Retrospective Evaluation of Phobic or Handicapped Patient’s Sedation Techniques for Dental Treatment

Aims: Phobic or handicapped patients presenting a lack of cooperation need pharmacological sedation techniques for performing dental procedures. The purpose of the study was to retrospectively evaluate the morbidity outcomes of dental patients receiving various levels of sedation in Oral and Maxillofacial Surgery Clinic supervised by an anesthesiologist.
Place and Duration of Study: This study was performed in the Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey from January 2009 to July 2010.
Methodology: This study was approved by the Department of Oral and Maxillofacial Surgery at Gazi University Faculty of Dentistry. All relevant data were obtained from the patients' dental records. The sample consisted of 321 patients. Dental procedures performed included tooth extractions (simple tooth and impacted tooth extractions), orthognathic surgery, maxillofacial trauma procedures, tumor resections, cystenucleations, excisional biopsies, reconstructive surgery, abscess drainage, prosthetic, endodontic, periodontal, combined treatments or surgery for orthodontic purposes.
Results: There were 164 males and 157 females (American Society of Anesthesiologists (ASA) I:181, ASA II:137, ASA III:3). Their ages ranged from 2.5 to 85 years with a median age of 25.8 years. 177 patients had phobic anxiety disorder and 96 patients had mental motor retardation. Sedation level was minimal (50), moderate (94), deep sedation or general anesthesia (177). Of the 321 cases nausea and vomiting (23, 7.1%), postoperative agitation (8, 2.5%), desaturation (5, 1.6%), bradycardia (3, 0.9%), hypotension (3, 0.9%), ventricular extra systoles (1, 0.3%) and tachycardia (1, 0.3%) were determined as a complication.
Conclusion: Careful consideration needs to be given to the objectives of the sedation when deciding which pharmacologic agents to be used because they all possess slightly different clinical characteristics and various degrees of risk. Patient and agent selection are the most critical factors when making decisions about sedation because the patient's expectations and general health status are of big importance for keeping the procedure safe. There are safe and effective sedative combinations for reducing patient fear and improving the level of comfort. But unexpected, rare and catastrophic events can occur with sedation.