I-2 A Milligram of Prevention is better than a Pound of Resuscitation
CE: 1.5
Course Description: The safety of sedation and anesthesia has been controversial for decades and has been the focus of a Consensus Development Conference held at NIH (Laskin and Dionne, 1986), workshops (Dionne et al. 2006) and large clinical trials to identify drugs, doses and combinations that optimize the relationship between clinical efficacy and patient safety (Dionne et al. JADA 2006). A recent case series to re-examine the safety of sedation resulted in a preliminary finding of N=39 deaths reported in the public domain. Most of the deaths in the series were attributed to respiratory depression, consistent with the administration of drugs that suppress respiration at the doses administered. The ADA revised their guidelines in 2016 for teaching the various levels of sedation which usually translates into regulations by state dental boards for training and emergency preparedness. What is often omitted is consideration of the drugs and doses that have evidence to support their safety when administered by dentists in an outpatient setting. The objective of this program is to review the evidence and rationale for minimizing adverse events associated with providing enteral sedation, and to present clinical strategies for effectively managing anxious patients with drugs that provide a wide margin of safety.
At the conclusion, participants should be able to:
- Describe that patient-centric relief of anxiety for a dental procedure is not synonymous with CNS depression resulting in the appearance of sedation.
- Explain the scientific basis for the efficacy and safety of anxiolytic drugs.
- Provide enteral sedation with anxiolytic and analgesic effects similar to parenteral sedation but without the risks of 'eminence-based' drugs, doses and combinations prone to significant morbidity and mortality in the dental office.
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Raymond Dionne, D.D.S., M.S. Ph.D.
Dr. Dionne received a DDS from Georgetown University and a PhD from the Medical College of Virginia. He conducted clinical and translational pain research at the National Institute of Dental and Craniofacial Research for 34 years, as well as practiced dentistry part-time in the District of Columbia. He is currently a restless retiree living in Missouri.
Speaker Disclosure
In accordance with this policy, I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: AIM Targeted Therapeutics: Consultant on preclinical development of an investigational analgesic formulation (Ongoing); Rilento Pharma: consultant for pre-clinical development of investigational analgesic formulation (Ongoing)
Raymond A. Dionne, DDS, MS, PhD
I declare I have a past or present proprietary or relevant financial relationship or receive gifts in kind (including soft intangible remuneration), consulting position or affiliation, or other personal interest of any nature or kind in any product, service, course and/or company, or in any firm beneficially associated therewith, as indicated: Aegis Dental Network () : Consultant, Honorarium; Charleston Laboratories () : Consultant, Honorarium; Novartis Consumer Health () : Consultant, Honorarium
