3 Common Mistakes in Sedation Dentistry
Discussing the most common mistakes made during dental sedation, questions to ask yourself, and how to make patient safety the centre of your practice.
Creating a safety culture within the dental practice is the responsibility of the entire dental team. Patient safety should be at the centre of our practice as health care professionals and there is value in having a team approach to ensure a culture of safety is embedded, reducing the risk to the patient.
Mistake 1
Insufficient pre-screening
Patient pre-assessments are key factors in determining:
- if the patient is a candidate for sedation
- the method of sedation to be used
- drug type/dosage
Sedation can be unpredictable; any drug can produce any level of sedation depending on the patient. For example – if we compare sedation to alcohol – a single glass of wine may have no effect on one person while another person could be unfit to drive, or over the legal limit. If we look at sedation in the same light, it’s easier to understand why every patient must be assessed before, during and after receiving sedation.
Before scheduling a procedure where sedation will be used, every patient must be evaluated to determine if they are a suitable candidate. Then, on the procedure day when the patient arrives, the patient must be evaluated again.
Questions to consider:
- Does your patient meet the criteria for sedation?
- Are there any contraindications for sedation with this patient?
- Is your facility the best place for the patient to undergo the procedure with sedation?
- Did the patient follow the right pre-appointment instructions?
- Has the patient taken any medications that could impact the effects of sedation?
Mistake 2
Inadequate training
The College of Dental Surgeons of Alberta (CDSA) sets standards for sedation in dentistry. The CDSA’s standards indicate all sedation team members must:
- be adequately trained
- be competent to carry out the delegated tasks
- have current Basic Life Support (BLS, also known as Healthcare Provider CPR – Level C) training
The CDSA defines a sedation team members as:
a responsible adult designated by the regulated member [dentist] to be part of the delivery of sedation services.
Additionally, they define a sedation monitor as:
a person designated by the responsible regulated member [dentist] to monitor a patient’s vital signs who is adequately trained, competent and indemnified to carry out the delegated tasks. Must have current Basic Life Support (BLS) training. A sedation monitor must be trained through a sedation monitoring training course approved by the CDSA.
Before assisting with sedation procedures, dental assistants must have adequate training and be able to answer:
- What drugs are being used, what is the average dosage, and could I recognize if someone is receiving too much?
- How does mixing sedatives impact the patient response?
- Do I know when monitoring equipment is required, and does the facility have adequate monitoring equipment?
- Do I have the theoretical knowledge and clinical competencies to:
- appropriately monitor a patient
- provide the best care for a patient
- Can I identify the subtle signs when a sedated patient is having an adverse reaction?
- What are the risks if I don’t have adequate training?
Mistake 3
Inability to rescue
Sedation is a continuum; knowing and understanding the differing levels of sedation is vital. Practitioners and team members should be able to identify when a patient has unexpectedly slipped beyond the intended level of sedation and be able to rescue the patient.
Ask yourself:
- Do I know what the responsiveness of the patient should be?
- Am I able to identify an airway obstruction without relying on monitors to indicate a problem is occurring?
- Am I able to assist during an emergency and/or an airway crisis?
- Will the sedation team be able to ventilate the patient if required?
- Are emergency medications available, present in the operatory, and not expired?
- Does the office have all necessary equipment to rescue a patient?
- Is all equipment in good working order and accessible?
- Have team members used simulated emergency scenarios to practice how to respond?
- Are there enough sedation team members present to adequately monitor the patient and respond to a patient in crisis?
This table can be found in the CDSA’s sedation standards. Being familiar with the content in this table will aid in patient safety.
| Minimal Sedation Anxiolysis | Moderate Sedation/ Analgesia (“Conscious Sedation”) | Deep Sedation/ Analgesia | General Anesthesia |
|
| Responsiveness | Normal response to verbal stimulation | Purposeful* response to verbal or tactile stimulation | Purposeful* response following repeated or painful stimulation | Unarousable even with painful stimulus |
| Airway | Unaffected | No intervention required | Intervention may be required | Intervention may be required |
| Spontaneous Ventilation | Unaffected | Adequate | May be inadequate | Frequently inadequate |
| Cardiovascular Function | Unaffected | Usually maintained | Usually maintained | May be impaired |
It is the duty of the entire dental team to place the patient’s well-being first. By taking appropriate training and being informed, common mistakes can be avoided, and we can ensure patient safety is at the centre of our practice.
After all, what would you expect if you were the patient?
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