A DOCS Education member seeks the faculty’s advice: We have a 65-year-old male patient with pain in the lower right region of his mouth. This pain, combined with broken and missing teeth have severely restricted his ability to eat solid food comfortably. He is losing weight. He has 20 teeth remaining, many of which are broken and decayed, and several of which have significant abscesses. Our treatment plan will consist of full mouth extractions and immediate dentures under oral sedation. I expect the case will take about two hours for the sedation, extractions and impressions. His health history involves schizophrenia—which includes hallucinations and hypomania, significant social anxiety, fear of doctors and a severe gag reflex. He is easily agitated which results in him yelling and screaming at health care providers. He has increased anxiety upon changes being made or about upcoming appointments. The patient rarely leaves home and likely has mild dementia and limited mental capacity. He exhibits overall tremors from prolonged use of his medications. Prolixin® (fluphenazine) and lithium have been used to control his behavior for the majority of his life. The local clinic sees him quarterly to refill his medication, but we are unsure when his last medical exam was. His last physician visit was with a neurologist in December 2014 for trembling caused by his medication. Lexi-Comp® analysis did not find any contra-interactions against the lithium and Prolixin® and the sedation medications. Can you please comment and advise on the best sedation medications to use and the success of using these meds based on the patient's health history? Thank you for your time.

DOCS Education faculty member, Dr. Jerome Wellbrock, offers his advice:

Patients with schizophrenia are NOT candidates for oral sedation. This patient would be best treated with IV sedation or GA. The problem with oral sedation is patient cooperation. If the patient displays uncooperative or unwanted behavior during treatment, it would be very difficult or even impossible to get the patient more deeply sedated in a quick manner to get past such unwanted behavior. IV sedation would allow rapid administration of the sedation meds that are titrated to use as little as possible to get the patient sedated past the unwanted behavior. I would highly recommend either referral to an oral surgeon or you could have an anesthesiologist provide the anesthesia while you deliver the dental treatment. The DOCS Education member responds: Thank you, Dr. Wellbrock, for this great information. This patient obviously needs some work and given his mental state, it is a delicate situation. We want to give him the best treatment possible under a safe environment for everyone involved.

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.

issue_no
0
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.
DOCS Membership

Upcoming Events
Streaming
May 17- 18, 2024
Atlanta, GA skyline
GA
August 23- 24, 2024
Streaming
October 04- 05, 2024

More Articles