A significant number of Americans do not visit the dentist for regular checkups because they are too fearful or suffer from dental anxiety. Sedation dentistry offers an excellent way to provide a safe, anxiety-free, dental experience to those who are afraid of the dentist.
Sedation dentistry is often mistakenly thought to induce sleep. In fact, most sedatives allow the patient to stay awake during the procedure. Sleepiness is a side effect of some medications, but nitrous oxide, oral conscious sedation and IV sedation only work to calm anxiety throughout the dental visit.
Sedation dentistry is popular because most sedatives can be taken by mouth, meaning no injections, no anxiety and no pain. Some sedatives work so effectively that even the smells and details of the procedure cannot be recalled afterward. Safety and compliance are two important aspects of treatments, so sedation dentistry offers both the individual and the dentist the best alternative.
Whatever the form of sedative, it is essential to be accompanied by a caregiver. Sometimes, sedatives are provided the night before the dental visit, which means that driving to or from the appointment is not advisable.
Here are some advantages associated with sedation dentistry:
What kinds of sedatives are available?
The most popular types of dental sedatives are nitrous oxide, oral conscious sedation, and IV sedation. Different levels of sedation (mild, moderate and deep) can be utilized depending on individual needs. Before administering any sedative, the dentist must analyze the full medical history of the patient, as well as taking note of any current medications.
Here is an overview of some of the most common types of dental sedatives:
Nitrous Oxide
Nitrous oxide, or “laughing gas,” is used as a mild sedative. It is delivered through a nose hood, and is administered throughout the entire procedure. Nitrous oxide elevates the general mood and can evoke a general sense of well-being. Most importantly, it relieves anxiety and reduces pain during the procedure. In addition, some tingling and numbness may be felt. There are few side effects associated with nitrous oxide, and it has been safely used in dentistry for many years.
Oral Conscious Sedation
Oral conscious sedation is an excellent choice for people who fear needles. Oral medication is provided prior to treatment in order to induce a moderate state of sedation. Though oral sedatives do not cause sleep, they usually dull the senses. This means that most patients cannot remember the pain, smells or noises associated with the procedure. Usually, a dose of medication is taken prior to the appointment, and then topped up during the procedure as required.
IV Sedation
Intravenous sedation is a moderate type of sedation. Patients who have previously experienced IV sedation often report feeling like they slept through the entire procedure. Generally, IV sedation is used for shorter treatments. It is administered via direct injection into the bloodstream, which means the effects are immediate. Sometimes patients feel groggy and sleepy when the IV sedatives are withdrawn. This is why it is important to bring a designated driver for the drive home.
What types of drugs are used in oral conscious sedation?
Most of the drugs used in sedation dentistry are classified as benzodiazepines. Benzodiazepines reduce anxiety, muscle spasms, insomnia and seizures. Each medication has a different half-life, meaning that the effects last for varying amounts of time. The estimated length of the procedure determines which type of drug is going to be most effective.
Here are some of the most common drugs used in oral conscious sedation:
Valium® – This sedative has amnesic properties and a long half-life. It is usually used for time-consuming, complex procedures.
Halcion® – Usually used to treat insomnia, Halcion is an effective sedative with amnesic properties. A short half-life makes this sedative useful for shorter procedures.
Ativan® – This sedative is best known for reducing anxiety. It has amnesic properties and a medium half-life. Ativan is typically used for treatments shorter than two hours.
Versed® – This sedative has the shortest half-life and is therefore less commonly used. It alleviates anxiety in much the same way as nitrous oxide, and is used for visits that will take less than 30 minutes.
If you have questions or concerns about sedation dentistry, please ask your dentist.
What is IV (Conscious) Sedation?
Intravenous sedation is a moderate type of sedation. Patients who have previously experienced IV sedation often report feeling like they slept through the entire procedure. Generally, IV sedation is used for shorter treatments. It is administered via direct injection into the bloodstream, which means the effects are immediate.
When a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment, this is referred to as Intravenous Conscious Sedation (aka "IV sedation"). Conscious sedation is sometimes (incorrectly) referred to as "twilight sleep" or "sleep dentistry". These terms are more descriptive of deep sedation anesthesia. Deep sedation isn't commonly used and is more closely related to general anesthesia (even though sedation occurs on a continuum). This page answers the most common questions regarding conscious IV sedation. Please be aware that this page contains some explicit descriptions.
What does it feel like? Will I be asleep?
A lot of dental offices use terms such as "sleep dentistry" or "twilight sleep" when talking about IV sedation. This is confusing, because it suggests that IV sedation involves being put to sleep. In reality, you remain conscious during IV sedation. You will also be able to understand and respond to requests from your dentist.
However, you may not remember much about what went on because of two factors: firstly, in most people, IV sedation induces a state of deep relaxation and a feeling of not being bothered by what's going on. Secondly, the drugs used for IV sedation can produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it is "reversed" or wears off. As a result, time will appear to pass very quickly and you will not recall much, or perhaps even nothing at all, of what happened. So it may, indeed, appear as if you were "asleep" during the procedure.
