Conscious sedation in pediatric dentistry. A short review of the current UK guidelines and the technique of inhalational sedation with nitrous oxide.

Conscious sedation is used in pediatric dentistry as elsewhere to reduce fear and anxiety in pediatric patients and so promote favorable treatment outcomes. This can help to develop a long-term positive psychological response to necessary dental procedures. The publication of ‘A Conscious Decision’ in 2000 (1) resulted in the cessation of general anesthesia for dentistry in the primary care setting. Up to this date, there had been an increased emphasis on the safe provision of conscious sedation for management of pain and anxiety in child and adult patients and this has continued following the removal of general anesthesia in the primary care. Several recent guidelines have sought to provide advice to general dental practitioners, community dentists and those in the hospital setting on the use of conscious sedation for both children and adults. The British Society of Paediatric Dentistry (BSPD) produced the UK Clinical Guidelines in pediatric dentistry for conscious sedation in children in 2002 (2) and in combination with the Scottish Intercollegiate Guidelines Network (SIGN), which published the Safe Sedation for Children guideline in the same year (3). Practitioners were able to understand the evidence base behind various techniques. The UK Department of Health sponsored an independent working party the Standing Dental Advisory Committee (SDAC) to develop further guidelines, which were published in 2003 (4). These guidelines were endorsed by the General Dental Council (GDC) and dental professionals are expected to follow it. Therefore, the SDAC report is now considered as professional regulation in combination with the GDC’s own Standards guidance of 2005 (5). This year has also seen the publication of the Scottish Dental Clinical Effectiveness Programme’s [SDCEP is an initiative of the National Dental Advisory Committee (NDAC)]. Conscious sedation in dentistry seeks to update and extend the SDAC guidance (6). Currently, different forms of sedation, for example, oral, intravenous (i.v.), inhalation, intranasal and combinations of treatments are used for pediatric dental patients worldwide. Some of these techniques do not comply with the UK definition of conscious or moderate sedation (3), where the patient remains in verbal contact throughout treatment and the margin of safety is wide enough to render the loss of consciousness unlikely [NDAC, GDC, SDAC, Dental Sedation Teachers Group (DSTG)]. In the UK, the state of deep sedation is considered to be a part of the spectrum of general anesthesia and this has sometimes caused confusion in comparing different research studies from other countries. A recent Cochrane systematic review (7) found evidence for a variety of techniques that have been used to provide safe and effective conscious sedation for children requiring dental procedures. However, there were few studies that fitted the selection criteria for the review (randomized controlled clinical trials) and it was not possible with the Correspondence to: I. Holroyd, Consultant in Paediatric Dentistry, Unit of Paediatric Dentistry, Eastman Dental Hospital, 256 Grays Inn Road, London WC1X 8 LD, UK (email: isabelleholroyd@ hotmail.com). Pediatric Anesthesia 2008 18: 13–17 doi:10.1111/j.1460-9592.2007.02387.x