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Establishment of an intravenous conscious sedation service at a University Dental Clinic in Tanzania

  • Karpal Singh Sohal (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences) ;
  • Frank Bald (Dr. Bald and Associates Oral Surgery Elizabeth City) ;
  • Samwel Mwalutambi (Department of Oral Health Services, Benjamin Mkapa Hospital) ;
  • Paulo J Laizer (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences) ;
  • David K Deoglas (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences) ;
  • Jeremiah Robert Moshy (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences) ;
  • Baraka Kileo (Department of Dental Services, Muhimbili National Hospital) ;
  • Noah Joshua (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences) ;
  • Sospeter Sewangi (Department of Oral and Maxillofacial Surgery, Muhimbili University of Health and Allied Sciences)
  • Received : 2023.02.19
  • Accepted : 2023.03.17
  • Published : 2023.04.01

Abstract

Background: With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania. Methods: In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic. Results: The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office. Conclusion: This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

Keywords

Acknowledgement

We are grateful to the participants for providing all necessary information required for the study.

References

  1. Sales N, Sohal KS, Moshy JR, Owibingire SS, Deoglas DK, Laizer PJ. Conscious sedation in dentistry: knowledge and practice among dental professionals in Tanzania. J Dent Anesth Pain Med 2021; 21: 557.
  2. Attri JP, Sharan R, Makkar V, Gupta KK, Khetarpal R, Kataria AP. Conscious sedation: emerging trends in pediatric dentistry. Anesth Essays Res 2017; 11: 277-81. https://doi.org/10.4103/0259-1162.171458
  3. Southerland JH, Brown LR. Conscious intravenous sedation in dentistry. a review of current therapy. Dent Clin North Am 2016; 60: 309-46. https://doi.org/10.1016/j.cden.2015.11.009
  4. Kapur A, Kapur V. Conscious sedation in dentistry. Ann Maxillofac Surg 2018; 8: 320-323. https://doi.org/10.4103/ams.ams_191_18
  5. Coulthard P. The indicator of sedation need (IOSN). Dent Update 2013; 40: 466-8, 470-1. https://doi.org/10.12968/denu.2013.40.6.466
  6. Abed H, Rahman A. Setting up dental sedation services for special care and medically compromised patients. Saudi Dent J 2018; 30: 105-6. https://doi.org/10.1016/j.sdentj.2017.12.002
  7. Strunin L. Intravenous conscious sedation for dental treatment: am I my brother's keeper? Anaesthesia 2007; 62: 645-7. https://doi.org/10.1111/j.1365-2044.2007.05177.x
  8. Moshy JR, Sohal KS, Shaban SD, Owibingire SS, Shubi FM, Mtenga AA. The spectrum of oral and maxillofacial surgical procedures at the National Referral Hospital in Tanzania from 2013 to 2017. Ann Res Hosp 2019; 3: 3.
  9. Al-Shayyab MH, Ryalat S, Dar-Odeh N, Alsoleihat F. Current sedation practice among general dental practitioners and dental specialists in Jordan: an example of a developing country. Ther Clin Risk Manag 2013; 9: 223-33. https://doi.org/10.2147/TCRM.S43166
  10. Bhuvaneswarri J, Elizabeth P. Conscious Sedation in Dental Practice - a Review. Eur J Mol Clin Med 2020; 7: 1908-12.
  11. Saxen MA, Urman RD, Yepes JF, Gabriel RA, Jones JE. Comparison of anesthesia for dental/oral surgery by office-based dentist anesthesiologists versus operating room-based physician anesthesiologists. Anesth Prog 2017; 64: 212-20. https://doi.org/10.2344/anpr-65-01-04
  12. Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation part 1: respiratory considerations. Anesth Prog 2011; 58: 82-92. https://doi.org/10.2344/0003-3006-58.2.82
  13. Becker DE, Haas DA. Recognition and management of complications during moderate and deep sedation. Part 2: cardiovascular considerations. Anesth Prog 2011; 58: 126-38. https://doi.org/10.2344/0003-3006-58.3.126
  14. Binnie RSL, Robb ND, Manton SL, Bonsor SJ. The establishment of an intravenous conscious sedation service for adult patients in a primary dental care setting. Dent Update 2020; 47: 22-36. https://doi.org/10.12968/denu.2020.47.1.22
  15. Corcuera-Flores JR, Silvestre-Rangil J, Cutando-Soriano A, Lopez-Jimenez J. Current methods of sedation in dental patients - a systematic review of the literature. Med Oral Patol Oral Cir Bucal 2016; 21: e579-86. https://doi.org/10.4317/medoral.20981
  16. Nelson TM, Xu Z. Pediatric dental sedation: challenges and opportunities. Clin Cosmet Investig Dent 2015; 7: 97-106. https://doi.org/10.2147/CCIDE.S64250