Oral Sedation Dentistry
What is Conscious Sedation?
Conscious Sedation is defined as a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by the pharmacological or nonpharmacologic method or combination thereof.
Sedation Dentistry, sometimes called Relaxation Dentistry, refers to the way dentist’s manage Pain and Anxiety during dental appointments.
Unlike General Anesthesia where a patient is completely unconscious, asleep, and unable to respond, patients under Conscious Sedation, are able to respond to commands and breath on their own.
There are actually 14 different ways that sedation drugs can be administered.
There are 3 primary ways that Sedation is administered in the Dental Office:
- IV Sedation: also known as Deep Conscious Sedation is usually used by Oral Surgeons and dentists with specialized training and special certification. With this type of sedation, medications are administered directly into the bloodstream. The greatest advantage of IV Sedation is that if someone is not sedated enough, the doctor can administer more medication and the effects are instantaneous. IV Sedation is not used commonly in most dental offices because of the specialized advanced training required and the requirements for certification by the State Board of Dentistry. The drugs used for IV Sedation are more effective than the same drugs taken orally. There is a more profound amnesia associated with this technique.
- Enteral Conscious Sedation: “Orally Administered Sedation,” sometimes called “Sedation Dentistry,” is administered by taking a pill. All body functions remain normal and the person is able to breathe on their own. The patient will often fall asleep. Some degree of amnesia is common. The disadvantage with this method of sedation is that the level of sedation for each person is not predictable.
- Inhalation Conscious Sedation: Nitrous Oxide/Oxygen Sedation also known as “laughing gas.” This is the most frequently used sedation method used in dentistry. All bodily functions remain normal and the person is able to breathe on their own. The patient will often fall asleep and experience some degree of amnesia about what happened during their dental appointment. Inhalation Sedation has been used my dentists for many years.
The 2 most common types of sedation used by general and restorative dentists who utilize this option are:
- Oral Conscious Sedation Inhalation Sedation: With Oral (Enteral) Conscious Sedation and Inhalation Conscious Sedation, the patient will experience a state of very deep relaxation. You can still speak and respond to the requests of others.
Since IV Sedation requires specialized training and certification it is not used in most general practices, for that reason I will not provide information related to that method of sedation.
- Sedation Dentistry Oral Sedation: This oral medication used for oral conscious sedation in dentistry are from a group of drugs known as Benzodiazepines. Not only do these medications have a sedative effect they also have some degree of amnesic effect for most people. Patients remember little or nothing about their dental appointment.
Advantages to Dental Oral Sedation:
- Easy to administer: swallow a small pill
- It is safe and easy to monitor
- Works well for most people
Disadvantages of Dental Oral Sedation:
- The level of Sedation is not easily changed
- Someone must drive you to and from your dental appointment
- There is no analgesic (pain relief effect)
What medications are used for Dental Oral Sedation?
The most common medication is Halcion (triazolam). Halcion provides a deep level of relaxation and amnesia effect.
For children, the most common medication is Versed (Midazolam) which is a liquid.
Sedation Dentistry Inhalation Conscious Sedation
Nitrous Oxide and Oxygen (“laughing gas”) have been used as the most frequent and primary means of sedation used in dentistry for many years. 35% of all US dentists offer nitrous oxide sedation to their patients.
Advantages of Dental Inhalation Sedation:
- Works well for mild to moderate anxiety
- Rapid Onset
- Flexible duration can be used for any appointment length
- Absolute Control. It is easy to quickly control the level of sedation which may be altered moment to moment
- People recover quickly
- Very few side effects
- There is an analgesic effect
- You can drive yourself to and from your dental appointment
- You can return to normal activities immediately
Disadvantages of Dental Inhalation Sedation:
- Severe anxiety may require a deeper level of sedation
- Not indicated for people who have respiratory problems (Asthma and Emphysema)
- Claustrophobic patients do not like anything covering their nose
What medications are used for Dental Inhalation Sedation?
- Nitrous Oxide (N2O)
- Oxygen (O2)
The safety features of the machine ensure a patient receives no less than 30% Oxygen mixed with Nitrous Oxide. Usually, the patient receives 50 to 70% Oxygen.
Who Should Consider Using Conscious Sedation?
You may benefit from Conscious Sedation if you have a lot of stress, fear and anxiety about going to the dentist. “You are afraid of the Dentist”. If you need or require a lot of dental treatment, you should consider the use of Conscious Sedation. Conscious Sedation is sometimes called, “Sedation Dentistry” or “Relaxation Dentistry.”
