A review of guidelines for sedation, anesthesia,and alternative interventions for people with special needs.

There are significant numbers of people in our society with disabilities or other special needs. Their number and percentage are growing, in some cases, dramatically. Many of these individuals need special support in order to receive dental treatment. Modalities that can be used to provide dental treatment include pharmacological approaches to produce various levels of sedation or anesthesia. In addition to the use of medications, there are also techniques that employ behavioral or psychological interventions. In some circumstances, physical support or protective stabilization is used. There are also social supports and prevention strategies that can impact the individual's preparation for and need for dental treatment. This review of the numerous guidelines, which have been published for the use of sedation and anesthesia to facilitate the delivery of dental treatment, indicates that there are fewer guidelines for the inclusion of behavioral or psychological interventions or for the incorporation of social supports or prevention strategies. In addition, most published guidelines do not include considerations for people with special needs. There is a need for increased research and documentation of combined treatment modalities, and these combined approaches need to be incorporated into guidelines for patient care for people with special needs. There is also a need to advocate for reimbursement systems that support all appropriate treatment options so that practitioners can be free to recommend treatment options based on the efficacy and safety of each option.