The following types of sedation are used in dentistry:
Inhaled (minimal sedation). You breathe nitrous oxide -- otherwise known as "laughing gas" -- combined with oxygen through a mask that's placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
Oral sedation. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. The pill will make you drowsy, although you'll still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake. Examples of Drugs for oral sedation:
- Diazepam - It has been around since the 1960s and is a well known and time-tested sedative with amnesic properties. Valium is particularly useful for appointments where extensive dentistry is being performed.
- Halcion is most well known for the treatment of insomnia.
- Zaleplon is commonly used for the treatment of insomnia.
- Lorazepam is commonly prescribed for the treatment of anxiety and has amnesic properties. It is an effective sedative and is useful for appointments <2 hours.
- Hydroxyzine has anti-anxiety effects with no amnesic properties.
- Midazolam is ideal for short appointments or simple procedures.
IV moderate sedation. You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
Deep sedation and general anesthesia. You will get medications that will make you either almost unconscious or totally unconscious -- deeply asleep -- during the procedure. While you are under general anesthesia, you cannot easily be awakened until the effects of the anesthesia wear off or are reversed with medication.
Regardless of which type of sedation you receive, you'll also typically need a local anesthetic -- numbing medication at the site where the dentist is working in the mouth -- to relieve pain if the procedure causes any discomfort.
Sedation dentistry may also be appropriate for people who:
- have a low pain threshold
- can't sit still in the dentist's chair
- have very sensitive teeth
- have a bad gag reflex
- need a large amount of dental work completed
How Safe Is Sedation Dentistry?
There is always risk anesthesia. It is usually safe, though, when given by experienced dentists. However, certain people, such as those who are obese or who have obstructive sleep apnea, should talk to their doctor before having sedation. That's because they are more likely to develop complications from the anesthesia. Other conditions such as heart and lungs conditions should also be disclosed to your dentist and medical doctor before proceeding.
It's important to make sure that your dentist is trained and qualified to administer the type of sedation you will be receiving.
To be a smart patient, you should make sure the following things are done:
- Before the procedure, your dentist should go over your medical history. Your dentist should also determine whether you are an appropriate candidate for sedation and ask about any medications you're currently taking.
- You should ask what dose of the sedative is appropriate for your age and health. You should also ask whether it is within the dose recommended by the FDA.
- You should receive a form detailing the risks of the procedure. Go over it carefully with your dentist. Ask questions if you're unclear on any of the wording.
- The dentist should continuously monitor your pulse rate and oxygen saturation and regular monitoring of depth of sedation and blood pressure throughout the procedure
- The dentist should also have oxygen -- artificial ventilation -- and drugs that reverse the effects of sedation on hand in case you need them.
Importance of Documentations (Paper work)
Documentation on of the following should be done for records.
a) Names of staffs involved in the procedure
b) History, examination and investigative findings
c) Dosages of drugs and their timings
d) Vital signs: Pulse rate, oxygen saturation and blood pressure: before, during and after the procedure.
Recommended read for Dentists: RECOMMENDATIONS FOR SEDATION AND ANALGESIA BY NON-ANAESTHESIOLOGISTS
- Guidelines for the Use of Sedation and General Anesthesia by Dentists (Amedican Dental Association)- https://www.ada.org/~/media/ADA/About%20the%20ADA/Files/anesthesia_use_guidelines.ashx
- RECOMMENDATIONS FOR SEDATION AND ANALGESIA BY NON-ANAESTHESIOLOGISTS (Ministry of Health Malaysia) - http://www.moh.gov.my/images/gallery/Rujukan/Recommendations%20for%20Sedation%20and%20Analgesia%20-%2016.pdf
- WebMD Educational Article - (http://www.webmd.com/oral-health/sedation-dentistry-can-you-really-relax-in-the-dentists-chair)
Rai, K, Hegde, A, and Goel, K. Journal of Clinical Pediatric Dentistry, 2007; vol 32: pp 1-4.
American Dental Association: "Policy Statement: The Use of Sedation and General Anesthesia by Dentists."
Joel M. Weaver, DDS, PhD, dentist anesthesiologist; emeritus professor, College of Dentistry, The Ohio State University; spokesman, American Dental Association.
American Dental Association: "Guidelines for the Use of Sedation and Anesthesia by Dentists."