Sedating for Dental Procedures

it is not uncommon for people to avoid going to the dentist because of fear. Some will even go to the extent of enduring their toothache until the pain becomes unbearable before deciding to pay a visit to their dentist. It may not necessarily be pain that is stopping them, since the toothache is already quite painful, but rather the negative psychological effects that may have been inflicted upon them from past visits. For such people, sedation may just be the answer to their anxiety. The Dental Organization for Conscious Sedation (DOCS Education), is an organization comprised of professionals dedicated to ensuring patients of dental care experience anxiety-free and comfortable procedures. Around 30 percent of the general population is evasive when it comes to visiting dental clinics. This dental phobia keeps people from forming their own routine dental care habits, which may prove detrimental to their dental health as well as for their aesthetic appearance in the long term.

For those who are considering sedation dentistry, there are thousands of dentists today who choose to be specifically trained in helping patients ease into a comfortable and safe dental experience via this method. These dentists understand that psychological barriers to proceeding with dental treatment is common and complex due to fear and anxiety, therefore undergoing specific training to deal with such situations is imperative

Sedation dentistry helps absolve patient anxiety by use of medication. Depending on the level of fear, the use of sedation may vary from a mere tooth cleaning to highly invasive procedures. Sedation dentistry is most appropriate for patients who have low pain threshold, can’t seem to sit still in the dentist’s chair, need an extensive amount of dental work done, have highly sensitive teeth, or have bad gag reflex. In the case of children who have dental courses phobia, sedation can also be recommended. Nitrous oxide is a preference for children since no complications have been found for those who have opted for it and additionally it is easily administered. Pediatric dentists are specifically trained to give oral sedation to children. This too is safe, providing the correct dosage is given according to the child’s weight and age.

Sedation dentistry has been otherwise dubbed as sleep dentistry, yet the term is misleading since it is not entirely accurate. Usually, patients are awake during the procedure - sleepiness is an effect of the sedative, which should not be potent enough to actually put a patient to sleep. Patients are usually kept awake, allowing them only to relax and not remember much about the procedure. This is true for all except for general anesthesia.

There are varied levels of sedation. These include:

 Minimal sedation – The patient is kept awake yet relaxed.

 Moderate sedation (also called "conscious or twilight sedation") - The patient may slur words when speaking and may not remember much of what took place during the procedure.

 Deep sedation – The patient is on the edge of consciousness but can still be roused.

 General anesthesia – The patient is completely unconscious.

As there are different levels of sedation, there are also a few varieties of sedation to accommodate the severity of a patient’s anxiety:

 Inhaled minimal sedation – Nitrous oxide, which is more popularly known as laughing gas, is combined with oxygen and placed over the nose to help the patient relax. The dentist can control the amount that is given to the patient. This sedation wears off quickly, and may be the only form that allows patients to drive themselves home after a procedure.

 Oral sedation. This can range from minimal to moderate, depending on the total amount given to the patient. A pill is usually give for minimal sedation, usually Halcion, which falls under the drug family that Valium is also a part of. Typically, this is taken an hour before a procedure, which will make the patient drowsy but still conscious. An increase in dosage is usually done for moderate sedation, which is the most common level of sedation. This may cause some patients to become groggy and even fall asleep during a procedure. Patients can easily be awakened with a gentle nudge, despite the effect of the sedative.

 IV moderate sedation. The sedative drug is received through the vein, so it takes effect more quickly as most intravenous procedures go. This allows the dentist the flexibility to constantly adjust the sedation level as needed.

 Deep sedation and general anesthesia. This is attained by giving medication that will render the patient either partially or completely unconscious, which is otherwise known as a state of deep sleep. The patient cannot be awakened easily until the anesthesia wears off or is reversed through the use of medication.

Typically, all types of sedation will require a local anesthesia to numb the area where the procedure will take place. This is done to relieve pain in case the procedure causes discomfort to the patient.

Communicating and giving assurance to the patient

Anesthesia does not come without risks but usually it is safe when administered by dentists who have had extensive experience. However, there are patients with certain complications such as obesity, sleep apnea, and other types that may even go undiagnosed. A proper assessment must be done before undergoing sedation to avoid the risk of developing complications during or after the procedure. In assessing a patient, the following steps must be carried out:

 Before the procedure, a copy of the patient’s medical history must be provided for review. It is the dentist’s responsibility to determine whether a patient is an appropriate candidate for dental sedation. Any medication that the patient is on should be taken note of.

 Determine which sedation method and dosage is appropriate for the patients based on their age and health. The Food and Drug Administration (FDA) should have recommended dosages based on patient conditions.

 Dentists must assure patients by letting them know what kind of training they have received as well as the number of procedures that required sedation that they have done in the past. This play on numbers will help ease a patient’s anxiety.

 As it is a basic responsibility of medical personnel, the patient must be informed fully of the details (including the risks) of the procedure. Patients must be encouraged to ask questions and dental professionals must be ready to answer them. All types of medication that will be used during the procedure should ideally be pointed out and their purposes must be explained.

 The patient’s vital signs must be monitored. Dental personnel must also have oxygen and emergency drugs (for reversing the effects of sedation) on hand should the need to use them arise.

For more information please visit: Dental Education Australia & Eden Education