Choosing a drug for anxiolysis (minimal sedation) in dentistry
Oral benzodiazepines and inhaled nitrous oxide are the most commonly used drugs for anxiolysis (minimal sedation) in a general dental practice. Administer a single drug. The choice between an oral benzodiazepine or nitrous oxide depends on patient factors (eg contraindications, potential drug interactions, preference), the clinical setting and the dentist’s expertise—see Advantages and disadvantages of oral benzodiazepines and inhaled nitrous oxide for anxiolysis in dentistry.
|
Drug |
Advantages |
Disadvantages |
|---|---|---|
|
oral benzodiazepine |
well accepted by patients easy to administer |
slow onset and long duration of action cannot be titrated to rapidly lighten or deepen the level of sedation not suitable for use in children or adolescents outside the specialist setting |
|
inhaled nitrous oxide |
rapid onset and offset of action easy to administer can be titrated to rapidly lighten or deepen the level of sedation suitable for use in children and adolescents |
requires training and specialised equipment |
Methoxyflurane is an analgesic used to facilitate painful surgical procedures and for the emergency relief of acute pain; however, it is not recommended for use as an anxiolytic for dental procedures because of inadequate evidence. The use of methoxyflurane is further limited by its short duration of action and the need for oral inhalation, which restricts access to the mouth. Repeated use can pose an occupational risk to staff, particularly during pregnancy.
Other sedative drugs (eg sedating antihistamines) are not recommended for anxiolysis for dental procedures.
Intravenous administration of sedative drugs (intravenous sedation) requires specialised postgraduate training. Further, intravenous sedation must be administered in an accredited facility, with appropriately trained staff present.