Sedation in Home Care Surgical Procedures for a Patient With Dental Phobia: A Case Report.

Abstract

An 88-year-old woman received dental evaluation at home after missing out on regular dental checks due to a stroke 3 years ago. Her orofacial complaints included pain in the right side of the face and a desire to use dental prosthetics. Her comorbidities included systemic arterial hypertension and sequels from episodes of a thrombotic stroke and an acute myocardial infarction. Medications used were a beta-blocker, an angiotensin-converting enzyme inhibitor, a statin, and an antiplatelet agent. During the initial evaluation, the patient was alert, using a wheelchair, and was quite anxious and apprehensive, reporting episodes of dental phobia. On intraoral examination, findings consistent with the orofacial pain mentioned by the patient were observed. Sequentially, a treatment plan was developed to address the oral condition. The treatment was initiated with basic periodontal therapy and restorative procedures, performed with non-pharmacological stress reduction management. However, due to the patient's behavior during previous follow-ups, it was decided to perform extractions under sedation with antihistamine and nitrous oxide in the home setting. The procedure was conducted with vital signs monitoring, and the use of antiplatelet drugs was not suspended. Local bleeding control measures were applied, and the postoperative period occurred without complications. Besides promoting accessibility, home dental care provides treatment in a safe environment for the patient, which enhances comfort and reduces patient anxiety. Additionally, using sedation with antihistamine and nitrous oxide achieved an adequate level of relaxation for more effective stress control during the extractions.