Risk of Dental Sedation for Seniors

Potential Risk with Dental Anesthesia and Sedation with Geriatric Patients

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Dental anesthetic, sedation, and general anesthesia in elderly patients can be a challenging aspect of operative and surgical dentistry. As individuals age, they often experience multiple comorbidities and physiological changes, which necessitate modifications in anesthesia administration. The increased prevalence of age-related polypharmacy and immune-suppression adds further complexity to dental anesthesia management in older adults.² These medical risks can include cardiovascular issues, respiratory complications, medication interactions, reduced organ function, impaired cognitive effects, decreased pain threshold, and delayed recovery.

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The Medical Risks in Geriatric Patients

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Delayed recovery in geriatric patients may result in a slower recovery time. This requires careful monitoring of patients over time after a procedure to avoid post-procedure complications. Aging often brings cardiovascular conditions such as hypertension, heart disease, and arrhythmias. The use of certain anesthetics in these patients can adversely affect blood pressure, heart rate, and interact with cardiovascular medications, potentially leading to complications like hypotension or even heart attack. As one expert notes, “Dental treatment, although usually considered safe, can be life-threatening if medical problems of the patient, especially cardiac disorders, are ignored.”⁵

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Aging results in a decline in immune function, which makes older adults more susceptible to infections, particularly after invasive dental procedures like extractions. Reduced organ function can also impair the body’s ability to metabolize or eliminate anesthesia drugs. This can lead to prolonged sedation or toxicity. For example, patients with decreased lung function or Chronic Obstruction Pulmonary Disease (COPD) have diminished lung function. Sedatives or anesthetics can depress the respiratory system and increase the risk of hypoxia. Older patients are also at high risk of cognitive dysfunction which can include confusion, delirium, or memory loss after anesthesia. Age-related changes in the nerve duction can also require anesthesia dosage increase to ensure effectiveness of the procedure.³

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Dental sedation is typically safe for most patients, and the risks of dental sedation and anesthetic are low; but geriatric or medically compromised patients require trained professionals to have a comprehensive review of medical conditions and medications before administration of anesthetic. Recognizing these risks, the Washington State Dental Quality Assurance Commission updated its guidelines on January 11, 2024, for dentists with moderate sedation and general anesthesia permits.¹ The new requirements include:

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• On-site inspections for those administering moderate sedation or general anesthesia.

• Emergency protocols and training for dental staff.

• 24-hour on-call availability for anesthesia-related emergencies.

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These protocols aim to ensure that dental practices are adequately prepared to handle the potential risks associated with anesthesia administration, particularly in elderly or medically compromised patients.

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Interprofessional Collaboration and Care Modifications

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For safe administration of anesthesia or sedation in elderly patients, an in-depth review of the patient’s medical history and physical condition is crucial. This may involve collaboration with an interprofessional medical team, especially when there are concerns about cardiovascular, respiratory, or renal function. Medication adjustments or changes in care settings (e.g., choosing a hospital-based procedure versus a dental office) might be necessary.³

Once a decision is made to proceed, the dental team must carefully monitor vital signs throughout the procedure and remain vigilant for any signs of complications. This requires a fully equipped dental office, with emergency drugs and supplies on hand, capable of responding to any urgent situations that may arise.⁴

While dental sedation and anesthesia are generally safe for most populations, extra precautions are essential when working with geriatric or medically compromised patients. The risks involved necessitate that dental professionals administering sedation or anesthesia are highly trained and prepared to handle any complications, ensuring patient safety and reducing morbidity and mortality. A tailored approach to treatment is crucial to minimize complications and ensure safe and effective dental care.

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Resources

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1. Washington State Department of Health. (2024, January 11). Administration of anesthetic agents during dental procedures. Washington State Dental Quality Assurance Commission. Accessed on January 21, 2024.

2. Kaye, K. (2022, February 3). 40% face a potentially risky condition during dental anesthesia. DrBicuspid.Accessed on January 21, 2024.

3. Staheli, B., & Rondeau, B. (2023, August 5). Anesthetic considerations in the geriatric population. In StatPearls. Accessed on January 21, 2024.

4. Leung, K. C.-M., & Chu, C.-H. (2022, December 23). Dental care for older adults. International Journal of Environmental Research and Public Health, 20(1), 214.

5. Gupta, K., Kumar, S., Kukkamalla, M. A., Taneja, V., Syed, G. A., Pullishery, F., Zarbah, M. A., Alqahtani, S. M., Alobaoid, M. A., Chaturvedi, S. (2022, July 20). Dental management considerations for patients with cardiovascular disease—a narrative review. Revista Cardiovascular Medicina, 23(8), 261.

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