What's new in paediatric conscious sedation in dentistry?

E research and clinical experience have demonstrated the usefulness of sedation in helping fearful patients receive dental treatment, particularly when they have urgent treatment needs. In addition, the efficacy of behavioural programmes for managing dental fears is well established. While often these two approaches are seen as oppositional, our work in Seattle, Morgantown and at King’s College London Dental Institute demonstrates the complementarity of the two approaches. Using the example of two compounds, one very familiar, propranolol, and one that has recently become of interest, D-cycloserine, we wish to illustrate the manner in which these medications can be used to enhance behavioural approaches to managing dental anxiety. Introduction Pharmacological approaches are an everyday part of dental practice in preventing and alleviating pain, yet many practitioners currently under-utilise them, failing to fully address anxiety, fear and panic. Behaviour therapy alone is very effective, yet is largely unavailable in dental surgeries or specialist hospitals. The combination of anxiolytic medications and behavioural techniques has great potential but is rarely practised in the UK or elsewhere. Several possibilities are available, including the use of behavioural approaches to enhance compliance with pharmacological approaches (such as sedation). This article focuses on a currently available anti-anxiety medication (propranolol) with demonstrated efficacy, and a medication (D-cycloserine) on the horizon, which has promise in terms of enhancing behavioural exposure (see Table 1 for a glossary of clinical terms) for anxiety disorders, including dental phobia. We have argued in this journal that dental sedation patients would be more effectively treated in the long run if they first received preparatory behavioural treatment. Indeed, this approach is being evaluated on a pilot basis at the Department of Sedation and Special Care Dentistry at King’s College London Dental Institute. In this on-going study, patients who are to be sedated because they have difficulty co-operating are able to learn coping skills to manage their own anxiety using a computer-driven self-help program, and therefore have the opportunity to develop more positive associations with dental care. Care then is safer because drug doses can be lower in patients who do not rely on intravenous medications alone to cope with dental treatment.