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Invasive dental procedures can be performed only with local anesthesia; in some cases, it may be useful to combine the administration of drugs to obtain anxiolysis with local anesthesia. Sedation required level should be individually adjusted to achieve a proper balance between the needs of the patient, the operator, and the safety of the procedure. Surgical time is an important factor for post-operative phases, and this could be greatly increased by whether the patient interrupts the surgeon or if it is not collaborative. In this manuscript some dentistry-used methods to practice conscious sedation have been evaluated. This manuscript could be a useful reading on the current state of conscious sedation in dentistry and an important starting point for future perspectives. Surely the search for safer drugs for our patients could have beneficial effects for them and for the clinicians.

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PURPOSE: The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. STUDY DESIGN: Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. RESULTS: There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. CONCLUSION: DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

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PURPOSE: The purpose of this study was to explore the trends and utilization of general anesthesia services among board-certified pediatric dentists practicing in the United States. METHODS: A 26 item survey was sent to 4,216 board-certified pediatric dentists by REDCap or mail. Results were tabulated, and trends were analyzed. RESULTS: A response rate of 31.8 percent was obtained. All American Academy of Pediatric Dentistry districts were represented proportionally. Most respondents (87 percent) reported using general anesthesia (GA) in their practices. Those who used GA, 50.4 percent reported using a hospital setting, and 60.5 percent used a physician anesthesiologist. Endotracheal intubation was the most common (88.5 percent) method of anesthesia delivery. Most diplomates (62.6 percent) favored dental anesthesiology as a recognized specialty by the American Dental Association. CONCLUSIONS: The majority of American Board of Pediatric Dentistry diplomates used general anesthesia in their practice. The preferred modality of delivery is oral/nasal intubation, with most services provided by physician anesthesiologists in a hospital/ambulatory setting. Physician anesthesiologists are inclined to provide care in a hospital-based setting. Dentist anesthesiologists provided care in the dental office. Most respondents support dental anesthesiology as a recognized specialty of the American Dental Association.

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The majority of dental procedures can be performed with an awake patient and the use of a local anesthetic, but when deep sedation and general anesthesia are needed, they typically are provided by those dentists with advanced training in anesthesiology, i.e., oral and maxillofacial surgeons and dentist anesthesiologists. Dental anesthesiology began with the discovery of anesthesia by a dentist in 1844 and has been recognized as a separate discipline in dentistry for nearly 70 years. Training over this time evolved from apprenticeships to one-year training programs, and in 2007, the Commission on Dental Accreditation (CODA) began accrediting two-year dental anesthesiology training programs. Since 2015, in recognition of the increasing complexity of the discipline, training has required three years of postgraduate study. The number of dentist anesthesiologists has grown with the increasing demand for anesthesia services by both the public and the profession. However, the present number of dentist anesthesiologists is not sufficient to meet the demand, so additional programs and growth in current programs are needed. Another valuable aspect of this discipline is its role as a positive example of interdepartmental collaboration since dental anesthesiology faculty, as members of a support discipline, typically work across many of the other departments in a dental school. This article reviews the history of the discipline, describes the educational goals and CODA standards for dental anesthesiology programs, using one program as an example, and discusses the needs and challenges that will shape the discipline's development in the future.

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BACKGROUND: Using local anesthetic is common to control the pain through blocking the nerve reversibly in dental procedures. Gow-Gates (GG) technique has a high success rate but less common. This study aimed to compare the onset time and success rate in GG and standard technique of inferior alveolar nerve block (IANB). MATERIAL AND METHODS: This descriptive, single blind study was consisted of 136 patients (59 males and 77 females) who were randomly received GG or IANB for extraction of mandibular molar teeth. Comparisons between the successes of two anesthetic injection techniques were analyzed with Chi-square test. Incidence of pulpal anesthesia and soft tissue anesthesia were analyzed with Kaplan-Meier method. Mean onset times of pulpal anesthesia, soft tissue and lip numbness were analyzed with Log-Rank test. Comparisons were considered significant at P≤0.05 by using SPSS software ver.15. RESULTS: The incidence of pulpal anesthesia in the IANB group (canine 49.3%, premolar 60.3%) were not significantly different from the GG group (canine 41.3%, premolar 74.6%) (P=0.200 and P=0.723). The success rate in the IANB group (80.82%) was not significantly different from the GG group (92.02%) (P=0.123). Furthermore, onset time of lip and buccal soft tissue numbness in GG group (3.25, 4.96 minutes) was quite similar to IANB group (3.22, 4.89 minutes) (all Pvalues >0.05). CONCLUSIONS: Although this study demonstrated higher clinical success rate for GG than IANB technique, no significant differences in success rates and onset time were observed between two techniques

