Sedation Dentistry - The Basics

Millions of people every year avoid the annual dental check-up. Why? For the most part, people are afraid of dental procedures because they can occasionally be uncomfortable or painful. Advertisements promising “sedation dentistry” or “sleep dentistry” are meant to attract those who avoid visiting the dentist. Sedation dentistry and sleep dentistry refer to the same thing, but the term “sleep” is not accurate. Patients who opt to have their teeth examined and treated under sedation may fall into a light sleep depending on the treatment required and anaesthetic used.

Suwanee dentists can choose from three options - oral sedation, intravenous (IV) sedation and inhalation sedation - using the lighter medication for simple dental cleanings and a heavier medication for more complicated surgeries or extractions. Intravenous sedation is administered directly into the blood stream of the patient, and is frequently referred to as “twilight sleep.” The patient is often so relaxed with the IV sedation that they may fall into a light sleep, and the patient will not remember anything about the procedure. Patients undergoing dental treatment under intravenous sedation hardly notice the passage of time, and procedures that require over an hour might seem to them to have taken just a few minutes.

Are there any drawbacks to IV sedation? Those who avoid dental appointment because of a fear of pain or needles may prefer an alternative treatment to IV sedation since this form of sedation involves use of needles. IV sedation does not address the issue of pain, so a dentist will still need to “freeze” the area with a numbing agent. The effects of the numbing agent, which is normally administered once the patient starts to feel the effects of the sedative, will linger until after the dental treatment is over. IV sedation is not recommended for those who are pregnant, of advanced age, who have allergies to certain sedative medications, or whose lungs, kidneys or liver are not in optimal condition.

Instead of intravenous sedation, a patient may opt for “inhalation sedation” where laughing gas (really a mixture of nitrous oxide and pure oxygen) is administered through a mask. The normal dosage is thirty percent nitrous oxide and the rest oxygen. Most patients will be brought through varying levels of awareness, with the deepest level producing a sense of euphoria and well-being. The inhalation sedative is administered mostly by a mask known as a nasal hood that is fitted over the patient’s nose, or by cannula, which are prongs inserted into the patient’s nostrils. It only takes about twenty to thirty seconds for the patient to begin to feel the effects of the nitrous oxide. Within two to three minutes the gas produces painkilling effects and the dental work can begin.

The major plus of inhalation sedation is the scope of control the dentist has over the degree of sedation, allowing him/her to increase or decrease the amount of gas as necessary, and the euphoric effects of the gas wear off quickly. Since oxygen is included in the sedative cocktail, it can be used throughout the duration of the dental treatment and rules out the possibility of the sedative wearing off mid-procedure as sometimes happens with either IV or oral sedation. The gaseous mixture also has no continuing effect or “hangover” associated with the other two methods. While some patients might feel a bit dizzy or lightheaded at the initial stages of inhalation this does not last long. Does inhalation sedation have any disadvantages? There are few contraindications for the use of inhalation sedation, because those who provide it as a treatment alternative must undergo extensive training, and because there are no known lingering side effects or allergies to the gas.

The final method of sedation dentistry involves the swallowing of oral medications to reduce fear, anxiety or nervousness in the patient. Depending on the procedure and the patient, a sleeping aid or sedative the evening before the dental visit may be ordered. The types of medications normally used for oral sedation are in the benzodiazepine family, commonly called “benzos,” and provide two possible effects. The first is a feeling of being soothed and perhaps a bit sleepy. The second effect is a feeling of freedom from worries and fears. The biggest differences between the types of benzos used are the areas of the brain targeted by the chemicals, with some inducing a sleep-like state rather than simply an overall sense of calm.

Is oral sedation safe for everybody? Unfortunately, because the drugs do have a wide range of effects they cannot be safely metabolized by everyone.

Oral sedatives cannot be fully relied upon to be effective sedatives, because they do not always work fully for some patients, while they have almost no impact on others. The oral sedative used will be prescribed by the dentist, because the medications are strong and present the risk of addiction. Directions for use should be strictly followed, including the restrictions on alcohol or consumption of other drugs.

Patients should not be ashamed of being afraid of pain or experiencing panicky reactions when faced with dental treatment. Suwanee dentists understand patients’ fears to this type of medical intervention and try to offer sustainable dental health maintenance in a relaxed and calm environment.