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.