TYPES OF DENTAL SEDATION
When a patient is given medication to relax during a dental procedure this is referred to as “sedation dentistry”. Although this is frequently called “sleep dentistry”, this term is
not precisely accurate. Patients are usually awake, but relaxed, during the dental visit except in the case of general anesthesia. (1)
The levels of dental sedation are:
Minimal sedation - The patient is relaxed but awake.
Moderate sedation – The patient may slur their words for a while and may not remember much of the procedure
Deep sedation - The patient is on the edge of consciousness
General sedation – The highest level of sedation is general anesthesia where the patient is completely unconscious.
The Four Types of Dental Sedation
Dentists and oral surgeons commonly use one of four different methods when sedating a patient for treatment. Which type of sedation is used depends on both the situation
and the patient. (2)
Nitrous Oxide (Laughing Gas)
Nitrous oxide is considered minimal sedation. With this method, the patient will be given a small mask to place over his or her nose and will breathe in nitrous oxide mixed
with oxygen. The dentist controls the amount of sedation a patient will receive. The gas helps the patient relax. Once the procedure has been completed and the mask
removed, the gas tends to wear off quickly. With this form of sedation, the patient is able to drive themselves home soon after the mask is removed.
Oral Sedation
The next level dental sedation is one which is taken in pill form. The amount of sedation is monitored by the dose and can range from minimal to moderate. Typically, the drug
used for oral sedation is Halcion, a member of the Valium family. Usually the patient will take the prescribed dose about one hour before the procedure. The drug will make the patient drowsy and some may fall asleep during the procedure. Once the dental treatment is complete the patient can usually be easily awaked with a gentle shake.
IV Sedation
This form of sedation is exactly what it sounds like. The patient receives a sedative drug through a vein. The drug acts quickly and the administered amount can be adjusted by the dentist to maintain the exact amount of sedation needed during the procedure.
General Anesthesia
General anesthesia is the highest level of dental sedation. The medication is given either through a face mask or IV. The amount of anesthesia given depends on the procedure and the individual patient. General anesthesia is used for longer procedures, or for patients who have major anxiety that might interfere with their dental treatment. The patient is completely unconscious during the procedure and will awaken only when the effects of the anesthesia wear off or are reversed with another medication. General anesthesia is relatively uncommon as far as sleep dentistry goes. Only patients who need significant oral surgery, or who are resistant to other types of sedation, will likely be given general anesthesia.
Regardless of which type of sedation is given, the patient will also receive an anesthetic to numb the site where the dentist is working.
1. https://www.webmd.com/oral-health/sedation-dentistry-can-you-really-relax-in-
the-dentists-chair#1
2. https://www.wisegeek.com/what-are-the-different-types-of-dental-sedation.htm#
3. https://www.healthline.com/health/dental-and-oral-health/dental-anesthesia#side-effects
How Much Does Conscious Sedation Cost?
When practiced by trained providers, conscious sedation has been proven to be safe and effective in helping patients with extreme dental anxiety.
The cost of conscious sedation depends on the type of sedation chosen, the drugs used, how long the sedation lasts, and the type of procedure being done. In some cases, the geographic area you’re in will also have an effect on the cost, with dentists in more expensive zip codes likely to charge more than those in less affluent areas.
Sometimes called laughing gas, N20 is inhaled through a mask with a mixture of oxygen. Costhelper.com estimates N20 sedation to cost as little as $25 at some dentists, while Delta Dental says N20 alone may cost $200 or more depending on the practice.
Anti-anxiety medications
Valium and similar drugs must be taken before your dental procedure begins. The dentist may administer the drug in his or her office or give you a prescription to purchase it yourself to bring with you or take before you arrive. The drug prescribed for dental sedation will cost $150-$500 depending on the type of medication. If the sedation is medically-required and covered by insurance, co-pays and deductibles may apply.
IV sedation is a good option for lengthy dental procedures, oral surgery and extractions. A dentist may use a mixture of intravenous drugs to kill pain (anesthetize) and provide relaxation. These may include a short-acting sedative or anti-anxiety medication, and a narcotic, pain-killing drug. The cost of intravenous sedation is $375 on average for the first 30 minutes, then less for additional 15-minute increment, according to Delta Dental.
Sometimes third-party insurers will help a patient offset the costs of sedation. This depends on the insurance company and the dental office policies.
Some dentists may include sedation in their costs for more complex procedures but most dental plans do not cover conscious sedation if it’s not required by medical regulations.
The fees for sedation are almost always in addition to the cost of the procedures being done.
https://www.healthline.com/health/conscious-sedation#cost
Is IV Dental Sedation Right for You?
Many people are so afraid of going to the dentist they’d rather endure the pain of a toothache or allow their teeth to deteriorate rather than go through the trauma of visiting a dentist. Patients with such strong fears and anxieties should take a look at the IV dental sedation as a possible solution to the problem.
IV sedation can be used for everything from lengthy invasive procedures to a simple cleaning. It all depends on the severity of the patient’s fear. (1.)
A good candidate for IV sedations is a patient who is in good general health but has such a high level of fear and anxiety that it prevents them from receiving the dental care they need.
Older people and people with certain other health conditions have an increased risk for side effects from any kind of sedation. When administering the IV solution, dentists will give those people a smaller dose thus lowering the risk of negative effects.
According to the American Society of Dentist Anesthesiologists (ASDA) the patient needs to take certain steps to prepare for IV Dental Sedation. (Specific instructions will be given to you by your dentist.)
Don’t eat or drink after midnight of the night before your appointment.
