There are literally millions of people who avoid even the most basic maintenance visits to their dentists each year. Why? For the most part, people are afraid of dental procedures because they can occasionally be uncomfortable or painful, or just as often patients do not like to feel out of their own control. It is now quite common to see advertisements or signs that indicate a dental office is currently providing “sedation dentistry” or “sleep dentistry”, and this is intended specifically for those who avoid the dentist. Provo sedation dentistry and sleep dentistry refer to the same thing, but the term “sleep” is not accurate. Those who choose to have their dental work done while under sedation are not actually sleeping, that would require general anesthesia which is not what occurs during any form of sedation dentistry. How is sedation dentistry done? There are three basic methods that dentists use to perform everything from cleanings to oral surgery, and they are oral sedatives, intravenous (IV) sedatives and inhalation sedatives. Each has a different effect upon a patient, and their choice in sedative depends upon their needs during the visit. For example, a patient who wants absolutely no awareness of any part of their office visit may opt for an intravenous (IV) sedation, while someone who needs their anxiety reduced or who is afraid of panicking while in the dentist’s chair may use an oral sedative.
Intravenous sedation is administered directly into the blood stream of the patient, and is frequently referred to as “twilight sleep”. This is a bit confusing however, because sleep is not involved in the process. The patient is conscious throughout the entire procedure but left mostly unaware of their experience, this is because the medications in IV sedation produce a sense complete relaxation and because they frequently induce amnesia, with partial or full memory loss about the visit. Most patients who undergo treatment under IV sensation have no sense of time passing and feel that their visit may have taken only a few minutes, when in fact it may have been an hour or more. Are there any drawbacks to IV sedation? Obviously anyone who is avoiding certain dental work due to a fear of needles will probably not be enthusiastic about an IV line in their arm or hand. Additionally, IV sedation does not provide any pain relief, so traditional injections of a numbing agent will still be required. Most dentists will do this after the patient is under sedation, but the affects of the numbing drug will still be present when the procedure is completed. As far as safety issues are concerned, health experts do not recommend IV sedation for those who are pregnant, of advanced age, who have allergies to certain sedative medications, or whose lungs, kidneys or liver are not in optimal condition.
A final note about IV sedation – it requires the patient to be accompanied on their visit, because the affects of the drugs do not wear off immediately, and they will need a family member or friend to bring them home where they must rest for the remainder of the day. The second method of sedating a dental patient is “inhalation sedation” which has been referred to as “laughing gas”, but which is actually the gas known as “nitrous oxide” mixed with pure oxygen. Usually it is a thirty to seventy mixture at best, meaning only a smaller percentage of nitrous oxide, which is still a remarkably effective sedative. Most patients will be brought through varying levels of sedation, with the deepest level producing a sense of euphoria and well-being. Most dentists deliver inhalation sedation through a small mask that fits over the nose of the patient, called a nasal hood or cannula. The patient is asked to breathe normally, and will feel the affects of the gas within twenty to thirty seconds. Within only two to three minutes the gas produces pain-killing affects and the dental work can quickly begin. One of the main benefits of inhaled sedation is that it can be readily controlled, and a patient can be brought out of sedation quite quickly, alternatively sedation can be deepened just as quickly and affectively as well. Because the gas is mixed with oxygen, it can be used for the duration of the procedure, and has no chance of “wearing off” the way IV sedation or oral sedation can. Additionally, the gas presents no possibility for lingering effects like the common “hangover” feeling from other techniques.
Those who choose inhaled sedatives will also be able to make their visit unescorted, because the gas wears off almost instantly. There are some people who experience dizziness, giddiness or lightheadedness early in the administration of the gas, but this wears off quite quickly. Are there any concerns about using inhaled sedatives? There are few contraindications for the use of inhalation sedation, especially because those who provide it must legally undergo extensive training, and because there are no side effects or allergies known. Women in the first trimester of pregnancy can choose this method of sedation, and it presents no danger to anyone with heart, lung, kidney or liver problems as well. The final method of sedation dentistry involves the swallowing of oral medications intended to reduce fear, anxiety or nervousness in the patient. Some procedures, or patients, will require a sleeping aid or sedative the evening before their dental visit. They may also need to take their oral sedative the morning of their visit, and this may necessitate an escort to handle driving or traveling to the dentist’s office. For the most part, the medications used for oral sedation are in the benzodiazepine family, commonly called “benzos”, and provide two possible effects. The first is a sedative and hypnotic effect, inducing calmness and even drowsiness in the patient. The second is an anti-anxiety effect which calms the patient’s fears. The biggest differences between the types of “benzos” used are the areas of the brain targeted by the chemicals, with some inducing a sleep-like state rather than simply an overall sense of calm. Can anyone use oral sedation? Unfortunately, the answer is no, because the drugs do have a wide range of effects they cannot be safely ingested by everyone. There are those that can cause trouble with liver and heart patients, and those that present frequent allergy issues as well as respiratory, heart and kidney problems, and pregnant women should avoid such medications all together.
Additionally, many dental experts say that oral sedation can frequently be “hit or miss”, meaning that some people do not absorb enough of the drug to make it an affective anti-anxiety measure, while others have little to no response to the chemicals in the medication at all. There are other oral sedatives that dentists rely on, but the majority are the “benzos”. It is important to remember that all oral sedatives will be through prescription only, because of the strength and addictive potential. Directions for use should be strictly followed, including the restrictions on alcohol or other drugs that affect the central nervous system. Fear of pain and loss of control are not “silly” issues that people should just “get over”. They are realistic reactions to certain situations, and luckily dental experts recognize and respect these fears, and offer a fear-free way of maintaining dental health.