Sedation dentistry is an approach to dental work that focuses on reducing patient anxiety, discomfort, and pain. It can be used for procedures as simple as a cleaning or as complex as oral surgery. An experienced sedation dentist can offer a variety of anesthetic and sedative options depending on each patient's level of fear regarding dental visits and their general pain tolerance. Dentists can minimize the discomfort of treatment for most individuals through the administration of appropriate medications.
Although a sedation dentist may be referred to as a "sleep dentist," most dental professionals prefer to have their patients conscious and able to communicate during their procedures. General anesthesia renders a patient completely unconscious. Dental surgeons only recommend this approach when other options prove inadequate. For example, young children who cannot be expected to remain sufficiently still during a surgical procedure may need full anesthesia.
Many dentists routinely offer some type of sedation to all patients. For example, cosmetic dentistry specialists are generally open to using highly effective sedatives because the dental procedures they perform are typically elective. This means they often see patients who are not currently in pain and who do not want to experience unnecessary discomfort while getting their smile makeover. However, some dentists are less amenable to administering oral or IV drugs unless they consider it absolutely necessary. This is due to the risks associated with the use of any medication. Some dentists also do not have the required training to administer IV sedation.
Fortunately, sedation dentistry has become common. Patients can now easily find a dentist who is comfortable with using sedatives and who knows how to use them correctly. Most dentists will at least provide an inhaled sedative (nitrous oxide) upon request if the patient has no medical history that would make this inadvisable. Others will recommend or prescribe an oral sedative for patients to take prior to their dental visit. The timing and dosage of oral medications depends on the type of drug used and the anticipated length of the procedure.
When selecting a dental provider, patients should inquire about the dentist's views regarding the use of sedation and whether staff members have received any special training in this area. Professional membership associations such as the DOCS (Dental Organization for Conscious Sedation) offer continuing education to dental professionals who want to stay abreast of the latest advances and protocols for safe and effective sedation. The American Dental Association (ADA) also provides sedation dentist courses that cover such topics as monitoring patients for potential breathing problems during the administration of IV sedatives.
Types of Sedation
The term dental sedation refers to many different types of pain and anxiety control treatments including oral, intravenous and inhaled medications. Here are some of the most commonly used sedatives:
Dental professionals administer nitrous oxide (N2O) through a mask to give patients a feeling of relaxation. Nitrous oxide, also known as laughing gas, provides both pain relief and anxiety reduction. Dentists often give patients this sedative prior to the injection of a local anesthetic. The gas helps patients cope with the pain of the needle entering their gums. Patients under the influence of N2O remain awake and are able to respond to questions. However, they may lose track of the passage of time. Dentists consider this lack of awareness a beneficial side effect since it increases a patient's ability to undergo lengthier procedures in a single sitting. The effects of N2O wear off quickly, so patients can drive themselves home after their appointment.
Oral sedatives used in dental practice include several members of the benzodiazepine family of drugs. Recognizable brand names for "benzos" include Valium, Xanax and Halcion. These medications work both by reducing pain and by decreasing anxiety. Some benzodiazepines cause drowsiness - although patients remain awake during their dental procedure. Patients frequently experience amnesia regarding what occurred during the time they were under the influence of drugs such as Halcion. However, this effect is not guaranteed since patients have a wide range of responses to oral benzodiazepines. Some dentists will prescribe anti-histamines as a sedative because these drugs typically make patients sleepy. These medications also cause dry mouth as a side effect. Reduced saliva production can make it easier for dentists to do their work quickly.
Conscious sedation is a deeper level of sedation than anxiolysis (the type of feeling provided by nitrous oxide). Conscious sedation is often brought about through the IV delivery of benzodiazepines such as Midazolam or Diazepam. Dentists occasionally administer barbiturates and opoids (such as morphine) in sedation dentistry. Sometimes, more than one medication may be given simultaneously by IV. Dental professionals require specialized training regarding the proper administration of intravenous sedatives. Always call ahead to determine what type of sedation options a particular dentist provides.
After any treatment involving conscious sedation, patients should not drive. Instead, a caregiver, friend or family member should drive the patient home and stay for a few hours until the sedative has worn off.
Cost of Sedatives
When patients opt to receive sedation to control anxiety and pain, dental insurance generally does not cover this aspect of their treatment. Whether or not an insurance carrier will reimburse sedative costs may also depend on how a procedure is coded for billing purposes. Patients should speak with their dentist prior to treatment to determine the cost of sedation since they may be paying it out of pocket. Oral conscious sedation may cost several hundred dollars per session. However, most dentists do not charge for this service if a patient is undergoing extensive dental work that costs tens of thousands of dollars.
Pros & Cons of Sedation
Patients who tend to benefit the most from being sedated during dental procedures are those who have a strong gag reflex, a phobia of dentists, difficulty relaxing due to physical problems with the back and neck or a tendency to not become fully numb from the administration of local anesthetics. Individuals who require extensive treatment (whether it's for oral surgery or cosmetic dentistry) can generally have more work done in a single session under proper sedation. Advances in the field of oral conscious sedation make it possible for more patients to follow through with their dental appointments and maintain better oral health as a result.
Not all patients are suitable candidates for sedation. Those who have a history of severe allergies to the types of drugs used as sedatives should not take these medications. Patients who have built up a tolerance to sedatives because they are taking them as prescribed for other purposes may not respond properly to dental sedatives, either. Patients should make their dentist aware of any other medications they are taking because some drugs can interact poorly with sedatives. Individuals who dislike the feeling of not being completely awake and aware during treatment or who experience nausea as a side effect of sedation may prefer a local anesthetic.