Table 2.

Prevalent special needs conditions with dental implications that frequently require sedation or general anaesthesia.

Condition	Dental concerns	Risks/contraindications with sedation
Down's syndrome	Craniofacial anomalies86 Dental anomalies87 Cardiovascular abnormalities5 Tracheal abnormalities57 Atlanto-axial instability61 Periodontitis, lack of cooperativity87	Cardiovascular emergencies such as bradycardia59 Large tongue can affect airway management5 Vascular access can be difficult5 Tracheal stenosis57
Autism spectrum disorder (ASD)	Poor oral hygiene64 Inability to tolerate longer procedures70 Sensory issues64 Food selectivity88 Dental anxiety66	Conscious sedation may be insufficient70 Vitamin B12 deficiency and N2O sedation70
Attention deficit hyperactivity disorder (ADHD)	Inability to tolerate lengthy procedures70 Parafunctional habits73	Risk of paradoxical reactions89
Cerebral palsy (CP)	Incompetent lips, malocclusions Difficulty in maintaining oral hygiene Involuntary movements70	Sedative agents metabolised via hepatic pathways Conscious sedation may be insufficient to minimise involuntary movements70 Airway management59
Alzheimer's disease	Difficulty in maintaining oral hygiene High prevalence of periodontal diseases and caries76 Polypharmacy78	Drug interactions12
Epilepsy	Seizures triggered by dental anxiety70 Unexpected movements in the chair, risking clinician and patient safety85 Elevated incidence of caries and periodontal disease Fractured teeth and restorations82	Antiepileptic medications such as carbamazepine and valproic may affect the clearance of benzodiazepines84 Hypoxia due to over-sedation can trigger seizures84