Introduction
Providing dental treatments for people with intellectual disabilities is
challenging. This is due to the lack of proper oral hygiene, higher
prevalence and severity of dental caries along with periodontal
problems. Such conditions are mainly caused by a lack of physical
functional skills, failure in understanding the importance of oral
hygiene maintenance, the complex systemic status of these people and
regular medication use. In addition, dental fear and anxiety usually
lead to delay in seeking dental treatments. [1] Behavioral control
methods cannot be effectively used in the intellectually disabled
people; therefore, dental treatments are usually performing under
general anesthesia. There is also the advantage of performing the
necessary dental procedures in just one session instead of multiple
consecutive sessions. [2]
For patients undergoing ambulatory dental treatments, a rapid and safe
recovery with minimal post-operative complications is desirable given
that treatment under general anesthesia is completed in a relatively
short time and patients are normally discharged the same day. It is also
important that patients have a smooth emergence without experiencing
agitation or pain. Despite many efforts to improve recovery conditions,
some patients with intellectual disabilities still experience
considerable post-anesthesia complications. [3] Multiple factors
including the anesthetic medication regimen used, type of treatment and
the underlying diseases play a key role in recovery conditions and
post-anesthesia complications. [4]
Dexmedetomidine as an adrenoceptor agonist acts highly selectively for
alpha-two receptors and acts 1620 times more on alpha-two than alpha-one
receptors. For the purpose of comparison, clonidine, which is also a
selective alpha-two agonist, has only 220-fold affinity for the
alpha-two versus the alpha-one receptors. [5] The main side effect
reported for this drug is prolonging the recovery time and altering
haemodynamics in forms of both hypertension and hypotension along with
bradycardia due to vasoconstriction, parasympathetic activation mediated
by baro-reflex and sympatholysis. [5, 6]
Most studies on the use of dexmedetomidine in dentistry have examined
its sedative properties. There are very few studies on the use of
dexmedetomidine in dentistry for general anesthesia, most of which are
related to pediatric dentistry. [7] However, there are no studies
evaluating the effectiveness of this drug on haemodynamics and the
recovery conditions of intellectually disabled adults for ambulatory
dental treatments. Therefore, this study aimed to examine the effects of
dexmedetomidine on patients’ blood pressure, recovery length and
agitation for the adult intellectual disabled in dentistry under general
anesthesia.