Fear of dental treatment is common. Experts estimate 30 percent of people have enough fear of the dentist that they avoid going. Sedation dentistry can help patients who are suffering from dental anxiety to get the dental treatment they need.
Sedation Dentistry describes the use of sedatives to relieve any anxieties a patient may have going to the dentist. Sedation dentists are trained professionals that achieve sedation using pharmaceuticals to aid the patient in relaxing and to help promote a positive and comfortable dental experience.
The Many Levels and Methods of Dental Sedation
There are various methods that dentists are able to sedate patients including oral sedation, inhalation sedation (commonly known as laughing gas) or intravenous delivery.
There are four levels of sedation employed in the health/dental field: Minimal, Moderate, Deep, and General anesthesia. Minimal sedation describes how the patient is relaxed but awake. Moderate sedation (aka conscious sedation) means the patient might be less aware of the procedure than with Minimal Sedation and will exhibit signs of the effect, e.g., slurring words when they try to speak, without compromising breathing or negatively affecting the heart. Deep sedation is the next level and indicates that the patient is unconscious but challenging to arouse by shouting or shaking. General anesthesia is seen typically in the operating room when the patient is unconscious and will be needing intervention to maintain their airway. It is important to note that in all cases except for inhaled minimal sedation (laughing gas), patients should not drive themselves home after receiving dental sedation.
A sedation dentist will use one of the following delivery methods:
- Inhaled minimal sedation (nitrous oxide, or laughing gas, administered by face mask)
- Oral sedation (pill form, usually Halcion, which is in the Valium drug family)
- IV moderate sedation (drugs delivered through a vein)
For more information detailed information on the levels of sedation dentistry, read this article from WebMD.
What Sedatives Do Sedation Dentists Use?
Sedatives are the tools a sedation dentist will use to calm the patient. They tend to fall into one of the following drug types.
- Benzodiazepines: Valium (Diazepam), Ativan (Lorazepam), Halcion (Triazolam), Versed (Midazolam)
- Nonbenzodiazepine Gaba Agonists: Ambien (Zolpidem), Imovane (Zopiclone), Lunesta (Eszopiclone), Sonata or Starnoc (Zaleplon), Rozerem (Ramelteon)
- Antihistamines: Atarx or Vistaril (Hydroxyzine), Benadryl (Diphenhydramine), Phenergan (Promethazine)
For a more in-depth understanding of oral sedation and sedatives, please read this article from the U.S. National Library of Medicine.
Who Should Consider Dental Sedation?
Sedation dentistry is appropriate for many different patients. In addition to patients that suffer from dental anxiety, dental sedation can benefit patients that have a low pain threshold, fidget or struggle to remain still in a dental chair, have sensitive teeth or a tricky gag reflex. It is also beneficial when extensive dental work is necessary. At times, dental sedation is recommended for children either too scared or too stubborn to get their dental care.
To read more about dental sedation and children, please read this article from Colgate.
Sedation dentistry is not without risk but is usually a safe procedure. In both minimal and moderate sedation, the patient’s airway, ventilation and cardiovascular function are maintained and unaffected in a negative way. For most cases, minimal or moderate sedation is sufficient, particularly for treating dental anxiety. Most dentists offer minimal sedation that can be sufficient for treating dental anxiety, but an increasing number of dentists provide moderate conscious sedation for patients that don’t get the benefits of minimal sedation.
To be licensed for moderate sedation, the dentist must go through an IV sedation course and BLS (Basic Life Support) certification and ACLS (Advanced Cardiac Life Support). General dentists that have a license for moderate sedation have limitations for the types of drugs they are able to administer to prevent the patient from going into more in-depth sedation. Oral Maxillofacial Surgeons are certified to perform deep sedation for their patients in both office setting and hospital setting. General Anesthesia can be the last resort for patients unable to sit in a dental chair and safely complete treatment. Typical patients seen in the operating room that receive general anesthesia are pediatric patients, geriatric patients or patients with special needs.
To read more about the uses of general anesthesia, check out this article from Dental Fear Central.
Overcoming fear of the dentist is a critical factor for a large number of patients. Sedation dentistry allows patients to reduce their dental anxiety to get the dental care they need. While it is not without risk, most dental sedation is safe and sufficient to help a patient relax while receiving treatment in the dental chair.
If you think you might suffer from dental anxiety, be sure to discuss it with your dental professional. Together, you can decide what level and method are appropriate to help you facilitate the best possible outcome for your dental health.
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“Sedation Dentistry: Can You Really Relax in the Dentist’s Chair?” webmd.com. Web. 14 March 2018. <https://www.webmd.com/oral-health/sedation-dentistry-can-you-really-relax-in-the-dentists-chair>.
“General Anesthesia.” Dentalfearcentral.org. Web. 14 March 2018. < https://www.dentalfearcentral.org/help/sedation-dentistry/general-anaesthetic/>.
“Is Dental Sedation Safe for Kids?” Colgate.com. Web. 14 March 2018. <https://www.colgate.com/en-us/oral-health/procedures/anesthesia/is-dental-sedation-safe-for-kids-0415>.
Donaldson M, Gizzarelli G, Chanpong B. Oral Sedation: A Primer on Anxiolysis for the Adult Patient. Anesthesia Progress. 2007;54(3):118-129. doi:10.2344/0003-3006(2007)54[118:OSAPOA]2.0.CO;2. From Web: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1993866/>