Sedation care provides more than just relief from anxiety — pain from TMD can be eased, helping the patient stay open comfortably, and gagging can be reduced. Sometimes, however, it's just the gagging that's an issue. Dr. Anthony Feck describes the options for reducing the gag reflex for a short appointment.

A DOCS Education Gold Member writes:

I have a dental-phobic patient who wants Zoom! teeth whitening. Recently, we successfully sedated her for a crown and 3 fillings, which went very well. However, we thought her level of sedation was such that she would not be able to provide the level of cooperation we needed for Zoom. We used the standard protocol, adding 0.25 mg of triazolam about halfway through her treatment. I'm looking for an option to sedate her very mildly to perform the Zoom and have her stay compliant to our instructions. At the same time we need to decrease her very strong gag response and TMD that limits her ability to hold her mouth open without sedation.

She takes the following medications: triamterene, enalapril, labetalol, Levoxyl®, Nexium®, 800 mg Motrin® as needed, Xopenex®, Lyrica®, Celebrex®, Patanol® and verapamil. She has no known drug allergies. During her first sedation her BP was 130/86 and a pulse ox reading of 96%.

Thanks for your input!

Dr. Anthony S. Feck, DOCS Education Dean of Faculty, responds:

I see three possible options (arranged in order of increasing CNS depression) to achieve the minimal sedation you are seeking for this patient:

  1. Titrating nitrous oxide to effect. Nitrous oxide is a good oral sedation alternative to address gagging. Properly administered, nitrous oxide in concentrations of 50% is equivalent to 15mg of morphine in its analgesic effects.
  2. NuCalm with or without nitrous oxide. If you haven't tried this product, it has proven to be effective in addressing anxiety and ameliorating an overactive gag response. While it takes longer than titrating nitrous, it has superior efficacy to nitrous oxide alone.
  3. Single-Dose Oral Conscious Sedation. If you eliminate the subsequent reassessment doses of a Diazepam/Triazolam protocol, you can achieve minimal sedation, gag response abatement, and maintain the cooperation you are looking for. Of course, with options 1 and 2 above, your patient won't need a companion, nor is there any post-sedation protocol. This option requires the usual pre-operative and post-operative sedation protocols.
Disclaimer

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.

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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 3250 Airport Way S, Suite 701 | Seattle, WA 98134. Please print a copy of this posting and include it with your question or request.
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