The aim of sedation in the dental chair is to make you, the patient, as comfortable as possible. Through the safe and effective administration of drugs we can relieve anxiety and reduce pain. From sedatives to laughing gas or conscious sedation administered by an aneathetist, there is a cost-effective option available for patients that have severe dental anxiety or are in need of very complex treatment.
Sedative medication helps relax patients by slowing the action of the central nervous system. People remain aware of their surroundings, but are less responsive to external stimuli like the sound of the drill or the smell of materials.
This also reduces their sense of pain. Sedatives aren't new; in fact, they date back thousands of years. Pain management is as old as medicine, and other ancient forms include alcohol, the mandrake root and opium poppies. The modern age of sedative medication began in the 1800s with the creation of bromides and chloral hydrate. Current medications are often more powerful and less likely to carry unpleasant side effects. However, all medications differ, and there's no one medication that's appropriate for every patient.
Ther are three primary ways that sedation is administered in the dental office:
- Inhalation sedation: nitrous oxide or 'laughing gas'
- Oral sedation
- Intravenous sedation or deep conscious sedation.
Laughing Gas | Nitrous Oxide
Commonly known as laughing gas, nitrous oxide is the most frequently used sedation method 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. Dentists have used inhalation sedation for many years.
What to expect with laughing gas
The gas is administered through a control box giving the dentist the ability to adjust the concentration of nitrous oxide according to the level of sedation required. There are four levels of sedation that can be experienced.
- A tingling sensation, especially in the arms and legs, or a feeling of vibration (parasthesia)
- This is quickly followed by warm sensations
- And a feeling of well being, euphoria and/or floating (drift). This is the ideal level for dental treatment. During heavier sedation, hearing may dissolve into a constant, electronic-like throbbing.
- At a deeper level of sedation again, sleepiness, difficulty to keep one's eyes open or speak (dream) can occur. Nausea would indicate oversedation.
For use in dental treatment you should be maintained within the first three stages. The 'dream' stage is indicative of too high a nitrous oxide concentration.
Oral Conscious Sedation
The medication used for oral conscious sedation in dentistry is from a group of drugs known as benzodiazepines. The most commonly used product is South Africa is Dormicum. 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.
IV Sedation | Deep Conscious Sedation
Intravenous Conscious Sedation (aka “IV sedation”) is when a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment. Although IV sedation is often confused with General Anaesthetic, in reality, during conscious IV sedation you remain conscious. You will be able to understand and respond to requests from your dentist.
However, you may not remember much (or anything at all) about what went on because of two things:
- IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on
- the drugs used for IV sedation produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much of what happened. Many people remember nothing at all. So it may, indeed, appear as if you were “asleep” during the procedure.
At HBDS we use the services of specialist anaesthetists to administer your IV sedation. This leaves your dentist free to concentrate only on you and the treatment you require.
What are the main advantages of IV sedation?
IV sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”.
The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
The maximum level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.
Benzodiazepines produce amnesia for the procedure.
The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.
Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.
Are there any disadvantages?
It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood).
While IV sedation is desired precisely because of the amnesia effect (i. e. forgetting what happened while under the influence of the drug/s), there can be a downside to this: if you can’t remember that the procedure wasn’t uncomfortable or threatening, you cannot unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem. Some people would voice a concern that some patients can’t be “weaned off” IV sedation, as dental anxiety tends to returns to baseline levels. As a result, people who rely on IV sedation may be less likely to seek regular dental care. Other people would argue that this is not a concern if IV sedation is readily available to people.
Some dentists may resort to IV sedation too quickly. Sedation should not be used as a substitute for TLC and behavioural techniques, but as an additional tool if these alone don’t work, or if it is a potentially traumatic procedure. You should want sedation, rather than feeling forced into it because your dentist is unwilling to explore other ways of helping you.
Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.
Cost is another disadvantage – IV sedation is more expensive than other sedation options.