Conscious sedation in dentistry is a technique whereby the patient is either hypnotised or given drugs to calm them and to take away the pain associated with dental fillings and surgery. I am going to abbreviate it as ‘conscious sedation dentistry’ for this article. Conscious sedation dentistry needs to be carefully distinguished from general anaesthesia in dentistry. Conscious sedation dentistry is distinct from an anaesthetic dental technique because with conscious sedation dentistry the patient is conscious enough to follow and respond to verbal instructions. Apart from hypnotic sedation dentistry, where at most a local anesthetic is given, other forms of conscious sedation dentistry rely on the use of various drugs plus local anesthetic. The most commonly used drugs for conscious sedation dentistry are diazepam, midazolam, propofol and nitrous oxide. All of these drugs can also cause anaesthesia and for this reason have to be administered by highly trained doctors and dentists. When using diazepam, midazolam, propofol one has to be especially careful to avoid transferring the patient from a conscious fairly cooperative patient to one who is anesthetised and therefore unconscious. For this reason, it is best if another dentist, doctor or anaesthesiologist administers these drugs, so that the person who administers this form of conscious sedation dentistry is not distracted by actually doing the actual operation. Another disadvantage of using these drugs is that one also needs, apart from another practitioner to administer the drugs, dedicated external monitoring devices. The minimum two monitoring devices necessary to correctly and safely monitor a patient under conscious sedation dentistry with diazepam, propofol, midazolam or similar drugs is an oximeter (to read arterial blood oxygen saturation) and an electrocardiograph (to monitor heart function). There is one drug however, that is much safer for operators who wish to apply conscious sedation dentistry while operating and that is low doses of nitrous oxide (with high concentrations of oxygen). When using nitrous oxide/oxygen. no external monitoring devices are necessary apart from the vigilance of the person who is simultaneously giving the sedation and doing the dental procedure.
PAN may only be used by registered medical, dental and nursing professionals. However, before using PAN, it is obligatory that such professionals must attend a short hands-on-training practical training under the supervision of an expert, such as Prof M Gillman. He has authored a presentation on the theoretical aspects of using PAN. The presentation is available as a (CD or via direct download). Those interested should write to Professor Gillman ( see below).
Click here for training program on nitrous oxide.