Conscious Sedation
Some people aren't very nervous about getting dental treatment. Others are very nervous. They may find that their hearts begin to beat fast, their breathing speeds up and their palms get clammy just thinking about going to the dentist. If you are nervous or fearful about dental treatment, sedation can help relax you. It will make your visit easier and more pleasant.
Talk to your dentist about your anxiety. He or she may not know about your fears. If your dentist doesn't know you are anxious, he or she most likely will not suggest sedation.
Talking with your dentist about your fears may be enough to make you feel better. There are other alternatives to address this anxiety or phobia. They include psychotherapeutic management, behavior modification, biofeedback, and acupuncture. As an adjunct or an alternative to these approaches to reduce dental anxiety, your dentist may prescribe a sedative medicine.
Training for Dental Anesthesia
Dentists who provide sedation to their patients must be specially trained. They are required to have specific types of training and experience in order to provide different types and levels of sedation. Almost every state has laws and rules about this.
Oral and maxillofacial surgeons learn to provide sedation, up to and including general anesthesia, as part of their hospital training. Dental anesthesiologists also receive this training. They are dentists who have completed a two-year residency in anesthesia. Some general dentists learn about sedation as part of their hospital training. Others take courses in sedation after they graduate from dental school.
Most dentists are not trained in sedation. Ask your dentist about his or her training and experience in sedation and anesthesia.
Types of Sedation
Many sedatives can be used during your treatment. They come in various forms. Nitrous oxide is a gas (commonly called "laughing gas"). Some sedatives may come in pill or liquid form. Others are intravenous medicines, meaning they are injected into a vein. Some sedatives for children come in a nasal spray form. Ask your dentist what form of sedative you will be given.
Your dentist can provide different levels of sedation. The level of sedation depends on many factors. They include:
- How anxious you are
- The type of treatment you need
- Most importantly, the training your dentist has
Your dentist might consider deeper levels of sedation for complex procedures or more anxious patients. A dentist who prescribes sedation must be trained to take care of a patient who inadvertently goes into the next, deeper level of sedation. Here are the main types of sedation:
- Anxiolysis — Very light sedation. This is usually induced by nitrous oxide and/or a pill you take before the procedure. It gives you a feeling of not having any worries. You may not recall the procedure.
- Conscious sedation — Medium sedation. This is induced by nitrous oxide or intravenous drugs. Your gag reflex still works, and you can respond to commands.
- Deep sedation — You are somewhere between conscious and unconscious, but closer to unconscious. You experience a partial loss of your gag reflex. You cannot respond consistently to stimulation or commands. You also may be unable to keep your airway open for breathing.
- General anesthesia — You are unconscious. You cannot keep your airway open for breathing. You do not respond to commands. Usually, a tube will be placed in your throat to help you breathe.
These are some indications for conscious sedation:
-Dental phobia and anxiety
-Traumatic and long dental procedures
-Medical conditions aggravated by stress, for example angina, asthma, epilepsy
-Special needs individuals
-Ineffective local anesthesic
Several different medicines are used for children for conscious sedation. These calming drugs can be used to manage special needs patients and children with anxiety. These intravenous medications include midazolam, ketamine, chloral hydrate, diazepam, and meperidine. Some children receive antihistamine-type sedatives, such as Benadryl (diphenhydramine) or Vistaril (hydroxyzine). Nitrous oxide is also used in conjunction with local anesthetics. Sedatives for children also come in a nasal spray form.
Before and After Your Appointment
Be sure to tell your dentist about all of the medicines you take. This should include over-the-counter drugs and also any herbs or vitamins you take. Also, tell your dentist about any reactions you have had with medicines, no matter how minor the reaction was. Some drugs can interact with local anesthetics. Some medicines can interact with sedative medicines. You must tell your doctor if you use street drugs, even if only occasionally.
Your dentist must give you detailed written instructions before your appointment. These will include what you may eat and drink and when you need to stop eating and drinking before the procedure. Depending on your medical history and the type of sedation planned, you may need to see your physician for an evaluation before your procedure.
Your dentist may prescribe a sedative for the night before your appointment, in case you have trouble sleeping. If you are going to be taking a sedative the night before your appointment, you should arrange to have someone drive you to and from the office. Also, avoid alcohol and over-the-counter sleep aids. They can react with sedatives.
If you receive nitrous oxide, it will be started just before treatment begins. If you are going to receive a sedative pill such as Diazepam (Valium), it will be given 30 to 60 minutes before treatment. These drugs do not replace the injection of local anesthesia that your doctor will give you. You will still get an injection to numb the area.
If you will be receiving nitrous oxide, eat lightly before and after your appointment to prevent nausea. After your procedure is over, you will receive oxygen for several minutes to clear the nitrous oxide from your system.
After any appointment in which you receive sedation, you must have an adult to drive you home.
If your child is going to have sedation, it is important that two adults go home with the child. One adult should drive and the second one should sit next to the child.
Last Updated January 21, 2021