An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study.

INTRODUCTION: Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. METHODS: A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. RESULTS: The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. CONCLUSIONS: There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping.

A clinical report of the management of episodic idiopathic pruritus occurring during endodontic therapy.

INTRODUCTION: In endodontic practice, conditions may arise that are unexpected despite thorough preparation. The purpose of this case report was to describe how a condition of episodic idiopathic pruritus, which was undiscovered in the medical history taking, was managed without a loss of time. METHODS: A 29-year-old woman presented to the graduate endodontic clinic for conventional endodontic treatment of tooth #30 and intravenous moderate sedation for dental phobia. Before the administration of intraoral local anesthetics or intravenous medications, the patient was unable to keep still because of itching. When questioned, the patient reported that she suffers from this condition fairly regularly. The patient reported that the itching could be initiated by stress or for no apparent reason. Intraoral local anesthesia was administered, intravenous access was attained, and an analgesic and antihistamine were given. RESULTS: Two minutes after the administration of the antihistamine, the itching resolved, and the treatment was completed without further incident. CONCLUSIONS: This case provides an example of how an unexpected incident of episodic idiopathic pruritus was managed via the intravenous route without a loss of scheduled appointment time.