The feasibility of office‐based propofol sedation for dental care in patients with intellectual disability by sedation practitioners

Vaessen, Hermanus H. B.; Schouten, A.J.; Hoeve, Henriette van der; Knape, J. T. A.

doi:10.1111/scd.12210

Cited by 5 publications

(28 citation statements)

References 36 publications

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“…BIS-TCI can reduce the dose and length of sedation for people with ID. Silva et al, 2018 (Portugal) [47]Observational studyAnalyse the utility of Bispectral Index (BIS) for anaesthetic depth monitoring in paediatric dental patients with IDD.17 patients with ID (female n = 7, male n = 10).The BIS correlated with end-tidal sedative concentration and had good prediction probability except in patients with Lennox-Gastaut, West syndrome, cerebral palsy and epilepsy. BIS may be able to reflect anaesthetic depth in patients with some types of ID. Vaessen, Schouten, van der Hoeve & Knape, 2017 (The Netherlands) [48]Retrospective studyEvaluate safety and effectiveness of propofol sedation by trained nonmedical sedation practitioners in dental patients with ID in an office-based setting.Participants a with ID; mild ( n = 21); moderate ( n = 56) and severe ( n = 47).Propofol sedation was effective, allowing a sufficient sedation level without moderate or severe complications. The intervention allowed successful dental treatment in safe, familiar home surroundings. Yeganegi & Tandon, 2008 (India) [49]RCTAssess the efficacy and retention of Fuji VII Glass Ionomer Cements (GIC) for surface protection in plaque-prone areas of teeth100 patients with ID (male n = 48; female n = 52).Mean plaque scores at follow up were significantly lower in the intervention group when compared to the comparison group.…”

Section: Resultsmentioning

confidence: 99%

“…The other six studies provided insights into the factors that could affect dental routines and treatment procedures for people with IDD, including one that examined the appropriateness of implementing GA in dental treatment [41], four that focussed on the depth of sedation or GA administered [42, 44, 46, 47], as well as one retrospective study on the feasibility of propofol sedation for dental care [48].…”

Section: Resultsmentioning

confidence: 99%

“…A study conducted in Japan used the International Classification of Functioning (ICF) as a means to measure tolerability for dental procedures as a way of determining the suitability of a person for dental treatment under GA [42]. The study by Vaessen et al [48] evaluated the safety and effectiveness of propofol sedation during dental treatment ( n = 124); propofol sedation is effective providing its flexibility in addressing individual patient needs in combination with low-dose propofol [48]. Silva et al [47] found that bispectral index (BIS) detected by a bilateral sensor placed on patient’s forehead may be able to reflect anaesthetic depth in patients undergoing dental treatment under GA.…”

Section: Resultsmentioning

confidence: 99%

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Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

et al. 2019

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Background: People with intellectual and developmental disability (IDD) have poor oral health and need support to maintain optimal oral health outcomes. Little is known about how, when and where to intervene for this population. Thus the aim of this review was to summarise the existing evidence surrounding improving oral health outcomes for people with IDD. Methods: A scoping literature review was conducted focusing on 'oral health' and 'intellectual disability'. Systematic searches of five electronic databases were conducted in line with the study aims and two authors independently examined all records for relevance, with consensus achieved by a third author. Results: A small number of approaches and interventions were identified to support people with IDD to independently maintain optimal oral hygiene. Identified studies highlighted that caregivers play a vital role in the provision of oral health support, emphasising the effectiveness of educational interventions for caregivers. However, there was uncertainty regarding the efficacy of specific tooth brushing interventions for people with IDD. In cases of more severe IDD and/or dental-related behavioural problems, dental treatment under general anaesthesia was often both a necessary and effective method of oral health care provision. The findings also identified outreach and exclusive oral health services as successful strategies for increasing the limited access of people with IDD to oral care services. Conclusions: A uniform approach to supporting oral health for people with IDD is unlikely to succeed. A systembased approach is needed to address the diverse needs of the population of people with IDD, their caregivers and service context. Further high quality evidence is required to confirm these findings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

et al. 2019

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“…Despite the sedative, hypnotic, anxiolytic, amnesic, and muscle relaxant effects of midazolam, it has been reported to produce delayed recovery in patients with disabilities after treatment completion. Therefore, given the peculiar pharmacological characteristics of propofol, it is more suitable for deep sedation because sedation can be performed safely and effectively in a dental office setting to patients with disabilities [14].…”

