Table 4.

Common mental health/psychiatric illnesses and dental considerations prior to sedation.

Mental illness	Symptoms	Recommendations
Bipolar Disorder	Presence of manic and depressive episodes. Manic Episode – period of 1 week or more where mood is consistently elevated or irritable; may include decreased need for sleep; pressured speech; racing thoughts; increased activity; and distractibility (pp. 357–361).19 Depressive Episode – see Major Depressive Episode/Disorder	Patients may be reluctant to discuss Bipolar Disorder diagnosis due to fear of stigma; discuss diagnosis in judgment free terms.20
		After discussing with patient, speak with treating psychologist or psychiatrist, particularly about any prior or current substance abuse.20
Generalized Anxiety Disorder	Presence of excessive worry and anxiety for a period of 6 months or more; patient finds it difficult to control the worry; accompanied by physical symptoms such as restlessness, fatigue, and disturbed sleep (pp. 472–476).19	Patients may express significant worry and feeling overwhelmed about dental needs and/or safety of sedation procedure.
		Focus on what will be fixed first (avoiding long discussions of future treatment needs) and how positive an experience it will be for the patient.21
Major Depressive Episode	Period of 2 weeks or more where mood is depressed; interest in all or nearly all usual pleasurable activities is lost; patient reports feeling sad or “down in the dumps;” feelings of hopelessness (pp. 349–356).19	Monitor patients carefully for increased caries rate due to lowered motivation for oral self-care and potential xerogenic medication side effects.22
		After discussing with patient, speak with treating psychologist or psychiatrist, particularly about any prior or current substance abuse.22
Panic Disorder	Presence of recurrent panic attacks, combined with worry or fear of having additional panic attacks (pp. 433–440).19 Panic Attack – period of intense fear in absence of real danger including cognitive (fear of losing control) and/or physical (shortness of breath, dizziness, trembling, etc.) symptoms (pp. 430–432).19	After discussing with patient, speak with treating psychologist, psychiatrist, and/or physician, particularly about any history of cardiac conditions or evaluations.23
		Reassure patients of the safety of the procedure and steps available in the unlikely event of a medical emergency.
Schizophrenia or Other Psychotic Disorders	Delusions – mistaken but unwavering beliefs that usually involve a misinterpretation of perceptions or experiences (pp. 297–302).19 Hallucinations – sensory experiences (hearing voices, seeing visions, etc.) that do not appear grounded in reality (pp. 297–302).19	Trust may be a significant issue; provide all treatment plans in writing to help avoid miscommunications.
		Consult with patient’s psychologist, psychiatrist and/or physician regarding interpersonal issues specific to patient and patient’s ability to provide informed consent.24
Social Anxiety Disorder/Social Phobia	Fear of social or performance situations in which the patient may be embarrassed (pp. 450–456).19	Patients are often embarrassed by the state of their teeth and/or mouth, or may be embarrassed by their dental fear and need for sedation.
		Praise for taking care of their dental health will be well received; focus on what patients are doing now to improve their dental health, rather than past neglect.
		Reassure patients that many are afraid of dental treatment and receive care under sedation; discuss possible future goal of being able to receive dental care without sedation.