Multiple chemical sensitivity is a disease in which autonomic and neuropsychiatric symptoms, such as fatigue, headache, joint pain, insomnia, and dermatitis, occur in response to exposure to a trace amount of a chemical substance. Here, we report the management of intravenous sedation for tooth extraction and caries treatment in a patient with multiple chemical sensitivities.
A 57-year-old woman visited a nearby dental clinic complaining of dentin hypersensitivity and requiring tooth extraction and treatment for a root fracture in the mandibular right second molar and caries in the mandibular right first premolar. However, she had a history of chemical hypersensitivity and dentophobia. She was referred to our hospital and was scheduled to undergo intravenous sedation in an environment with minimal exposure to inducers.
We monitored her blood pressure, percutaneous arterial oxygen saturation (SpO2), and pulse, and a single dose of midazolam (2 mg) and propofol (10 mg) was administered after securing an intravenous route. The continuous administration of propofol was started at 3 mg/kg/h under 3 L/min of oxygen after the patient fell asleep. No symptoms or risks associated with multiple chemical sensitivity were observed during the tooth extraction or caries treatment.
The patient was successfully treated in an environment that eliminated the triggers for the onset of symptoms of multiple chemical sensitivity after meticulous interviews with specialists in collaboration with each clinical department. Intravenous sedation using midazolam and propofol under 3 L/min oxygen was a successful approach for minimizing the psychosomatic mechanisms of multiple chemical sensitivity in a patient with dentophobia.