Section: Discussionmentioning

confidence: 99%

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

Salmeron

Kim

Seo

2019

J Dent Anesth Pain Med

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Background We aimed to assess the dose needed to achieve the propofol effect-site concentration using target-controlled infusion in intellectually disabled patients and to detail the most effective method for achieving a safe level of consciousness without hemodynamic changes as well as detail any resulting adverse effects. Methods We performed a retrospective review of sedation service records of 138 intellectually disabled patients (51, mental retardation; 36, autism; 30, brain lesion, 12 genetic diseases, 9 dementia) aged over 15 years and weighing over 30 kg. These patients had received propofol via target-controlled infusion in the special care dental clinic of Seoul National University Dental Hospital from May 2008 to September 2018 for restorative treatment (112), minor surgery (13), prosthodontics (7), periodontics treatment (5), and implant (1). Results For all groups, the duration of dental treatments was 43 ± 18 minutes, total sedation time was 73 ± 23 minutes, and total BIS values was 57 ± 12. The propofol maintenance dosage values for each group were: mental retardation, 3 ± 0.5 (2–4) µg/ml; autism, 3.1 ± 0.7 (2–5) µg/ml; brain lesion, 2.8 ± 0.7 (1.5–5) µg/ml; genetic disease, 2.9 ± 0.9 (1–4) µg/ml; and dementia 2.3 ± 0.7 (1–3.4) µg/ml. Conclusions The dementia group needed a lower dosage to reach a safe, effective propofol effect-site concentration than the other groups. Since there were no complications, deep sedation is a great alternative to general anesthesia for dental treatment of intellectually disabled patients.

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“…However, in dental practice, many patients with ID often have severe dental caries and an abnormal morphology of the teeth and mouth 2 . Many of these dental complications are reported to be caused by the underlying disease and poor oral hygiene 3,4 . As the comprehension of oral hygiene and the degree of independence in teeth cleaning are low in individuals with ID, they are unable to maintain healthy oral hygiene habits, and their oral health is naturally inadequate.…”

Section: Introductionmentioning

confidence: 99%

Dental treatment under intravenous sedation prolongs longevity of a fixed prosthesis in patients with intellectual disabilities

Yamaguchi-Komeyama

Tanoue

Kurata

et al. 2021

Special Care in Dentistry

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This study aimed to assess the longevity of a fixed prosthesis in patients with intellectual disability (ID) and to investigate the risk factors associated with the failure of a prosthesis due to abutment tooth extraction or prosthesis dislodgement or removal. Methods: We studied past medical records to evaluate the longevity of 315 prostheses that were luted in 76 patients with ID. We calculated the survival rates and assessed 15 variables potentially associated with prosthetic failure using multivariate Cox regression analyses with shared frailty for patients.Results: Three-quarters of our sample population had severe or profound ID. The maximum observation period was 31.0 years, and the corresponding survival ratio was 32.5%; the survival ratio at 10 years was 59.4%. The use of intravenous sedation significantly influenced the success of the prosthesis, with the hazard ratio (HR) being 0.49 times that of conventional treatment without behavioraltering drug therapy. The most significant risk factor for prosthetic failure was age at placement; the HR for patients aged ≥31 years was 2.82 times that for patients aged ≤ 20 years. Conclusions: In patients with severe ID, appropriate intravenous sedation was effective in prolonging the longevity of a fixed prosthesis.

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The feasibility of office‐based propofol sedation for dental care in patients with intellectual disability by sedation practitioners

Abstract: Propofol sedation can be safely and effectively performed in an office-based setting by sedation practitioners, who have experience in propofol sedation and are trained in the care of patients with disabilities.

Cited by 5 publications

References 36 publications

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

Countering the poor oral health of people with intellectual and developmental disability: a scoping literature review

Effects site concentrations of propofol using target-controlled infusion in dental treatment under deep sedation among different intellectual disability types

Dental treatment under intravenous sedation prolongs longevity of a fixed prosthesis in patients with intellectual disabilities

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