The following is definitely a scenario that many dentists experience: An anxious patient takes a prescribed sedative medication to "settle down" prior to coming to a dental visit. The dentist has not been previously informed about this decision. The patient has decided that "there is enough" medication to effectively relax to begin treatment. Some dentists would treat this patient with no additional attention paid to the sedative medication, and the visit would appear to be successful with no difficulties of any kind.
Even though the above scenario may be commonplace, there is a significant amount of risk that is created for the patient, the doctor, and the team. There are a number of medical, ethical and legal issues with this situation.
1) Even if a physician or dentist has prescribed a sedative medication for anxiety control, and the patient had self-administered the recommended dose, it is always implied that the drug can impair ability to drive or operate machinery. It is no different than being under the influence of alcohol. The drugs should not be used unless the patient has consulted with the doctor about the safest, most effective dose to reduce anxiety and complete the treatment successfully. The patient needs an advocate and/or escort present. The safety of the patient is at risk. The safety of the public at large is at risk if the patient was to drive away from that appointment under the influence.
2) Sedative medications can impair the ability to make sound decisions. If treatment had to change, or an unforeseen event demanded a change in treatment, it would be difficult for the patient under the influence of the medication to offer clear-minded consent to change their treatment. The best ethical and legal choice is to have the patient's advocate (who had been designated prior to sedation) make the choice in the best interest of the patient.
3) Without proper and continual monitoring, there is no way that the dentist or any healthcare provider can assess the real-time safety and physical status of any patient under the influence of sedation medication. The medical implications are too numerous to get into. Let's just briefly summarize the potential consequences: Injury, disability, or death are possible outcomes without proper attention to sedated patients.
4) Consultation and planning prior to treatment is essential in order to safely administer the least amount of medication to produce the best sedation effect for the anxious patient, while successfully and comfortably completing their treatment. This falls under the ethical category of non-maleficence: do no harm.
5) It takes time, effort, and expense for a healthcare team to manage a sedated patient to ensure their safety and success with any treatment while under the influence of sedation medication. So you should be aware: whenever our team treats you, and you have self-administered medications or substances to eliminate dental anxiety, you can expect us to deliver the safest and most successful outcome for you. But it will come at a nominal price to ensure that happens.
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