Policy Statement 6.17 - Conscious Sedation in Dentistry

Position Summary

Dentists must comply with the Dental Board of Australia registration standards to practise conscious sedation. It must remain available as a treatment option for relief of dental patients’ anxiety and pain.

1. Background

1.1. Conscious sedation in dentistry has been safely practised in Australia for many years under various levels of regulation dependent upon jurisdiction.

1.2. Conscious sedation provides access to care at a lower cost-of-service than general anaesthesia, facilitating better access to care.

1.3. A Registration standard for conscious sedation has been adopted by the Board.

1.4. Until 2010, the ADA had recognised the ANZCA and RACDS document PS21 published in 2003. This was replaced by ANZCA document PS09 in 2022.

1.5. In 2010, the ADA Guidelines for Conscious Sedation in Dentistry were adopted.

1.6. In 2019, ANZCA published the “Safe Procedural Sedation Competencies” that are applicable to adult patients.

Definitions

1.6. ANXIOLYSIS includes the use of a single low dose oral medication or inhalation of gases for treating anxious patients, but not inducing a state of conscious sedation. This excludes oral administration of medicines formulated for non-oral use, such as injection fluid. Appropriate initial dosing of a single oral drug should be no more than the maximum recommended dose that a patient could take unmonitored at home. Anxiolysis
does not include polypharmacy (i.e., the use of more than one drug).

1.7. RELATIVE ANALGESIA is a technique in which the inhalation of a combination of nitrous oxide and oxygen enables treatment to be carried out and in which;

(a) purposeful verbal contact with the patient can be maintained or the patient responds appropriately to light tactile stimulation throughout the administration of relative analgesia; and

(b) the drugs and techniques used have a margin of safety wide enough to render unintended loss of consciousness extremely unlikely.

1.8. GENERAL ANAESTHETIC is any drug or substance which when administered to a patient will induce a controlled state of unconsciousness accompanied by a partial or complete loss of protective reflexes, including the inability to maintain an airway independently and continuously, and respond to physical stimulation or verbal command.

1.8. BOARD is the Dental Board of Australia.

1.9. CONSCIOUS SEDATION is a technique in which the use of a drug or drugs administered to produce a state of depression of the central nervous system enabling treatment to be carried out, and in which:

•verbal contact with the patient can be maintained or the patient responds appropriately to tactile stimulation throughout the period of sedation, and

•the drugs and techniques used have a margin of safety wide enough to render unintended loss of consciousness unlikely.

2. Position

2.1. Patient safety should be the prime consideration in forming guidelines for conscious sedation.

2.2. Regulation of conscious sedation in dental practice should be evidence-based.

2.3. The Board should adopt the ADA Recommended Guidelines for Conscious Sedation in Dentistry.

2.4. Dentists practising conscious sedation must comply with the Board’s registration standard.

2.5. Anxiolysis and Relative Analgesia - as stand-alone techniques – should not be considered Conscious Sedation.

2.6. Only dentists who have been endorsed by the Board should practise conscious sedation.

2.7. Conscious sedation needs to remain a treatment option for relief of anxiety and pain in dentistry.