Sedation and Special Care

Question 1

What problems may make providing dental treatment difficult?

Answer 1

Anxiety
Movement disorders- muscular dystrophy, cerebral palsy, MS, Parkinson’s, Huntingdon’s.
Learning difficulties

Question 2

How long does the AWI form last for in Scotland?

Answer 2

Lasts up to 36 months.

Question 3

What factors influence the choice of sedation technique?

Answer 3

Patient co-operation
Degree of anxiety
Dentistry required- how long do you need for the treatment?
Skills of the dental team
Patient’s previous experience
Facilities available
Anaesthetist required?

Question 4

What is Remimazolam?

Answer 4

Sedative drug that has gone through 3 phases of clinical trials, great interest in the dental profession.

Question 5

What are the advantages of Remimazolam compared to Midazolam?

Answer 5

Rapid onset and breakdown compared to midazolam.
- Midazolam elimination half lifee is 1.5-2 hours, remimazolam is 7-11 minutes.

Broken down by tissue esterase and hepatic carboxylesterase-1 and not P450.

Question 6

What factors would you consider if you were deciding between sedation and GA?

Answer 6

Medical history
Is the patient in pain?
Waiting lists and access to services
Co-operation of the patient
Safety- controlled airway in GA, difficult intubation.