“Painless extraction -As always Dr Cross & his staff were very kind, professional & knowledgeable. I have more work to follow but have no fears. I would recommend this practice anytime. Office is always clean as well.”
– Hillary S.
Many people experience anxiety about undergoing dental work or visiting the dentist at all, a fear known as dental phobia. It can keep them from seeking dental care, and may compromise their dental health. Dental phobia can be helped by sedation dentistry.
Sedation dentistry involves the use of medication to provide a relaxing and anxiety-free experience for people undergoing dental treatment. Although sometimes referred to as “sleep dentistry,” most patients remain awake but feel sleepy. There are several different methods available to achieve varying degrees of sedation. Which method is used depends on the type of procedure and the preference of the patient.
Although sedation produces a relaxed state, it does not have the same effect as anesthesia, which is used for most dental procedures. A patient will still require an injection of local anesthesia to eliminate the pain caused by the procedure. Sedation simply helps relieve the nervousness and anxiety that often accompany a visit to the dentist. A patient is usually sedated prior to getting anesthesia to reduce any anxiety about its injection.
Benefits of Sedation Dentistry
Sedation allows people to feel comfortable about undergoing complex and lengthy procedures. When under sedation, it can seem to patients that lengthy procedures have lasted for only a few minutes. Another benefit of sedation dentistry is that extensive treatment can be performed in only one or two appointments. Sedation dentistry may benefit those who:
- Have a low pain threshold
- Have sensitive teeth
- Cannot sit still in the dentist’s chair
- Gag easily
- Need a large amount of dental work done
Types of Dental Sedation
Sedation can be administered through several different methods, depending on the overall health and level of relaxation required by the patient. Most patients use nitrous oxide, also known as laughing gas, to achieve relaxation. A mask is placed over the nose and the patient breathes in the gas. The sedated feelings begin anywhere from a few seconds to a few minutes after inhaling. Numbness throughout the cheeks and gums also begins quickly. Other methods of sedation can be delivered orally or intravenously.
Depending on a patient’s anxiety level, different degrees of dental sedation may be required. They include:
Most dentists use conscious sedation, which lets patients feel relaxed but also remain awake and able to respond to commands. The patient will not remember most of the procedure with this sedation.
Can You Really Relax in the Dentist’s Chair?
Does the thought of having your teeth cleaned make your entire body tense with fear? Would you rather endure the agony of a toothache than step foot in a dentist’s office? You’re not alone. A lot of people are so phobic about going to the dentist that they prefer not to have any treatment.
For people who avoid dentists like the plague, sedation dentistry may take away some of their anxiety. Sedation can be used for everything from invasive procedures to a simple tooth cleaning. How it’s used depends on the severity of the fear.
What Is Sedation Dentistry?
Sedation dentistry uses medication to help patients relax during dental procedures. It’s sometimes referred to as “sleep dentistry,” although that’s not entirely accurate. Patients are usually awake with the exception of those who are under general anesthesia.
The levels of sedation used include:
- Minimal sedation — you are awake but relaxed.
- Moderate sedation (formerly called “conscious sedation”) — you may slur your words when speaking and not remember much of the procedure.
- Deep sedation — you are on the edge of consciousness but can still be awakened.
- General anesthesia — you are completely unconscious
- 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. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. 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.
- 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.
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.
During sedation dentistry, varying degrees of sedation may be used, depending on the needs of the patient and the type of procedure being performed.
Levels of Sedation
The point of sedation dentistry is to provide peace of mind to the patient undergoing treatment. In most cases, it does not involve anesthesia, but simply puts the patient into a very relaxed state. Because in most cases the patient is still awake to a degree, a local anesthetic must still be employed to deaden any anticipated pain. In anxious patients, sedation is administered prior to the anesthetic so the patient won’t have heightened anxiety about the injection.
Sedation for dental patients may be administered in a number of ways, depending on the procedure being performed and on the physical and emotional needs of the patient.
Inhaled Minimal Sedation
One way of administering sedation is by having the patient breath in nitrous oxide (“laughing gas”) through a mask placed over the nose. Although the nitrous oxide will definitely put the patient into a relaxed state, the gas wears off quickly. For this reason, adult patients who have been treated with nitrous oxide are able to drive themselves home from the procedure. Nitrous oxide is sometimes used as a safe alternative on children who are phobic or uncooperative about dental treatment. Patients under minimal sedation are groggy and slur their speech, but can be easily roused.
Oral sedation is the most common type used in sedation dentistry. It ranges from minimal to moderate and is administered in pill form. When only minimal sedation is required, the patient is usually given a medication similar to Valium, which takes full effect in approximately one hour. Once the pill takes effect, the patient becomes drowsy, but is still awake. When a slightly greater degree of sedation is required, the patient is administered a somewhat larger, or moderate, dose of the medication.
With the moderate dose of this medication, most patients remain fully asleep, although they can be awakened with minimal effort. Children are sometimes given a mild dose of oral medication which is carefully administered according to the child’s age and weight.
IV Moderate Sedation
Because this type of moderate sedation is administered intravenously, it works almost immediately. It also has the advantage that the dentist can adjust the dosage as needed during the procedure.
Who Can Have Sedation at the Dentist’s?
Sedation is most appropriate for people with a real fear or anxiety that is preventing them from going to the dentist.
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
Sometimes, children are given sedation if they are terrified of going to the dentist or refuse to cooperate during the visit. Nitrous oxide tends to be safe in children, and just about any dentist can administer it. A smaller percentage of pediatric dentists are trained to give children oral sedation. Oral sedation can be safe when kept within the recommended dose for the child’s age and weight.
Can Any Dentist Perform Sedation?
Most dentists can administer minimal sedation (such as nitrous oxide or pills). An increasing number of dentists can give moderate sedation. However, only a small percentage of dentists who have completed the Commission on Dental Accreditation (CODA) program in deep sedation and general anesthesia can use these more complex techniques. These dentists are typically oral and maxillofacial surgeons and dentist anesthesiologists. Some dentists use a dentist anesthesiologist, who is specially trained to give all levels of sedation and anesthesia to both children and adults.
Each state’s dental board carefully regulates the use of sedation techniques. Many states require dentists to hold permits in order to perform sedation.
How Safe Is Sedation Dentistry?
There is always a risk in getting 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.
Dr. Cross is trained and qualified to administer the type of sedation you will be receiving. To be a smart patient, you should be rest assured the following things are done:
- Before the procedure, Dr. Cross will go over your medical history. Dr. Cross will determine whether you are an appropriate candidate for sedation and ask about any medications you’re currently taking.
- Dr. Cross will determine what dose of the sedative is appropriate for your age and health. It’s important to have sedation dentistry performed with a well-trained, certified expert with experience.
- You will receive a form detailing the risks of the procedure. Go over it carefully with Dr. Cross.
- Ask questions if you’re unclear on any of the wording.
- Your vital signs will be monitored during the procedure following the American Dental Association’s guidelines. You also will be given supplemental oxygen– and drugs that reverse the effects of sedation on hand in case you need them.