Sedation dentistry is a term that refers to the use of anesthesia during treatment to put patients into a relaxed state, almost like sleep. Sedation dentistry is often used during procedures that require an extensive amount of time in the treatment chair, and sedation is ideal for patients who exhibit dental phobia or have difficulty controlling their movements (this includes children). While sedation dentistry implies that patients are unconscious, this is usually not the case. Some forms of sedation dentistry simply alleviate anxiety or put patients in a sleep-like state, so that little is felt or remembered from the dentistry procedure.
If you are afraid to go to the dentist, relax! sedation dentistry and a trained sedation dentist can change your life for the better with a light sedative!
You can have the beautiful smile and the good dental health you’ve always wanted with sedation dentistry. Ask your dentist about more benefits of pain-free conscious sedation.
Imagine being able to smile with confidence and chew your food without pain. A sedation dentist and conscious sedation dentistry makes it possible to be totally relaxed during your dental treatment, as if you were asleep.
You won’t feel any discomfort and likely won’t remember the treatment itself. Because you’ll be completely comfortable, your sedation dentist can do many dental care procedures during the same visit, including:
- whitening yellow or stained teeth
- replacing crowns or dentures
- fixing chipped or damaged teeth
- restoring sore gums to good health
Best of all, you’ll probably only need one or two appointments with a dentist using sedation dentistry. So in hours you can start enjoying the confidence that comes with a bright new smile and good dental health.
Plus sedation dentistry is safe. Before your sedation dentist begins work, he or she will thoroughly review your medical history, and then monitor you closely during your conscious sedation dental treatment.
Conscious Sedation is defined as a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by pharmacological or nonpharmacologic method or combination thereof.
Sedation Dentistry, sometimes called Relaxation Dentistry, refers to the way dentist's manage Pain and Anxiety during dental appointments. Unlike General Anesthesia where a patient is completely unconscious, asleep, and unable to respond, patients under Conscious Sedation, are able to respond to commands and breath on their own.
Sedation Dentistry Information
There are different types and degrees of dental sedation; the sedation dentistry technique recommended by your dentist will depend upon the treatment being performed and/or the degree of your dental anxiety. Your dentist will be able to tell you if you are a candidate for moderate sedation with oral sedatives or nitrous oxide, or deeper sedation with intravenous drugs
Sedation Dentistry Candidates
Candidates for sedation dentistry include patients with a fear of needles or other dental anxiety, as well as individuals who require complex treatment and would like their treatment performed during a single, pain-free visit.
Dental Anxiety
Some patients (including children) have a natural fear of the dentist, while others have had a traumatic dental experience in their past that has made them reluctant to seek treatment again. Many patients find their anxiety is eased when they undergo procedures while in a sleep-like state. Learn more about sedation dentistry as a solution to dental phobia and anxiety.
Dental Sedation Methods
Many patients assume sedation dentistry will put them to sleep; however, sedation dentistry techniques that can be utilized to achieve varying degrees of relaxation.
Choosing a Sedation Dentist
While most dentists offer light to moderate sedation with sedatives or nitrous oxide, some sedation dentistry techniques require dentists to have the kind of expertise that only additional training can provide.
There are actually 14 different ways that sedation drugs can be administered.
There are 3 primary ways that Sedation is administered in the Dental Office:
1. IV Sedation also known as Deep Conscious Sedation is usually used by Oral Surgeons and dentists with specialized training and special certification. With this type of sedation, medications are administered directly into the blood stream. The greatest advantage of IV Sedation is that if someone is not sedated enough, the doctor can administer more medication and the effects are instantaneous. IV Sedation is not used commonly in most dental offices because of the specialized advanced training required and the requirements for certification by the State Board of Dentistry. The drugs used for IV Sedation are more effective then the same drugs taken orally. There is a more profound amnesia associated with this technique.
2. Enteral Conscious Sedation "Orally Administered Sedation", sometimes called "Sedation Dentistry" is administered by taking a pill. All body functions remain normal and the person is able to breathe on their own. The patient will often fall asleep. Some degree of amnesia is common. The disadvantage with this method of sedation, is that the level of sedation for each person is not predictable.
3. Inhalation Conscious Sedation, Nitrous Oxide/Oxygen Sedation also known as "laughing gas". This is the most frequently used sedation method used in dentistry. All bodily functions remain normal and the person is able to breathe on their own. The patient will often fall asleep and experience some degree of amnesia about what happened during their dental appointment. Inhalation Sedation has been used my dentists for many years.
The 2 most common types of Sedation (Sedation Dentistry) used by General and Restorative Dentists who utilize sedation are:
Oral Conscious Sedation
Inhalation Sedation
With Oral (Enteral) Conscious Sedation and Inhalation Conscious Sedation, the patient will experience a state of very deep relaxation. You can still speak and respond to the requests of others. Since IV Sedation requires specialized training and certification it is not used in most general practices, for that reason I will not provide information related to that method of sedation.
Sedation Dentistry
Oral Sedation
This Oral Medication used for Oral Conscious Sedation in dentistry are from a group of drugs known as Benzodiazapines. Not only do these medications have a sedative effect they also have some degree of amnesic effect for most people. Patients remember little or nothing about their dental appointment.
Advantages to Dental Oral Sedation:
Easy to administer: Swallow a small pill
It is safe and easy to monitor
Works well for most people
Low Cost
Disadvantages of Dental Oral Sedation:
The level of Sedation is not easily changed
Someone must drive you to and from your dental appointment
There is no analgesic (pain relief effect)
What medications are used for Dental Oral Sedation?