Is it still necessary to be numbed with local anesthetic? Will my dentist numb my gums before or after I'm sedated?
The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added, see below for a more detailed discussion), but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.
If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anesthetic has taken effect (i. e. until you're numb) before starting on any procedure.
How is IV sedation administered?
"Intravenous" means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand (and sometimes wherever a vein can be found). This needle is wrapped up with a soft plastic tube. The needle makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube (which is correctly referred to as an "indwelling catheter", but more commonly known by the tradename of Venflon). The tube stays in place throughout the procedure.
The venflon to the right is a pinkie, which is one size bigger than the blue one that's usually used for IV sedation in dentistry.
Throughout the procedure, your pulse and oxygen levels are measured using a "pulse oximeter". This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you're getting dangerously low on oxygen, although your dentist and team are paying attention and will see it before the machine does =). The warning signs are unresponsiveness and slow breathing. Blood pressure before and after the procedure should be checked with a blood pressure measuring machine (a tongue-twister called "sphygmomanometer", which for obvious reasons is referred to as "sphyg").
Is it safe? Are there any contraindications?
IV sedation is EXTREMELY safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it's even safer than local anesthetic on its own!
However, contraindications include pregnancy, known allergy to benzos, alcohol intoxication, CNS depression, and some instances of glaucoma. Cautions include psychosis, impaired lung or kidney or liver function, and advanced age. Heart disease is generally not a contraindication.
What are the main advantages of IV sedation?
(1) IV sedation tends to be the method of choice if you don't want to be aware of the procedure - you "don't want to know". The alternative is to use Oral Sedation (like Valium)
(2) The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual's needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
(3) The maximum level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.
(4) Benzos produce an amnesia: You won't remember what happened during the procedure.
(5) The gag reflex is hugely diminished - people receiving IV sedation rarely experience difficulty with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.
(6) It can be ideal for those with a phobia of dental injections.
(7) Unlike General Anesthesia or Deep Sedation, conscious IV sedation doesn't really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.
Are there any disadvantages?
(1) A very thin needle has to be put in the arm or hand ("venipuncture"). If you have a general phobia of needles, this won't be your idea of fun. If you cannot tolerate this, having inhalation sedation ("laughing gas") before the venipuncture helps, because it relaxes you and produces a tingling feeling in arms and legs which distracts from the venipuncture.
(2) It is possible to experience complications at the site where the needle entered, for example some swelling, blood blistering (hematoma), or bruising.
(3) While IV sedation is desired precisely because of the amnesia effect (i. e. forgetting what happened while under the influence of the drug/s), there can be a downside to this: if you can't remember that the procedure wasn't uncomfortable or threatening, you can't unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem. Some people would voice a concern that some patients can't be "weaned off" IV sedation, as dental anxiety tends to returns to baseline levels. As a result, people who rely on IV sedation may be less likely to seek regular dental care. Other people would argue that this is not a concern if IV sedation is readily available to people.
(4) Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.
(5) You should WANT to be sedated. You have to give into it. If, for any reason, you're unwilling to "let go", for example because you don't like not being in control, it will be more difficult to be successfully sedated. If you resist the sedation, it will not be very effective.
After IV Sedation, we recommend the following:
(1) You will still be a little groggy and "slow" after we reverse the IV sedation, so you'll want to make sure you have someone to drive you home. (No one to give you a ride? We can provide transportation if you let us know in advance).
(2) You'll feel tired and a little "loopy" for the rest of the day, so make sure you have someone at home to help you, or stay with a friend or family member.
(3) Your reflexes will be slow and your mind a little dull for the first day, so don't plan to perform any strenuous or hazardous activities and don't drive a motor vehicle or operate any machinery for the rest of the day.
(4) You'll probably be really hungry when you get home, but remember that your stomach is empty and your body is still moving in "slow motion", so don't eat a heavy meal immediately. Stick to something light, like pudding or soup, and only eat small portions, taking little bites. It will upset your stomach and could affect the surgical area if you eat too heavily after IV sedation, so don't let yourself get carried away.
(5) If you experience nausea, lie down for a while. Use a cool, damp cloth on your neck and/or forehead, and slowly sip a glass of juice (or any other cool, non-carbonated drink).
(6) If you're already taking regular medication for other conditions, make sure we have a complete list BEFORE we schedule you for surgery! After surgery, don't drink alcohol or take medications unless approved by your dentist and physician first. If you received a prescription from us, you'll want to follow the instructions as indicated by your dentist and pharmacist.
(7) Only take medications as directed by your dentist.
(8) If you have any unusual problems, or the sleepy feeling lingers for more than a day, call our office right away!
This information and more can be found at: www.dentalfearcentral.org