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The Russian delegation of the European Federation for the Advancement of Anesthesia in Dentistry (EFAAD) participated in IV Congress of EFAAD where were considered such problems of dental and anxiolysis in patients with severe concomitant diseases and training dentists improvements on such problems as anesthesia, sedation, prophylaxis and emergency management inpatients with accompanying diseases.

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Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

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AIMS: This study aimed to assess the temporal and spatial changes in the demand for general anaesthesia, relative to disease incidence, in 0-19-year-olds. METHODS: Hospitalisation data were obtained from the Western Australian Morbidity Data System for the financial years 1999/2000 to 2004/2005, and principal diagnosis was obtained from every patient discharged from a public or private hospital. Hospitalisation data was correlated with socioeconomic status and the geographical location of primary residence. RESULTS: In the public hospital sector, there were greater rates of people residing in Statistical Local Areas (SLAs) with decreasing accessibility to healthcare services utilising the option of treatment of dental caries under general anaesthetic (GA) compared to people living within highly accessible areas. In the private sector, children who resided in SLAs with the greatest access to healthcare facilities had a greater rate of being hospitalised for the treatment of dental caries under GA. CONCLUSIONS: The results demonstrated distinct patterns of trends in demand for general anaesthetic care among different SES groups and geographical location of primary residence. There was an overall emerging trend of increasing demand placed on public sector both among dental care users among high and low SES. Moreover, the results demonstrated the potential application of geographic modelling as a service planning tool for estimating the future demand for GA care for dental caries in addition to the timely need for focused attention on preventive services for early identification, prevention and control of dental caries among children.

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OBJECTIVES: To identify likely future trends in recruitment of consultant anaesthetists to the ambulatory dental general anaesthetic (DGA) services. PARTICIPANTS: The sample consisted of all anaesthetic specialist registrars (SpRs) in their final year of training, within Mersey and South-Western Deaneries in the U.K. RESEARCH DESIGN: A questionnaire divided into a quantitative section to establish level of training in ambulatory DGA, and a qualitative section designed to elicit opinions and attitudes towards ambulatory DGA services. RESULTS: The response rate was 75% (27/36). Within both regions 81% (22/27) had received practical training in ambulatory DGA procedures. SpRs in the South-Western Deanery held the greatest misgivings about the ambulatory DGA technique. Once appointed to Consultant position only 11% (3/27) of respondents expressed a definite interest in providing ambulatory DGA services. CONCLUSIONS: Within the Northwest and Southwest of England, most specialist registrars in anaesthetics receive training in ambulatory DGA, although their future commitment to the delivery of these services is questionable.

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Sedation of patients for minor procedures is here to stay. However, it is the responsibility of every physician to be aware of the potential complications associated with the combination of drugs administered and to practise in an environment where no risks are taken and no procedures performed outside the circle of safety. Furthermore, as an anaesthetic service, monitored anaesthesia care (MAC) is clearly distinct from moderate sedation and it is important for patient safety that these differences are recognised and adhered to. In essence, all practitioners must observe the strict distinctions between sedation and MAC to prevent the drift into deeper sedation under inappropriate circumstances.

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This paper describes developments in the field of dental local anaesthesia. Recently introduced injectable agents, advances in the field of topical anaesthesia and new delivery systems are discussed.

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Advances in medical science have increasingly extended human life expectancy, thereby increasing the number of risk patients who require dental treatment under conditions of maximum safety. On the other hand, a part of the population presents physical or mental impairments which preclude minimum cooperation with the dental professional to ensure treatment with the necessary guarantees. Dentists and stomatologists must therefore consider the possibility of performing general anesthesia in these special patients, as the only way to ensure adequate dental treatment.

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