Oral sedation or pre-medication for an anxious patient?

When a member wasn't sure what sort of sedation it would be appropriate for them to prescribe to an anxious patient, they called the DDU.

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The scene

A member called the advice line seeking guidance about managing an anxious patient. The patient had requested our member provide them with oral sedation before treatment, and the member wanted to know if this was appropriate.

DDU advice

Our adviser suggested that it would be for the member to assess the patient's request in light of the patient's level of anxiety and the planned treatment.

It would be important to distinguish between an oral pre-medication (such as a low dose of diazepam) and oral sedation. An oral pre-medication could be prescribed by a GP or by the member themselves, and would involve self-administration by the patient outside of the dental practice. The member would have to consider if this was a safe option to consider before suggesting it, and should keep good records of their decision making process.

The member was advised that oral sedation, by contrast, would involve the administration of a higher dose of an oral sedative within the dental practice, and as such, they would need to be fully trained, competent, and indemnified to provide this service, since monitoring and discharge requirements for oral sedation are the same as for intravenous sedation.

For further guidance, the adviser directed the member to the Royal College of Surgeons' 'Standards for Conscious Sedation'. The member was grateful for the advice.

Learning points

It is important to recognise that there are different kinds and levels of conscious sedation, and whichever one a dentist chooses to use when managing a nervous or anxious patient should be based on clinical need and patient assessment. Good communication skills are essential, and should include face-to-face discussions and explanations about the type of sedation to be used.

Any dentist considering administering oral, intravenous or inhalation sedation must be trained, competent and indemnified, and the environment must also be suitable for its delivery. It would be advisable to give written information to everyone involved, which would include carers and anyone else accompanying the patient. Clinicians should be able to appropriately manage any associated adverse incidents and medical emergencies.

Regardless of whether an oral pre-medication or oral sedation were to be used, a patient's capacity to consent could be affected. Remember that being able to fully consent means a patient must be able to:

  • understand information relevant to the decision (for example, the nature of proposed treatment and its consequences)
  • retain the information provided to them
  • weigh up the information as part of their decision-making process
  • be able to communicate their decision.

If the treatment plan were to change mid-way through treatment under an oral pre-medication or oral sedation, it would be advisable to delay treatment if it was felt this would be in the patient's best interests, especially if treatment was irreversible. As ever, good record keeping would be very important.

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This page was correct at publication on . Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.