Sedation

Dental Sedation

There are many patients who suffer from some degree of stress when they have to visit the dentist. But for a minority of people, the level of anxiety becomes a barrier to coming to the dental surgery at all. This extreme fear may be related to memory of an unpleasant experience at the doctors or dental surgery during childhood, that the patient finds difficult to simply put behind them to seek the care they require.  For these patients it is more acceptable to continue to experience dental pain than to find a resolution to it.

Dental sedation is also useful when a patient who is not normally fearful of coming to the dentist is undergoing a particularly difficult surgical procedure.

Dental Sedation is a safe technique that can help to treat nervous patients successfully. It can help even the most dentally phobic patients achieve good oral health and a beautiful smile.

What is intravenous sedation?

Intravenous sedation is a sedative given via a vein. This makes you feel much more relaxed about the treatment you are about to receive, it takes away your fears and anxieties. Although you will not go to sleep, you may think that you have been. Many people cannot remember very much about the treatment afterwards. During sedation your pulse and breathing will be monitored by a clip on your finger or thumb. You may be given extra oxygen to breathe.

What does it feel like? Will I be asleep?
 
You remain conscious during conscious intravenous sedation. You will also be able to understand and respond to requests from your dentist.  However, you may not remember anything at all about what went on because of two things:

  1. IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
  2. 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 it may appear as if you were “asleep” during the procedure.

Is it still necessary to be numbed with local anaesthetic?
 
The drugs which are usually used for intravenous sedation are not painkillers. While they relax you and make you forget what happens, you will still need to be numbed. If you have a fear of injections, you will not be numbed until the intravenous sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (until you are numb) before starting on any procedure.
 
But I’m terrified of all needles, not just dental injections!
 
You can get a topical numbing cream to make the site where the needle goes profoundly numb. It as also possible to spray some midazolam in the nasal cavity to partially sedate you.
 
What drugs are used? Are there different types of IV sedation?
 
The most commonly used drugs for IV sedation are benzodiazepines. These are anti-anxiety sedative drugs. In the benzodiazepines are almost always the only drug used for IV sedation.  Midazolam is the first choice because of its relatively short duration of action.  This means that it will be out of your system faster.
 
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 being carried.
  • 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 sedation.
  • Benzodiazepines produce amnesia for the procedure.
  • The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging.
  • 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 drugs), there can be a downside to this: if you can not remember that the procedure was not uncomfortable or threatening, It is difficult to unlearn your fears.
  • Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.
  • Sensible clothing is advised, avoiding tight sleeves and high heeled shoes. You must not wear nail varnish or false nails as it can interfere with our monitoring.
 
 
 
What about eating and drinking before sedation?
 
It is best to have a light meal about an hour before you come in  for your treatment under intravenous sedation.
 
After IV sedation
 
  • Have your escort take you home and rest for the remainder of the day.
  • Have an adult stay with you for 8 hours after you have been treated
  • Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
  • Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e. g. liquids and toast.
  • Take medications as directed by your dentist.
  • If you have any unusual problems, call your dentist