Considerations for the use of oral sedation in the institutionalized geriatric patient during dental interventions: a review of the literature

Some institutionalized elderly persons need a sedative prior to a dental examination or treatment because they have a disturbance due to physical illnesses, degenerative changes in the brain, and/or psychiatric disorders, associated with advanced aging. Oral administration is one of the safest methods of delivery of a sedative drug. It is almost universally acceptable, easy to administer, costs little, has a low incidence and severity of adverse reactions, and requires no additional formal specialized training for the dentist. However, theoretical and practical knowledge of sedation is essential. This paper reviews the literature on oral sedation for the geriatric patient. Benzodiazepines are most often used for oral sedation of geriatric patients. The properties of these drugs were reviewed, and recommendations were made with respect to the drugs of choice and their dosage. Generally, fast-acting benzodiazepines of short duration, with rapid rate of elimination and no active metabolites, are recommended. The drug of choice, and the dosage, may vary according to the medical history and physical condition of the patient.