Frequently Asked Questions

E. ORAL SEDATION OR PREMEDICATION

Please click on the appropriate question to navigate the knowledge base.

1. Please can you clarify if temazepam before dental implant surgery is oral sedation or premedication. Does this require sedation training and a consent form to be signed for the sedative part of the procedure. The patients are given 10 mg an hour before their surgery onsite, then sometimes given another 10 mg during the procedure if needed.
Is the dosage (max 20 mg) classed as pre-medication or oral sedation?

There is a distinction between oral premedication (which the patient takes before attending the surgery or the night before) and oral sedation (which the patient takes at the practice in your presence where they can be monitored). No additional sedation qualifications are needed for a prescription for temazepam as a pre-medication. However, as soon as the patient is taking a higher dose of sedative at the surgery, this becomes oral sedation. This would require additional equipment such as a pulse oximeter etc. You would also need to consider whether the team has the appropriate theoretical knowledge, skills training (including cannulation) and experience.

With oral sedation, written consent is needed for the sedation and if you are providing complex dental treatment, presumably dental treatment consent is being completed as well. I would suggest adding the premedication to the consent form. Consent should cover discussion of all likely outcomes before the procedure, consider if the patient has had any sedative (oral or premedication) and the treatment plan changes, they are unable to give valid consent once a sedative has been administered. You should also be providing written information for the patient and escort. Please see IACSD guidance for more information (pages 18, 35, 96).

The dose range in the BNF is to allow the correct dosage to be tailored to an individual patient rather than a one size fits all approach. The BNF reference to 15-30 mg is an oral sedative whilst the 10-20 mg is referring to premedication. 30 mg would rarely be required as a premedication dose in general practice. I would not advise giving 20 mg to all patients, the prescribing clinician will need to assess each individual and make a judgement on the appropriate dosage. I would also urge caution with topping up during the procedure, as it can take a couple of hours for peak onset. It would be preferable and safer to cannulate the patient and administer midazolam intravenously in a controlled manner, thus facilitating reversal with flumazenil if needed.