Estimating the Need for Sedation in Patients with Dental Anxiety and Medical Complexities Reporting to Tertiary Care Dental Hospital Using the IOSN Tool

Abstract

Objectives. To provide consistent method for assessment of sedation need among patients undergoing dental treatment based on specific risk factors that is dental anxiety, medical status, and treatment complexity of needed dental treatment using IOSN (indication of sedation need) tool for assisting the clinician in decision making process. Methods. A total of 237 patients aged ≥12, ASA I and II were enrolled in the study. A structured questionnaire comprising of three sections was distributed among the participants. Section 1 comprises details about age, gender, literacy level, occupation, monthly income, and previous dental treatment history. Section 2 is based on Modified Dental Anxiety Scale which is a questionnaire comprising of five questions ranging from “not anxious” to “extremely anxious.” The third section was based on using the IOSN tool comprising three components: MDAS (Modified Dental Anxiety Scale) rank score, Systemic Health (ASA status) rank score, and treatment complexity rank scores. The total of three scores was then computed to determine the total rank score which suggested the sedation need. History of past traumatic dental experiences was also inquired from each patient. Results. A total of 237 patients aged ≥12, ASA I and II were enrolled in the study, out of which 56.1% were female. Statistical analysis was conducted by using the IBM SPSS Statistics 23 software. Based on the MDAS score, 47/237 (19.8%) participants were found to be highly anxious related to dental procedures. 34.6% of the participants showed to have a high sedation need while performing a dental procedure. The sedation need was found to be significantly associated with the female gender with a significant p value of p = 0.016 , higher education status p = 0.016 , and history of previous traumatic dental experience p < 0.001 . Conclusion. A simple assessment tool can enable clinicians in their decision making to identify patients in need for dental treatment under sedation based on patient-specific risk factors such as past traumatic dental experiences. Need for sedation can be assessed by information on patient anxiety level towards dental treatment, medical history, and complexity of planned dental treatment. The IOSN tool is a simple and quick assessment tool that can be applied for preprocedural assessment of sedation need for dental treatment.

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

“…While it has been suggested that clinical guidelines often oversimplify treatment decision-making regarding implants, numerous studies highlighted the importance of considering multiple factors before selecting, preparing, or saving implants, particularly the patient’s medical history, bone quality, and implant location [ 30 , 75 , 76 , 77 ]. This was echoed by studies investigating surgical, extractive, and sedative decision making, which suggest consideration of patient factors such as medical history, including oncological prognosis and the level of dental anxiety [ 78 , 79 , 80 , 81 ].…”

“…Dentists should consider the specifics of the individual patient, and assess the applicability of existing guidelines. The guidelines suggested by numerous studies emphasised patient-centred care and the importance of considering patient factors during treatment [ 75 , 76 , 78 , 81 ]. For example, a history of endocarditis and bisphosphonates may lead to a general refusal of implants [ 75 , 76 ].…”

The Need and Use of Procedural Sedation and General Anesthesia in Dentistry

“…They found that almost 20% of study participants were highly anxious due to undergoing dental procedures, and more than 30% of them had high sedation needs, which was significantly associated with the female sex, higher education status, and a history of previous traumatic dental experience. 30 Madouh and Tahmassebi conducted a similar study in the pediatric population. The study included 40 pediatric patients evaluated using the IOSN tool; out of them, 20 scored more than six and were subjected to more advanced methods of DS.…”

Modern sedative agents and techniques used in dentistry for patients with special needs: A review

“…For other patients who are cooperative but unable to maintain an open mouth for long periods, dental sedation may be used for procedures such as root canal therapy, surgical extractions, full mouth rehabilitation or extensive restorative work. 7 Additionally, depending on the patient and treatment needs, several routes of administration for dental sedation may be used: inhalation, intravenous, oral, intranasal and intramuscular. 8 A survey of dentists in the United States and Canada has revealed that 75.7% regularly use conscious sedation in practice; half reported using sedation as many as six times per month, and the other half reported using sedation more than six times per month.…”