Sedation Dentistry - The Basics

Millions of people every year avoid the annual dental check-up with their Denver dentist. Why? These people fear the possibility of pain.

Sedation dentistry and sleep dentistry refer to the same thing, but the term “sleep” is not accurate. Those who choose to have their dental work done while under sedation can be awake or in a light sleep, where they are still in control of their airway and respond to instructions from the dentist.

Denver dentists work with 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. IV sedation - which most patients fall asleep with - may be preferred for the patient who doesn’t want to remember the procedure at all, while an oral sedative may be more appropriate to address issues of stress or anxiety associated with under going dental care.

Intravenous sedation is administered directly into the blood stream of the patient, and is frequently referred to as “twilight sleep”. Under IV sedation, some patients will fall asleep as if they’ve just gone to bed, and are not aware of the treatment being administered.

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. A nerve numbing medication will still need to be administered so the patient will not feel any pain during the procedure. Dentists will do this once the patient is sedated, but the effects of the numbing drug won’t wear off until up to several hours after the patient goes home.

IV sedation is contraindicated in conditions like pregnancy, old age, for those who may be allergic to the sedative agent, and for people whose lungs, liver or kidneys are not in particularly good condition.

IV sedation also requires the patient to be accompanied on their visit, because the effects of the drugs do not wear off immediately, and they will need a family member or friend to drive them home where they must rest for the remainder of the day.

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.

Nitrous oxide is inhaled through a nasal hood or mask that fits over the nose, or through nasal prongs (cannula) that are inserted into the nose. 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 greatest advantage of inhalation sedation is the fact that it can be controlled by the dentist, raised or lowered as required, and the sedation wears off shortly after the mask is taken away. 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. Some people experience dizziness, giddiness or lightheadedness early in the administration of the gas, but this wears off quite quickly.

What are the risks involved in inhalation sedation? 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. Women in the first trimester of pregnancy can choose this method of sedation, and it presents no danger to anyone with heart, lung, kidney or liver problems.

The third method of sedation dentistry is oral sedation where the patient swallows sedative pills to reduce their apprehensiveness and nervousness. Depending on the procedure and the patient, a sleeping aid or sedative the evening before the dental visit may be ordered. This treatment may be further supplemented by a second oral sedative on the morning of the dental visit, and the patient will need to arrange for someone to escort them to the office.

The oral sedatives commonly used in this method belong to a group called benzodiazepines, or “benzos”, and have two main consequences. The benzos can make the patient feel calmed and drowsy. They can also make the patient feel free from anxiety and apprehension. 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.

Can everybody choose oral sedation?

No, since they are known to result in quite a number of side effects.

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.

It is important to remember that all oral sedatives will be through prescription only, because of the strength and potential for addiction. When they have to be taken, the prescribed directions as to dosage and consumption of alcohol must be followed faithfully.

Fear of pain or losing control over one’s senses are not frivolous issues that patients need to be ashamed of. Denver dentists understand and treat these fears with respect, and provide alternatives that can ensure dental health without terrifying the patient.