘have a duty to provide and patients have a right to expect adequate and appropriate pain and anxiety control’. This statement is fundamental to the provision of successful conscious sedation.
Conscious sedation has been defined as:
‘A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation.’1
The drugs and techniques used should carry a margin of safety wide enough to render loss of consciousness unlikely, with protective reflexes maintained.
Two categories of sedation techniques exist; basic and advanced techniques.
Basic techniques involve the use of a single agent drug at a time, administered via a single route. This includes inhalational sedation using nitrous oxide with oxygen, intravenous sedation using titrated midazolam alone, or a benzodiazepine administered orally or transmucosally.
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