A DOCS Education Member seeks the faculty’s assistance:
I had a 24-year-old, recovering drug addicted female weighing 142 lb presents with multiple caries. She will require extractions, implants and dentures. Her rehab therapy medications are Suboxone® 8 mg two times daily along with 12.5 mg of Klonopin® daily. The patient is anxious about her dental treatment. She states she can come off these meds two days before her appointment. Is this ok and is there an OCS protocol for her?
Dr. Jerome Wellbrock, DOCS Education faculty, responds:
Recovering addicts can be very difficult and unpredictable in terms of successful sedation, especially with oral sedation. They are most likely hypo-responders and may not be successfully sedated with oral meds without approaching TOP DOSE. These patients are more successfully treated with IV Sedation where they can be truly titrated to the appropriate level of sedation.
A physician consult with the treating physician is important as is current liver function status. Careful consideration must be given to post operative pain control and there needs to be discussion with the patient and their physician about the proposed dental treatment, sedation med usage and post operative pain control.
If you are going to use oral sedation then I would recommend a trial sedation appointment. The patient should be informed that it is a trial sedation to evaluate her response, and that it is possible she may need to be referred for IV Sedation if adequate sedation is not achieved.
The information contained in this, or any case study post in Incisor should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece. DOCS Education accepts no liability whatsoever for any damages resulting from any direct or indirect recipient's use of or failure to use any of the information contained herein. DOCS Education would be happy to answer any questions or concerns mailed to us at 106 Lenora Street, Seattle, WA 98121. Please print a copy of this posting and include it with your question or request.
