Berenguer Periodontics & Oral Implantology
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Sedation & General Anesthesia

The administration of local anesthesia, sedation and general anesthesia is an integral part of dental practice. The American Dental Association is committed to the safe and effective use of these modalities by appropriately educated and trained dentists. The purpose of these guidelines is to assist dentists in the delivery of safe and effective sedation and anesthesia.

Definitions

  • Analgesia - the diminution or elimination of pain.
  • Local anesthesia - the elimination of sensation, especially pain, in one part of the body by the topical application or regional injection of a drug.
  • Minimal sedation - a minimally depressed level of consciousness, produced by a pharmacological method, that retains the patient's ability to independently and continuously maintain an airway and respond normally to tactile stimulation and verbal command. Although cognitive function and coordination may be modestly impaired, ventilatory and cardiovascular functions are unaffected.
  • Moderate sedation - a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

The following definition applies to the administration of moderate or greater sedation:

  • Titration - administration of incremental doses of a drug until a desired effect is reached. Knowledge of each drug’s time of onset, peak response and duration of action is essential to avoid over sedation. Although the concept of titration of a drug to effect is critical for patient safety, when the intent is moderate sedation one must know whether the previous dose has taken full effect before administering an additional drug increment.

Our Office

At our office, we provide minimal and moderate sedation using oral and intravenous (IV) methods of drug administration. IV titration of medicaments is our method of choice for added patient safety and comfort. With IV sedation, medicaments are titrated directly into the blood stream and have an instantaneous effect. The same can be said for reversal agents in case of complications. When administering IV sedation, if desired sedation objectives are not achieved, the doctor may safely administer more medication until desired effects are obtained. Efficacy of medicaments, amnestic effects of medicaments and safety increase with IV sedation. It is not commonly used in dental offices due to the specialized advanced training required and the requirements for certification by the State Board of Dentistry.

Educational Requirements

  • Minimal Sedation
    1. To administer minimal sedation the dentist must have successfully completed:
      • training to the level of competency in minimal sedation consistent with that prescribed in the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, or a comprehensive training program in moderate sedation that satisfies the requirements described in the Moderate Sedation section of the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students at the time training was commenced
      • an advanced education program accredited by the ADA Commission on Dental Accreditation that affords comprehensive and appropriate training necessary to administer and manage minimal sedation commensurate with these guidelines;
      • a current certification in Basic Life Support for Healthcare Providers.
    2. Administration of minimal sedation by another qualified dentist or independently practicing qualified anesthesia healthcare provider requires the operating dentist and his/her clinical staff to maintain current certification in Basic Life Support for Healthcare Providers.
  • Moderate Sedation
    1. To administer moderate sedation, the dentist must have successfully completed:
      • a comprehensive training program in moderate sedation that satisfies the requirements described in the Moderate Sedation section of the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students at the time training was commenced,
      • an advanced education program accredited by the ADA Commission on Dental Accreditation that affords comprehensive and appropriate training necessary to administer and manage moderate sedation commensurate with these guidelines;
      • a current certification in 1) Basic Life Support for Healthcare Providers and 2) Advanced Cardiac Life Support (ACLS) or an appropriate dental sedation/anesthesia emergency management course.
    2. Administration of moderate sedation by another qualified dentist or independently practicing qualified anesthesia healthcare provider requires the operating dentist and his/her clinical staff to maintain current certification in Basic Life Support for Healthcare Providers.

For additional information, please visit The American Academy of Periodontology at: www.perio.org

For the full length ADA document, please visit the The American Dental Association at: www.ada.org

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