Chapter 1

Introduction

A small percentage of the population in any country actively avoids attending a dentist because of fear and those who do attend declare themselves anxious in a dental environment. The two main reasons for non-attendance are fear and associated costs. Patients who do not attend because of fear can be classified as being phobic, whereas others can be termed anxious. Other reasons for non-attendance can be attributed to lack of dentists in the area, difficulty in registering with a dentist or inability to access a dentist because of factors such as mobility problems. The provision of sedation in oral, intravenous, inhalation and transmucosal (off-licence) forms helps to overcome a patient’s fears and anxieties, but not necessarily their phobia. However, by accepting sedation patients are able to undergo the dental care required to maintain a healthy mouth. These forms of sedation are explained in detail in Chapter 5 [1].

DEFINITION OF CONSCIOUS SEDATION

Conscious sedation is 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. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely’. This means that patients must remain conscious and are able to understand and respond to any requests, (i.e. if the patient is asked to take a few deep breaths, he or she is able to do so). There is no such thing as deep sedation as any loss of consciousness is classed as a general anaesthetic and compromises the patient’s safety. This definition explains the state of conscious sedation but not how it should be achieved. However, it is widely recognised that clinicians use different techniques involving the administration of one or more drugs through different routes, all of which provide patients with safe sedation [2,3].

WHY DENTAL SEDATION IS USED

Humanitarian reasons

Sedation can help patients accept treatment who have treatment-related anxiety and phobia [1].

Anxiety and phobia

Anxiety is a state of unease that a person can often relate to because of the memories of whatever is causing them to feel anxious. This existing memory may be something that was experienced by the patient or it could be a translated experience from their family, friends or media. Very often the patient is able to explain and relate to the specific cause or occasion in their life that results in their anxiety when faced with a similar situation/experience. As anxiety is controllable to a degree, patients who are anxious will attend the dentist for treatment and with good patient management they undergo treatment, with or without the aid of sedation, depending upon their treatment plan. These patients are often found to have sweaty palms and an e/>