“Sedation Dentistry” comes up a lot when talking about options for people with a fear of the dentist. However, not many people really understand what it involves: how it works, how it’s different from a regular dental visit and what types of people should consider it.
We went to the source and asked the dentists we know to help shine some light on the subject. Here’s what they had to say:
Patients who are fearful or who need a lot of dentistry should consider getting Oral Sedation. A patient is in a relaxed state. They are not completely asleep. However, the next day, most patients do not remember a lot about the appt. Patients take pills and are not given an IV to be sedated. They do need to have someone pick them up from the appointment and stay with them for 24 hours after treatment.
There are different modalities of sedation dentistry. The most basic is nitrous oxide gas. “Laughing gas” has the advantages of being completely reversible within five minutes by using oxygen to remove it from the patients body as well as it being impossible to be allergic to.
The second most commonly used method of sedation would be oral medications, specifically anti-anxiety drugs like valium or halcyon. These medications have a lengthy track record of safe use. However, like any medication, they have the potential for abuse or misuse. It is also possible, as with any other medication, to have an adverse reaction to it. Use of this type of sedation requires that an escort deliver the patient to and from the office, as well.
The final modality is I.V. sedation. This is delivered in the office setting by the dentist in a controlled environment. State laws vary significantly in terms of what kind of sedation may be employed and in what setting (specifically, hospital setting vs. clinic and the presence of a licensed anesthesiologist or not). Clearly, this is the most expensive method of sedation as well as presenting the most risk to the patient.
Our perspective is that we attempt to make every dental experience the least stressful event possible under the circumstances; as well as making it as pain-free as possible. We explain every procedure carefully in an effort to have the patient acquire a thorough understanding of what we are going to do before we do it. With all of that being said, however, there are still very rare circumstances which a patient would be well served by being sedated prior to treatment using one of the previously described modalities. There are several dentists who focus on this high anxiety demographic to the benefit of both the patient group and the doctor. In my office, however, we focus on behavioral and educational approaches to anxiety with the very rare use of valium as an adjunct to help patients have the best possible, i.e. least stressful experience.
The majority of our patients are treated anxiety-free, pain-free, and ready to return to their day’s schedule with individualized, local anesthetic techniques. For our patients that are more nervous or have dental phobia, “sedation dentistry” can enhance an “anxiety-free zone.” Usually not covered by dental insurance, it is worth it for those patients. Ultimately your dentist will help you determine which type of sedation, if any, is in your best interest.
Mild sedation involves breathing nitrous oxide “laughing gas” through a mask placed over the nose. This sedation is provided on-site. The patient is awake, relaxed, and ready to return to activities.
Oral sedation involves taking a pill, usually Halcion. Depending on the dose, this type of sedation can be minimal to moderate with little to no memory of the procedure. A driver is required to take the patient home and this sedation is also provided in the dental office.
IV sedation involves giving the medicine through a vein and works very quickly. Usually, there is no memory of the dental work that is performed. A driver must accompany the patient to the office to provide transportation after the procedure.
General Anesthesia is rarely, if ever, given in a dental office. If the procedure and patient require this form, hospitalization is required.
The dentist must have proper training and licensure for administering any dental sedation. Age, health status and a variety of other factors will need to be considered when choosing which is appropriate. Your dental provider will certainly be able to provide further information.
Sedation dentistry means different things in different offices. There are many levels of sedation that can be offered patients. The lightest level of sedation in my office would be nitrous oxide. It is an inhaled gas that often relaxes the patient enough that the procedure can be performed comfortably. The patient can drive and leaves the office feeling normal.
If that isn’t a deep enough layer of relaxation, we often recommend a short-acting barbiturate (like Ativan) coupled with an antihistamine (like Atarax) be taken orally a couple hours before the appointment. The patient needs a driver to and from the office, but they are much more relaxed than trying to white knuckle the visit. This works in my office for a vast majority of apprehensive patients.
For deeper sedation, I have an anesthesiologist come to the office to administer IV sedation. This is a deeper level of sedation and the patient remembers nothing about the visit. Of course, the patient again needs a driver to bring them to and from the appointment. Usually, all the necessary dentistry is done on this day to minimize the necessity for more than one visit. The trick is to give the least amount of sedation that will give the patient a comfortable result.
If you’ve had questions about sedation dentistry, hopefully, the answers provided by these dentists will help shed a little light on the subject. For more detailed answers, consider asking your dentist.
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