Conscious Sedation will allow most people to overcome the stress fear and anxiety associated with dental treatment because they can relax during their dental visit.
Previous bad dental experiences cause fear and anxiety about Dentists and Dentistry. If these feelings are preventing you from getting the dentistry that need Conscious Sedation can help you.
Conscious Sedation is safe, cheap and effective.
Many people have a fear of needles, had difficulty getting numb, or have a bad gag reflex, all these people can be helped through conscious sedation. These are a few of the problems that people encounter which will prevent them from seeking the Dentistry that they need.
When someone is sedated and relaxed it is possible to complete a large amount of complex dental treatment during a single visit to the dentist. People often have little or no memory of their dental visit.
If you exhibit any of the following characteristics, Sedation Dentistry may help you:
- Fear, stress and anxiety about going to the dentist
- People who desire a beautiful and natural smile and have fear and anxiety associated with dentistry
- Fear of needles
- You have a difficult time becoming numb
- Dental Phobia
- A history of bad dental experiences
- Painful or sensitive teeth
- Afraid to go to the dentist
- You are troubled with a bad gag reflex
- Difficulty controlling movement from conditions such as Cerebral Palsy or Parkinson’s disease
- You need complex treatment requiring long dental appointments
- People who have limited time to complete their required treatment and want to accomplish a lot in a single appointment
- Treatment requiring multiple visits can often be accomplished in a single visit
- Patients who are on other medications should consult their medical doctor before taking sedatives
- Previous allergic reactions to other drugs should also be reported to the sedation dentist
How Does Oral Conscious Sedation Work?
You will be prescribed a pill to take one hour prior to your scheduled dental visit. It is imperative that you have someone drive you to, and from your dental appointment. When you arrive at the dental office, you will be awake and feeling very drowsy and relaxed.
Upon your arrival for your dental appointment, you will be immediately escorted to the dental treatment area and seated in the dental chair. You will be placed on a monitor to carefully watch your vital signs during the entire appointment.
Tinted glasses will be used to keep the bright light out of your eyes, and for protection. If you feel cold, you will be covered with a blanket. A small pillow is available for the small of your back. It is our desire that you are fully relaxed and comfortable before, during and after your dental appointment.
There is no analgesic or pain relieving qualities provided by oral sedatives. Local anesthetics will be used to prevent pain. Because you are so relaxed, and because of the use of painless injection techniques, you will probably not remember when your teeth were actually being “numbed.”
When your treatment is completed, your friend or relative will drive you home, where you can climb into bed for a soothing, relaxing nap.
When you are fully awake, you will feel comfortable, relaxed and free from stress. You will probably remember very little about your wonderful, relaxing, dental experience.
Sedation Dentistry: Eating and Drinking Instructions
If you are preparing for a dental procedure where sedation will be used, there are certain instructions that you will need to know before and even after the surgery. One of the key safety parameters for the provision of anesthesia is to follow the eating and drinking instructions. If these guidelines aren’t followed, a catastrophe may occur during anesthesia. Here are some of the instructions for eating and drinking when preparing for sedation dentistry.
Before the day of the surgery
Where the patient is scheduled to undergo the surgery in the morning, fasting should start at midnight of the night before. If the appointment is scheduled in the afternoon, it is recommended that the patient should not eat anything 6 hours before the time of dental surgery. For instance, if your surgery is at 10:00 AM, you will need to have consumed any food before 4:00 AM. You can also continue with fluids until 8:00 AM. While it isn’t practical to eat after 4.00 AM, you can continue drinking as much clear liquids as you want. On the other hand, if your appointment is at 3.00 PM, you will need to eat food before 9.00 AM and continue drinking fluids until 1:00 PM.
During the fast, drinking apple juice or water is allowed. However, other beverages such as orange juice, alcohol, creamer, milk, or even opaque drinks are not allowed. However, this rule comes with some exceptions. This is due to the fact that there are certain medications that the patient may be required to take with some small amounts of water. These include:
- Pulmonary medications
- Cardiac medications
- Anti-Parkinson’s medications
- Anti-seizure medications
- Any other medications that the dentist may prescribe on the day of procedure
Therefore when it comes to eating and drinking instructions for sedation dentistry, the most important thing to note is that you should avoid taking any kind of drink including water and apple juice within 2 hours before the surgery. Follow these instructions carefully to avoid the risk of any complications during and after the surgery.
You should not operate a motor vehicle for 24 hours after receiving Oral Conscious Sedation.
To learn more about our oral sedation in Woodbridge VA, please call our office at (703) 583-2800. If you’re closer to our Manassas location, please contact this location by calling (703) 330-5578.