Conscious sedation practices in pediatric dentistry: a survey of members of the American Board of Pediatric Dentistry College of Diplomates.

Members of the College of Diplomates of the American Board of Pediatric Dentistry were surveyed in January, 1988, to establish current trends in the use of conscious sedation and to relate these trends to certain demographic data and circumstances of contemporary pediatric dentistry practice. Several questions were restatements of the 1980 Association of Pedodontic Diplomates Survey of attitudes and practices in behavior management (Pediatr Dent 3:246-50, 1981) and provided comparison data. The 1980 survey was also important in establishing the Diplomates as a valid sample of American Academy of Pediatric Dentistry members at large. Of 479 questionnaires sent in 1988, 369 were returned, 363 of which were usable (76%) vs. 75% in 1980 and 77% in a similar survey of Diplomates in 1971. Significant findings of the current survey include: 1. The average member of the College has been in pediatric dental practice between 11 and 20 years. 2. Forty-five per cent trained in a program located in District IV (northern Midwest); the next highest percentage (13.8%) came from programs in District (southern Midwest). 3. The highest proportion of College members (20.4%) practice in District I (Northeast), closely followed District IV (northern Midwest) at 19.8% and District III (Southeast) at 18.0%. Private practitioners constitute 79.3% compared to 61% in the 1980 survey, while 12.2% are in academics and 5.1% are hospital based. Respondents practicing in communities between 10,000 and 100,000 population were 34.6% of the total. The second largest group (28.5%) practice communities between 250,000 and 1,000,000. Only 1.6% practice in communities of less than 10,000. "Conscious sedation" as defined by the Academy* is used by 7.9% for "more than 75%" of their patients; 68.5% use it for "selected patients", and 23.6% "never employ" conscious sedation. In the 1971 survey 86% "used premedication", in the 1980 survey 83% used premedication, and in this survey 77.4% did so. 7. Nitrous oxide-oxygen is used by 28.7% for "more than 75%" of their patients; 58.9% use nitrous oxideoxygen for "selected patients"; and 12.4% "never use" nitrous oxide-oxygen for patients. Combining the first two groups yields a total of 87.6% who employ nitrous oxide-oxygen in their practices. This is a dramatic increase from only 35% using nitrous oxide-oxygen in 1971 and 65% in 1980. 8. When asked about the most significant changes in utilizing conscious sedation during the immediate past two years, 37.1% reported the most changes in "protocol" (e.g., monitoring methods, personnel duties, consent and permission forms). "No significant changes" were reported by 29.5%. "Fewer agents administered" per sedation was the third most frequent response at 23%. 9. Only 0.2% reported increasing their use of conscious sedation (with agents in addition to nitrous oxide) 1987 vs. the previous year. Only 6.3% reported increasing their use of sedation "more than 10%." Sedation use "remained the same" for 64.4%. A decreased use of "more than 10%" was reported by 10.2%, and 18.9% reported that their use of conscious sedation during the past year had "decreased more