The most common medication is Halcion (triazolam). Halcion provides a deep level of relaxation and amnesia effect.
For children the most common medication is Versed (Medazolan) which is a liquid.
Sedation Dentistry
Inhalation Conscious Sedation
Nitrous Oxide and Oxygen ("laughing gas") has been used as the most frequent and primary means of Sedation used in Dentistry for many years. 35% of all US dentists offer Nitrous Oxide Sedation to their patients.
Advantages or Dental Inhalation Sedation:
Works well for mild to moderate anxiety
Rapid Onset
Flexible duration can be used for any appointment length Absolute Control. It is easy to quickly control the level of sedation which may be altered moment to moment.
People recover quickly
Very few side effects
There is an analgesic effect
You can drive yourself to and from your dental appointment
You can return to normal activities immediately
Disadvantages of Dental Inhalation Sedation:
Severe anxiety may require a deeper level of sedation
Not indicated for people who have respiratory problems (Asthma and Emphysema)
Claustrophobic patients do not like anything covering their nose
What medications are used for Dental Inhalation Sedation?
Nitrous Oxide (N2O)
Oxygen (O2)
The safety features of the machine insure a patient receives no less than 30% Oxygen mixed with Nitrous Oxide. Usually the patient receives 50 to 70% Oxygen.
Some thoughts on sedation
There is no doubt that sedation is a fantastic option for some people. Some dentists will opt for it for themselves when undergoing certain procedures (I've even heard of one who'll have nitrous oxide for a simple cleaning!). But it's not for everyone - and it shouldn't be pushed on people.
Nowadays, you'll come across quite a few websites which advertise themselves as "catering to the dental phobic" or even "catering to cowards". Or they'll breathlessly announce "sleep dentistry" or "twilight dentistry" as the solution to all your problems... but with some of them, all they seem to offer, apart from being not particularly unfriendly, is sedation or even general anaesthesia. There may be blanket statements along the lines of "if you are terrified of dentistry, sedation is THE answer". Of course, there isn't one answer that applies to everyone. And personally, I'd be quite wary of any place which advertises itself in that way. True enough, often the website design is left to a professional dental website design company, who simply inserts a standard piece of text. It's even possible that the owner(s) of the practice/office are blissfully unaware of the marketing hype. I'm not saying that all dental offices which advertise themselves in this way are bad - there are some great ones around that receive excellent feedback.
Perhaps the most disturbing aspect of the marketing hype for sedation is this: some people will agree to (or even request) sedation even though they'd prefer not to be sedated - because they worry that the dentist is going to be upset with them should they panic. They're worried that they'll inconvenience their dentist because s/he may have to stop what s/he's doing, that their dentist will then get frustrated or angry with them, which in turn will cause them to react with more fear. This reasoning is usually based on the assumption that no dentist will want to deal with someone who's "difficult" (i. e. someone who needs more assurance than the average patient).
If that is the way you feel, please don't settle for a "put up and shut up" approach - instead, make an extra effort to find a calm and understanding dentist who has the ability to put you at ease, even if this means meeting more than one dentist (for a chat, initially) to see whom you feel comfortable with. Hey - you're worth it ;) !
It's also true that depending on where you live, sedation may not be widely offered - and it's more expensive. If you suffer with dental phobia, it can be very disconcerting, if not scary, to read statements along the lines of "the only way people like you can be treated is when you're sedated". Not true in most cases! So don't have a nervous breakdown if you can't avail of it - generally speaking, pain can be controlled extremely well with the use of local anaesthetic, and anxiety can often be controlled using psychological methods. However, if you have an instinctive feeling that behavioural methods can't help you, make sure you seek out a dentist who offers sedation.
Many dentists who offer sedation simply do so as an adjunct to empathetic treatment, to patients who desire to know as little as possible of the procedure or who want to get things fixed in the least amount of time possible. However, there are also some who offer it because they lack the people skills needed to make frightened clients feel at ease.
In this context, it is informative to note what Stan Malamed, the author of "Sedation - A Guide to Patient Management" (2003 edition) has to say on the subject:
"I have received extensive training in the administration of drugs for pharmacosedation and general anaesthesia, yet I have received no formal training in any aspect of psychology or human behavior. It would appear, therefore, that I should have a strong bias toward the use of techniques requiring drug administration. When I first started my training in anaesthesiology in 1969 this was true. However, in the ensuing years I have become acutely aware that iatrosedation [i. e. the relief of anxiety through the doctor's behaviour] is an integral part of the success (or possible failure) of every procedure that we in medicine and dentistry attempt." (p. 79)
Malamed cites a classic study by Egbert et al (1963) illustrating the importance of human behaviour in the control of anxiety. In this study, patients about to undergo surgery the next day were placed in one of three experimental groups. Participants in group 1 were visited the day before by the anaesthesiologist who explained the upcoming events to them and answered any questions the patients had in order to allay their fears. Those in group 2 received a sedative one hour before the operation but no visit. Those in group three received both the visit and the pre-op sedative.
The results showed that patients in group 1 were alert upon arrival in the operating room but quite calm and didn't appear to be apprehensive. Those in group 2, who had received a sedative only, were drowsy - but apprehensive. People in the third group were both drowsy and calm. This example demonstrates that using pharmacosedation instead of, rather than as an adjunct to, iatrosedation just doesn't do the trick.
Anyway, what I'm really trying to get at is: as a dentist, explore if and what level of pharmacosedation is required first, paying particular attention to the issues mentioned above.
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