Sedation Dentistry - The Basics

A vast number of people do not make a single visit to their dentist over the course of a year. Now, why is that?People are mostly fearful of any pain or discomfort that may accompany any dental treatment.

While "sleep" is an incorrect description, both sedation dentistry and sleep dentistry are used interchangeably to describe the same treatment. 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.

The dentist 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. A patient with a bout of nerves may only require an oral sedative, but someone undergoing more extensive treatment and does not want to recall anything about the procedure (eg: wisdom teeth extraction) might need intravenous sedation.

With intravenous sedation, a sedative is injected into the patient’s bloodstream, inducing what is called a "twilight sleep". The patient is technically conscious throughout the procedure, but will not be aware of the experience because the medications relax them.

What are the disadvantages of 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 freezing agent is normally administered after the patient has been sedated, but its effects will last for quite a while after the procedure has been completed.

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. Usually it is a thirty to seventy mixture, meaning a smaller percentage of nitrous oxide to that of oxygen, depending on the amount of sedation required. 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. The dentist will instruct the patient to breathe as usual, and the effects of the gas will take effect in about half a minute.

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. Because the gas is mixed with oxygen, it can be used for the duration of the procedure, and has no chance of “wearing off” the way IV sedation or oral sedation can. 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.

Are there any concerns about using inhaled sedatives? While there have been no known lingering effects or allergies to the gas reports, a patient must feel confident that their dental provider has been thoroughly trained in administering it.

The last method of sedation dentistry consists of oral sedatives (eg: Ativan) relax a particularly anxious patient. A sleeping pill or sedative is sometimes needed at bedtime the night before the dental appointment.

In general, the drug family, benzodiazepines, also called "benzos", are used as oral sedative and can cause two types of effects. The first is a drowsy and hypnotic effect, inducing calmness and even sleepiness in the patient. The second is an anti-anxiety effect, which calms the patient’s fears.

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

It is important to remember that all oral sedatives will be through prescription only, because of the strength and potential for 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. Dentists understand patients’ fears to this type of medical intervention and try to offer sustainable dental health maintenance in a relaxed and calm environment.