Key Points
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Describes the use of intravenous conscious sedation (IVCS) with midazolam in adolescents within a primary-care setting.
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Illustrates the potential for conscious sedation to provide a viable alternative to general anaesthesia for some adolescents undergoing surgical dental procedures.
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Identifies the need for appropriate assessment of patient suitability to receive treatment under conscious sedation.
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Highlights the potential for IVCS midazolam to facilitate care for young people both within other areas of dentistry and medical specialities.
Abstract
Background Surgical dentistry during orthodontic care often occurs in adolescence and may involve surgical removal or exposure of teeth. The invasive nature of treatment, combined with dental anxiety, means care can often be provided under general anaesthesia (GA). Best-practice guidelines however endorse conscious sedation as an alternative, where appropriate. Although a limited number of studies have shown safe and effective use of intravenous conscious sedation (IVCS) with midazolam in this cohort, robust evidence to support routine use is lacking. Aim To assess whether IVCS with midazolam can effectively facilitate surgical dentistry in adolescent orthodontic patients in primary care.
Method A retrospective service evaluation was undertaken reviewing clinical records of adolescents (aged 12–15 years) undergoing surgical exposure and/or surgical removal of teeth under IVCS with midazolam.
Results A total of 174 adolescents (mean age 14.2 years) attended for treatment between 2009 and 2015. Of these adolescents, 98.9% (N = 172) allowed cannulation, with all surgical dentistry completed during a single visit. Midazolam dose ranged from 2–7 mg with 79.1% of patients having good or excellent cooperation and three minor adverse events occurring.
Conclusion This service evaluation shows IVCS with midazolam can effectively facilitate surgical orthodontics in carefully selected adolescents. There is however a distinct need to further explore potential for this technique to provide a viable alternative to GA.
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CRV is funded by a Clinician Scientist Award supported by the National Institute for Health Research. This paper details independent research and the views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health.
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Stamp, A., Dorman, M., Vernazza, C. et al. Can intravenous conscious sedation with midazolam be effective at facilitating surgical dentistry in adolescent orthodontic patients? A service evaluation. Br Dent J 222, 113–119 (2017). https://doi.org/10.1038/sj.bdj.2017.78
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DOI: https://doi.org/10.1038/sj.bdj.2017.78
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