Minimal Adult Sedation in Dentistry: Oral Sedatives and Nitrous Oxide Inhalation Sedation

Course Overview
Providing dental care to anxious and fearful patients continues to be a major challenge facing dentists. Despite advances in management techniques and treatment delivery, patients’ preexisting opinions and experiences contribute to dental anxiety and fear.  Feelings of apprehension create psychological obstacles that prevent dental patients from seeking and receiving care. Of the current techniques to facilitate coping or to minimize procedure apprehension, in-office enteral sedation or oral conscious sedation has garnered the most attention. In recent years, the use of oral benzodiazepines such as triazolam and lorazepam (with or without nitrous oxide - oxygen) for the diminution of perioperative anxiety and fear in dental patients has increased.   State dental boards, in response, have changed or developed new regulations outlining the training and equipment needed for in-office anxiolysis and oral conscious sedation.  Although state regulations for the provision of in-office sedation vary widely with respect to training and pharmacological strategies, consonance exists on the use of inherently safe drugs, the use of pulse oximetry, and the availability of emergency equipment including pharmacologic antagonists.  
Upon completing this intermediate-level course, the learner will be able to discuss the continuum of consciousness and understand where oral sedatives with or without N2O/O2 sedation may fit in the treatment paradigm. This course will also fill gaps in knowledge concerning patient selection, regulations, contraindications, and techniques for appropriate administration in certain special populations requiring advanced consideration. The principles learned will be directly applicable in determining the most suitable approach for patients and will help to address staff concerns around potential environmental risks to inhalational sedation.

Learning Outcomes 
Upon the completion of this course, the learner should be able to:

• Describe the continuum of consciousness, the mechanism of action, and pharmacological properties of the benzodiazepine family of medications.
• Describe the history, pharmacology, and physical properties of oral and nitrous oxide–oxygen inhalational sedation medications.
• Discuss the use of oral sedatives with or without nitrous oxide-oxygen inhalation sedation for in-office minimal adult sedation.
• Recognize important physiological considerations when providing sedation to select patient populations.

About the Author/Presenter 
Mark Donaldson, BSP, RPH, PharmD, ACPR, FASHP, FACHE, received his baccalaureate degree from the University of British Columbia and his doctorate in clinical pharmacy from the University of Washington. He has further completed a residency at Canada’s largest tertiary care facility, Vancouver General Hospital, and is the current AVP of Pharmacy Consulting Services at Vizient. Dr. Donaldson is a clinical professor in the Department of Pharmacy at the University of Montana in Missoula, and clinical associate professor in the School of Dentistry at the Oregon Health & Science University in Portland. He has a special interest in dental pharmacology and has lectured internationally to both dental and medical practitioners. Dr. Donaldson has a number of published works in peer-reviewed literature and has co-authored textbook chapters. He spent three years in Japan focusing on cross-cultural communication and internationalization. He currently serves on the Editorial Board for The Journal of the American Dental Association (JADA), is board-certified in healthcare management, and is the past-president and current Regent of the American College of Healthcare Executives’ Montana Chapter. In 2016 he was recognized by the Academy of General Dentistry as the recipient of the Dr. Thaddeus V. Weclew Award. This award is conferred upon an individual who has made outstanding contributions to the art and science of dentistry and/or enhanced the principles and ideals of the Academy. In 2019 he was awarded the “Special Friend of Canadian Dentistry Award,” by the Canadian Dental Association (CDA) in Ottawa. This international award is given to an individual outside of the dental profession in appreciation for exemplary support or service to Canadian dentistry and/or to the profession as a whole.

Audience/Accreditations and Approvals 
TRC Healthcare/ NetCE 
In support of improving patient care, this activity has been planned and implemented by TRC Healthcare/ NetCE. TRC Healthcare/NetCE is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 
This course is designed for the following healthcare professions (select your profession for details):
Dental AGD Code: 340

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