Ethics & Law · patient case question
A different patient arrives for a scheduled intravenous sedation appointment smelling strongly of marijuana. What should the dentist do?
Patient case: Anxious adult with a traumatic dental history
Patient: Male, 44 years old
Chief Complaint: Needs restorative treatment but is visibly frightened.
Background: He describes a previous dentist who treated him without adequate anaesthesia and, when he complained of pain, told him to stop crying like a baby. He has avoided dental care for eleven years.
Current Findings: Tense, tearful, hyperventilating slightly on sitting in the chair. Multiple untreated carious lesions.
Show answer and explanation
Correct answer: D. Reschedule the appointment
- A. Dose reduction does not resolve the unpredictability of the interaction, and it does not address the consent problem at all.
- B. Marijuana emphatically does interact with sedatives — additive CNS depression and cardiovascular effects are both well documented.
- C. Abandoning the sedation but proceeding with treatment still leaves an intoxicated patient who cannot consent, and elective care under those circumstances is not defensible.
- D. CORRECT. Recent cannabis use interacts unpredictably with intravenous sedatives — it potentiates CNS depression, alters the dose response, and raises the risk of tachycardia and dysrhythmia when combined with anaesthetic agents. Beyond the pharmacology, an intoxicated patient cannot give valid informed consent. Reschedule, and explain clearly why.