DHJ Davies
Clinical Service Manager/Senior Dental Officer and Specialist in Special Care Dentistry, Community Dental Service, Swansea, Wales, UK

Dental treatment for adults with a severe learning disability can be complicated due to lack of co-operation. This often results in treatment being provided under general anaesthesia (GA) with exodontia rather than restorative care and maintenance (Holland and O’Mullane, 1990). Supportive care and periodontal maintenance is also difficult (British Society for Disability and Oral Health, 2009). Midazolam has anxiolytic, muscle relaxant, anticonvulsant, hypnotic and amnesic properties, and is commonly used in dentistry by trained sedationists as an intravenous conscious sedation agent. Where cannulation for adult patients has not been possible, midazolam has been administered orally or intranasally to facilitate cannulation and subsequent administration of additional midazolam intravenously. These combined approaches have enabled the provision of dental treatment in many cases that would otherwise only have been possible under GA. This paper reviews the use of intranasally administered midazolam in adults, the safety of the technique and its application in dentistry, particularly as an alternative to the use of GA for adults who are unable to comply with conventional dental care.

Journal of Disability and Oral Health 2015; 16 (3).