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

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: Intravenous Conscious Sedation; Oral and Maxillofacial Surgery; Special Need; Tanzania.

Fig. 1. (A) A woman sedated and planned for a surgical procedure under intravenous-conscious sedation with a group of trainees observing. (B) An intraoperative picture of the patient showing a bony defect on the anterior part of the maxilla following the enucleation of a cystic lesion.

Fig. 2. A man being monitored while being surgically managed under intravenous-conscious sedation.

Fig. 3. A child being prepared for an incisional biopsy carried out under intravenous-conscious sedation in a dental office setup.