Oral sedation protocols for pediatric patients as taught by DOCS Education faculty

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The DOCS Education Teen Sedation Dentistry Course began as an extension of protocols developed specifically for pediatric dentistry by the Central Coast Pediatric Dental Group in Salinas, CA.

Three principals at the CCPDG are also current faculty members at DOCS Education. They adopted protocols established and taught in pediatric residency programs and in the courses for pediatric sedation dentistry taught at the University of Southern California School of Dentistry, the University of California at San Francisco School of Dentistry and the University of California at Los Angeles School of Dentistry.

These protocols include midazolam and hydroxyzine and have been in clinical use by the practitioners at the CCPDG for more than 15 years. The drug-dosage maximums are in accordance with guidelines published in pediatric dentistry textbooks.

The Teen Sedation Dentistry Course applies the same medications as the Pediatric Sedation Dentistry course, with the addition of meperidine and lorazepam in some protocols. The dosage maximum of 20 mg/dose of midazolam as a single dose is consistent with prescribing guidelines for pediatric patients.

The dosage maximums of hydroxyzine and meperidine of 50 mg/dose as a single dose are lower than the published maximums. These are used in teen sedation protocols as multiple-agent protocols and their additive or synergistic effects do not require higher doses.

The “black box” warning of respiratory depression as it relates to midazolam is discussed and emphasized in the pharmacology and monitoring/emergency preparedness sections of the course.

Incremental dosing in the adolescent dental sedation patient is neither taught nor advocated. Incremental dosing is not taught in the pediatric sedation course either.

The Teen Sedation Dentistry Course and protocols are an extension of the guidelines published by the AAP (American Academy of Pediatrics) and the AAPD (American Academy of Pediatric Dentistry). These are titled “Guidelines for the monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures.”

The Teen Sedation Dentistry Program taught by DOCS Education carefully outlines the aforementioned guidelines in its lectures. These guidelines should be fundamental to the practice of dentists who treat children and adolescents. While patients aged 12-18 may be as large physically as adults, they are nevertheless not adults in a medical, dental or legal sense. The practice of treating children is different from the treatment of adults. For that matter the practice of treating teenagers differs from the treatment of children (those under 12).