What is Conscious Sedation?

To sedate or not to sedate, that is the question.  Dental sedation has been brought to light by the media in the past few years and the light has not been very complementary.  Sedation is when medications are administered to create a relaxed or peaceful state.  It is a spectrum, and depending on the patient’s needs, the provider will decide what level of sedation is necessary to accomplish the desired goal.

Dental sedation can be used for adults, but I will be focusing on sedation for children since that is my area of expertise.  When I was in residency, in our first sedation class my professor said, “Children are not little adults!  Do not sedate them like they are an adult.”  At the time, I did not know what he meant.  When working with adults, there is more standardization as far as prescribing medications.  With a child, typically, prescribing should be based off his weight and not his age or maximum dosage.  Young children do not have mature respiratory systems, do not have a large oxygen reserve, and can become overly sedated quickly.

There are hundreds of medications that can be used to sedate children and as some would say, “many ways to skin a cat.”  I will not discuss specific medications, but each provider has their “go to” medications that they use depending on the situation and the desired goal.  When the term “conscious sedation” is used, I am referring to minimal sedation.  My goal for a child is that he be awake but relaxed for the procedure.  The child should be able to follow my instructions and have all his normal reflexes intact.

Conscious sedation is safe when practicing within the guidelines set forth by the American Academy of Pediatric Dentistry.  This is not to say that there should not be some level of healthy fear anytime medications are introduced.  As I stated before, sedation is a spectrum and a child can easily slip further down the sedation spectrum than may be intended.  Whenever a child is sedated, it is important to keep in mind where the child is on the spectrum, and as a provider, “Am I comfortable with how this child is responding?”  If not, what is the causing the problem and how do I fix it quickly. 

When I was in dental school, I had several patients that were terrified of the dentist.  Many of these patients had a bad experience as a child and have carried these fears into adulthood.  Sedation was not a common practice even twenty years ago.  At that time, it was not uncommon to use restraints or behavioral techniques that are not as acceptable at this day in time.  Children are impressionable creatures and do remember bad experiences that may affect them for the rest of their life.  This is one of the reasons why I decided to go into pediatric dentistry.  If I can give a child a good dental experience, then that child will carry this mindset to adulthood and is more likely to seek dental care on a routine basis instead of waiting for an emergency to arise. 

I am not going to lie, sedation appointments are not my favorite, but if it will give a child a good experience, I will do it.  During residency, I completed over double the amount of sedation cases required and feel comfortable with the medications I prescribe.  I maintain my Pediatric Advanced Life Support certificate.  All my staff is certified in Basic Life Support.  I complete an inventory of our crash cart monthly to make sure I have everything I need on the off chance I run into a situation where I may need to rescue a child.  We have staff meetings weekly where we discuss various office emergencies, and how we will handle them.  I hope to always maintain a healthy fear that I may need to use my advanced training.  Sedating a child is never something to be taken lightly, but it can be a useful tool in creating an enjoyable dental experience for some children.