Introduction
Sedation dentistry, as the name suggests, involves techniques that are aimed at making the patient unconscious or calm during a dental procedure. It is very useful in the case of lengthy procedures where a person feels more uncomfortable. The patient is administered with pharmacological agents that cause sedation by depressing the central nervous system (CNS), mainly focusing on the areas that are concerned with conscious awareness. The term can be confusing, as it is often referred to as ‘conscious sedation’. The patient will remain conscious and can respond to requests, but may not remember much about the procedure.
Who Needs Sedation During Dental Procedures?
People of any age group can opt for sedation, but the groups who will be more beneficial are:
- People who have dental anxiety.
- A person with aichmophobia - It is referred to as the phobia or fear of needles.
- Individuals with extreme teeth sensitivity.
- People with a decreased sensitivity to local anesthetic agents.
- People with a highly sensitive gag reflex.
What Are the Phases of Sedation?
The different phases of sedation include:
- Minimal Sedation: The patient is completely awake but is in a relaxed state.
- Conscious Sedation: The patient is awake and responds to requests but may not remember the procedure.
- Deep Sedation: The patient is asleep and cannot remember anything about the procedure.
- General Anesthesia: The patient is completely unconscious, with no reflexes. The patient may also need assistance in breathing.
What Are the Types of Sedation Used in Dentistry?
Sedation dentistry can be of varying types based on the patient’s need. The factors that help to select the appropriate type of sedation would mainly include the length of the procedure, the medical history of the patient, one’s anxiety level, and the patient’s preferences. The most common types of sedation in dentistry include the following:
- Inhaled Sedation - The most common agent used in inhaled sedation is nitrous oxide, which is widely known as ‘laughing gas’. It is combined with oxygen and inhaled with the help of a nosepiece. The onset of action begins within three to five minutes. The dentist can control the dosage or the amount of sedation to be given to the patient. The effects are usually mild and do not have long-lasting effects; hence, one can continue normal activities like driving back home from the clinic after some time.
- Oral Sedation - This provides minimal to moderate sedation and is the most common form of sedation used in dentistry. It simply involves administering a prescribed dose of an oral sedative before the procedure. The most commonly prescribed medications in this category include Triazolam, Lorazepam, and Zaleplon. However, in pediatric dentistry, liquid sedation is recommended, and the common agent administered to the pediatric population is Midazolam oral syrup. The duration of action of the oral sedatives will be higher than that of inhaled sedatives, and the effects may be present even 30 to 60 minutes after the procedure. People with higher levels of anxiety mostly benefit from this type of sedation dentistry. In some instances, it may take a day for the effects of the drug to completely wear off. Hence, normal activities like driving are not recommended for the day.
- Intravenous (IV) Sedation - It delivers sedative medications directly into the patient’s bloodstream through an IV line. The sedation is given by an injection through a vein in the arm. The dose selected for the procedure mainly depends on the length of the procedure. IV sedation is mainly recommended for patients with severe dental anxiety or any other special health issues. Most patients who receive IV sedation fall asleep and have little or no memory of the procedure. The effects may last long, and hence, activities such as driving, after the procedure are not recommended.
When Is General Anesthesia Used in Dentistry?
The use of general anesthesia is an uncommon practice in dentistry. It is reserved for patients who need to undergo major surgical procedures. General anesthesia makes the patient completely unconscious and the patient does not respond to any requests until the effects of the medication wear off or are reversed by other medications. It is only practiced in hospitals or specialized clinics in the presence of an anesthesiologist who is in charge of administering the medications and monitoring the vitals.
What Are the Factors to Be Considered Before Sedation Dentistry?
During the initial consultation, the dentist discusses the medical and medication history with the patient and gathers all the necessary information. The dentist may recommend not to eat or drink anything for at least six hours before the dental appointment. The patient should continue taking all of their ongoing medications unless otherwise notified by the dentist. However, in case the patient is taking blood thinners like Warfarin, the dentist may ask to stop taking the medication a few days prior to the procedure.
What Are the Advantages of Sedation Dentistry?
Sedation dentistry offers the following advantages:
- Ease of patient anxiety.
- Patient relaxation and comfort during dental procedures.
- Proper control of gag reflex.
- Movement control.
- Improved patient cooperation.
- The dentist can work faster when the patient is under the influence of a sedative.
What Are the Risks or Complications Associated With Sedation Dentistry?
Sedation dentistry is safe, but there is a small risk of complications, which include:
- Drowsiness.
- Xerostomia (dry mouth) due to the effect of some sedative medications.
- Nausea and vomiting.
- Headache.
What Are the Special Instructions to Follow After Sedation?
- The effects of the sedative may last longer; therefore, a responsible adult should accompany the patient back home after the procedure.
- Do not drive or engage in any activities that require proper consciousness for 24 hours after receiving the sedation.
- Do not perform any kind of strenuous activities.
- Take all the medications that are prescribed by the clinician.
What Are the Contraindications in Sedation Dentistry?
- Alcohol intoxicated patients.
- Pregnant women.
- Patients who have experienced hypersensitivity reactions to sedative medications (such as Benzodiazepines).
- Patients taking CNS (central nervous system) depressants.
- Patients with neurological disorders.
Conclusion
Sedation dentistry helps a person feel comfortable during dental procedures and eases phobias and anxieties. The effects of sedation may vary depending on the type of sedation given. A person usually recovers within 24 hours from intravenous (IV) and oral sedation and within 15 to 30 minutes from nitrous oxide sedation. It mainly depends on how one’s body responds to the sedation drugs or medications.
