Sedation Dentistry - The Basics

A vast number of people do not make a single visit to their dentist over the course of a year. Why? For the most part, people are afraid of dental procedures because they can occasionally be uncomfortable or painful.

While "sleep" is an incorrect description, both sedation dentistry and sleep dentistry are used interchangeably to describe the same treatment. The use of sedation dentistry may render a person asleep, but it is not the same type of sleep experienced by a person under general anaesthetic (like that used for removal of tonsils or an appendix).

Depending on the extent of the dental treatment involved a dental practitioner can choose from one of three types of sedatives: oral sedation, intravenous or IV sedation and inhalation sedation (nitrous oxide). 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.

Intravenous sedation is administered directly into the blood stream of the patient, and is frequently referred to as "twilight sleep".The patient is technically conscious throughout the procedure, but will not be aware of the experience because the medications relax them.

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. Additionally, IV sedation does not provide any pain relief, so traditional injections of a numbing agent will still be required. 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. With only a thirty to seventy percent ratio, nitrous oxide to oxygen, this is a very effective sedative.

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. When a patient inhales normally, he/she will feel the affects of the gas within twenty to thirty seconds. The dentist will wait another minute or so before starting the treatment to ensure that the inhalant’s painkilling effects have taken affect.

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. Some people experience dizziness, giddiness or lightheadedness early in the administration of the gas, but this wears off quite quickly.

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. There is no contraindication for this method of sedation for women still in the first trimester of pregnancy, or for people with lung, kidney or liver disease.

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 oral sedatives commonly used in this method belong to a group called benzodiazepines, or "benzos", and have two main consequences. The first is a drowsy and hypnotic effect, inducing calmness and even sleepiness in the patient. They can also make the patient feel free from anxiety and apprehension. Varying effects can be achieved with the use of different types of benzos as they target different regions of the brain inducing sleep in some and tranquility in others.

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.

Patients should not be ashamed of being afraid of pain or experiencing panicky reactions when faced with dental treatment. Dental professionals understand and treat these fears with respect, and provide alternatives that can ensure dental health without terrifying the patient.