The Direction of Pediatric Sedation: A Contemporary and Historical Look at its Science, Art, Strengths and Shortcomings

This manuscript takes a critical look at the contemporary state and direction of sedation for the pediatric dental patient from the viewpoint of an academician, researcher, and clinician with over thirty five years experience. When non-pharmacological strategies prove inadequate or inappropriate for managing the fearful and disruptive responses of the pediatric dental patient, conscious sedation is often selected as a viable alternative to unconscious techniques. The efficacy, safety, and predictability of this modality are described from both anhistorical and contemporary evidenced-based perspective. Despite the development of guidelines by multiple health provider disciplines, mishaps involving morbidity and mortality are reported which impact on institutional training and the direction for future use. Changes in philosophy, utilization, and the range of agents and dosing selected for overcoming childhood dental anxiety over the course of the past three decades are described. Emphasis will be given to the variability in training, experience, and current thinking within the educational arena and private practice setting. Lastly, discussion will include a review of cases resulting in fatalities, their etiology, and implications on drug availability, dosing recommendations, and projected future use of sedative modalities for children.