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a beach position (30 to 90 degrees), different types of
suction tips available (yankauer most useful), and sched-
uling appointments during times when reflux possibility
is at its lowest. Extensive and lengthy dental procedures
may need to be broken up into smaller appointments and
requesting patients see their medical care provider for
reflux treatment is wise.
Discussion
Malfunction of one or all of these protective mechanisms
may be the root cause of a patient’s declining oral health.
Halitosis, oral lesions, enamel erosion, xerostomia, fungal
infections, and sleep apnea are all health conditions that
can result from disrupted ref lexes. Protective airway
reflexes further diminish as patients age due to decreased
response from mechanical and chemical receptors located
along the laryngeal tissue.
14
It is important for general
dental surgeons and dental specialists to understand how
dysfunction of a patient’s protective reflexes can affect
oral health and how normal protective behavior can
affect the surgical field during dental procedures. This is
especially important for those dental surgeons who offer
sedation concurrently with the dental procedure since
sedation, in any form, will blunt these protective reflexes
to varying degrees and modify their protective action.
As anesthesia modalities evolve and patient treatment
expectations increase, many practitioners are utilizing
combination anesthetic techniques which often involve
intravenous drugs with narrow therapeutic indices such
as propofol and fentanyl. Hypoventilation and apnea is
more likely to occur with combination sedatives. Milgrom
et al. reported that 63% of patients had at least one
apneic episode during dental treatments when sedated
with intravenous benzodiazepines and narcotics.
15
The
prudent practitioner should bear in mind that increases
in the administration of sedation medications will cause
decreased innate airway protection.
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