By Krista Lewandowski, CDA, EFDA
Sedation dentistry is growing in popularity. Its benefits are well-thought-out selling points not only to make the procedure easier on the patient, but also easier on the dental team that provides the services.
Daily, I see ads for weekend seminars that train dentists for in-office oral sedation dentistry. It’s more affordable than traditional intravenous sedation, and it’s easier to monitor and doesn't require the services of an anesthesiologist.
For a short time when I returned to work full time following the birth of my son, I worked in a dental office that prided itself on "free" oral conscious sedation dentistry. As we all know, nothing in this world is free. Though we were well equipped to monitor our patients’ vital signs, every case caused anxiety, as there is so much that can go wrong. Personally, I felt this type of extensive dentistry should be referred to an oral surgeon, or taken on case-by-case as hospital dentistry.
Though I am well educated, I didn’t feel I was good enough to be the eyes and ears watching over these people while they were being sedated. I know it isn’t the case in all offices, but the dentist I was working for was not as involved in this process as I thought he should be, coming in to prep and perform dentistry only, and working on other patients the hour before and the 90 minutes following sedation treatment. The patients’ care in the time leading up to and following the dental procedure was left in my very capable but anxious hands. There is so much that can go wrong, and it can only take seconds.
Dental offices where sedation dentistry is performed should ensure that there is a medication within reach to reverse the sedation. Blood pressure, oxygen saturation, and heart rate are all closely monitored, as well as the type and amount of prescription sedatives administered during the procedure. Among these drugs are chloral hydrate, Valium, Ativan, Midazolam, and nitrous oxide. These are usually used in some combination to relieve anxiety and sedate a patient.
Pre-existing medical conditions, diseases, and illness can complicate oral sedation procedures. It seems like the littlest patients should be our biggest concern. Of the oral sedation-related deaths I researched prior to writing this article, all except one were children. If you work in an office that routinely provides pediatric sedation, please keep in mind that some offices discourage parents from coming back to the treatment area while work is being done. As an assistant, you need to become the patient’s advocate during that time. Protect this precious child with all your love and talents, and never, ever leave a sedated patient alone.
I was blessed that while I worked in this type of dental office — or any dental office for that matter — I was never faced with a life or death emergency. That’s not to say that there weren't situations. I once had a man who easily outweighed the doctor and me put together who became violent during conscious sedation. All we could do to remedy the situation was sedate the patient further and stand back and wait for the medication to take effect.
I also treated countless escape artists who were obviously sedated trying to get up and leave. I had one older lady who kept asking me if I moved the ashtray, and she kept looking for it while making smoking motions with her hands. One girl getting her impacted wisdom teeth removed had an hour-long conversation about brands and flavors of yogurt. I had a man sing to me and tell me about the time he got shot. There are too many other funny incidents to count. You never know what you'll get when you sedate a patient, so my advice is to hope and pray for the best and be prepared for the worst. Know that every patient gives you more experience and makes you more valuable to the doctor you serve.
It is important to note, however, that requirements for dental assistant monitoring of different types of sedation vary by state. Contact your state dental board for sedation and monitoring requirements. State-specific information, including state dental board contact information, can also be found on the Dental Assisting National Board (DANB) Web site. Visitors can download DANB's "State Regulation of Dental Assistants' Roles in Sedation and Anesthesia" chart directly by clicking here.
Krista C. Lewandowski, CDA, EFDA, has been in dental assisting since 1999. She has worked as both a chairside and expanded functions dental assistant. She is on the ADAA council for new membership. She has been married since 2001 and has two children — 8-year-old Isabella and 3-year-old Jack. She also started a social networking Web page for dental assistants called “wichita kansas dental assistants” on Facebook. Contact her at [email protected].
By Krista Lewandowski, CDA, EFDA