Overview of anxiolysis and sedation in dentistry
Anxiolysis refers to a range of pharmacological and nonpharmacological methods used to alleviate fear and anxiety. This topic focuses on the pharmacological methods used for anxiolysis (minimal sedation) in patients undergoing dental procedures. Safe and effective use requires careful patient assessment, appropriate choice of drug and effective management of patients.
Anxiolysis should only result in minimal sedation. Patients respond normally to verbal commands. Cognitive function and coordination may be impaired, but no interventions are required to maintain a patent airway, spontaneous ventilation or cardiovascular function. The transition from consciousness to loss of consciousness is a continuum. There is significant interpatient variability in the effects of drugs used for anxiolysis—loss of consciousness can occur rapidly and unexpectedly. Therefore, practitioners involved in the administration and monitoring of patients receiving anxiolysis must be prepared to manage the associated risks, including:
- oversedation or loss of consciousness
- airway obstruction or respiratory depression
- cardiovascular depression
- drug interactions, adverse reactions or anaphylaxis.
Conscious sedation refers to a drug-induced depressed conscious state; patients respond purposefully to verbal commands, with or without light tactile stimulation. In exceptional circumstances, interventions to maintain a patent airway, spontaneous ventilation or cardiovascular function may be required. The Dental Board of Australia provides a standard for the use of conscious sedation in dental practice1.
Deeper sedation (including intravenous sedation) and general anaesthesia are characterised by a greater depression or loss of consciousness, and are restricted to appropriately trained practitioners practicing in accredited facilities. Fatalities have occurred due to incorrectly administered intravenous sedation in dental practice. Guidelines on intravenous sedation are under constant review to improve its safety and those applicable to dental practice were updated in 20142.
Conscious sedation, deeper sedation and general anaesthesia are beyond the scope of this topic (for management of pain associated with a painful procedure, see Procedural sedation and analgesia).