The patient tell their dentist about any medications they are taking and should follow instructions from their dentist regarding these. Anesthesia affects the entire body and it’s important for the dentist or dental anesthesiologist to know about all the drugs and medications a patient is taking. This includes all prescription, over-the-counter, and ‘recreational’ drugs as well as vitamins and herbal supplements. Even marijuana, alcohol and tobacco use affect the way anesthetic drugs work in the body. Any of these necessitates careful monitoring of vital signs during the procedure.
If the patient is a smoker or is using “The Patch” she or her must stop nicotine intake starting the day before the dental appointment.
The patient should have a friend or family member escort them to the visit and drive them home.
No plans should be made for the rest of the day following IV sedation. (4)
Anesthetic drugs can occasion after effects such as nausea, dizziness, sleepiness and loss of normal body coordination. Some patients may experience a sore throat and minor aches. Usually these effects will have significantly lessened within twenty-four hours after the IV sedation has been discontinued.
Your dentist is best equipped to help you decide whether or not IV sedation is the right option for a particular patient. It might be that another sedation option, such as inhaled sedation, makes more sense for that particular patient or that procedure. (3)
1. https://www.webmd.com/oral-health/sedation-dentistry-can-you-really-relax-in-the-dentists-chair#1
2. https://old.asdahq.org/expect?_ga=2.78130132.138432307.1595366931-1765112072.1595366931
3. https://corsondentistry.com/how-does-iv-sedation-dentistry-work-and-is-it-right-for-you/
4. https://www.colgate.com/en-us/oral-health/procedures/anesthesia/is-iv-sedation-dentistry-right-for-you-
What are the Side Effects of Dental Sedation?
Nitrous Oxide
Nitrous oxide causes a feeling of euphoria and slows down a person’s reaction time. Onset of the effects of the gas happen rapidly and wear off quickly once the flow is turned off.
Short term side effects are uncommon, but they can occur. The most common reasons a patient may experience short term side effects are being given too much gas, or being given it too quickly.
The most common side effects of nitrous oxide are:
Dizziness
Nausea
Vomiting
Fatigue
Headache
Excessive Sweating
Shivering
A patient may be given oxygen after being given nitrous oxide in order to clear the remaining sedative gas from their body. This helps the individual regain alertness and can help prevent a headache.
People may feel sluggish or not alert following the inhalation of nitrous oxide. This effect typically wears off quickly.
To help avoid stomach issues, a person should eat a lightly for several hours after their procedure.
Most side effects dissipate quickly after the patient has been given the gas. However, a patient should let their dentist know if they experience any unusual side effects or if the normal side effects last longer than a few hours following the dental procedure.
Allergic reactions to nitrous oxide may occur. If the patient experiences chills, hives, fever, wheezing or problems breathing following the administration of nitrous oxide they should immediately seek medical help.
There is little evidence to suggest that nitrous oxide causes any serious long-term side effects.
IV Conscious Sedation
Conscious sedation helps reduce anxiety, discomfort, and pain during certain procedures. This is accomplished with medications and (sometimes) local anesthesia to induce relaxation.
The drugs used in conscious sedation (other than nitrous oxide gas) vary based on delivery method:
Oral. You’ll swallow a tablet containing a drug, usual of the Valium for benzodiazepine family. These include Halcion, Midazolam, and Valium.
Intramuscular. The patient will get a shot of benzodiazepine, such as midazolam (Versed), into a muscle, most likely in your upper arm or your butt.
Intravenous. The patient will receive a line in an arm vein containing a benzodiazepine, such as midazolam (Versed) or Propofol (Diprivan).
Common side effects of conscious sedation may last for a few hours after the procedure, including:
Slow reflexes
Low blood pressure
Headache
Drowsiness
Feelings of heaviness or sluggishness
Loss of memory of what happened during the procedure (amnesia)
Feeling sick
Conscious sedation is a good option if a patient feels anxious about a dental procedure. Compared with other options, such as general anesthesia, it has few side effects or complications.
https://www.medicalnewstoday.com/articles/325910#long-term
https://www.healthline.com/health/conscious-sedation#what-it-feels-like
What Does the Recovery Feel Like After Dental Sedation?
Recovery from conscious sedation is a gradual process, occurring over a period of several hours. During this time, it’s important for the patient not to push themselves, allowing time for the sedation to fully leave the body.
Here is what a patient should expect to experience as they recover from dental sedation:
When dental treatment requires a sedative or anesthetic, the patient will still feel “out of it” after the procedure is complete. The immediate effect of the anesthesia will take half an hour to wear off. After that, the patient can expect to be light headed for the next few hours. The extent f the light headedness will depend, in part, on the scope of the dental work and the amount of sedation that’s been administered. Conscious sedation affects the entire body, as well as the patient’s attentiveness and concentration for at least several hours.
The patient will need to stay in the treatment or recovery room following the procedure for an hour, sometimes more. The dentist or dental anesthesiologist will monitor the patient’s breathing, blood pressure, and heart rate until these are back to normal.
If the patient is getting any form of sedation other than nitrous oxide, they’ll need to have a friend or family member drive them home.
Once the patient leaves the office and heads home, it will take several more hours for the effects of the sedation to go away. Some sedation side effects may last for the rest of the day. This includes, nausea, headaches, sluggishness, and drowsiness.
It’s recommended the patient takes the day off work and avoids any major physical activity, especially those that require precision or could be dangerous if incorrectly done.
The best place for the patient to be during recovery is in his or her own home where they can be safe and comfortable.
Someone should be available to assist the patient as needed during the first few hours of recovery. The patient should not be left alone until they are fully recovered.
The patient should be fully awake before being given anything to eat or drink. When clear fluids are able to be consumed without any problems, then slow progression to more solid food is allowed.
By the morning following dental sedation, all effects should have worn off leaving the patient free of any after-effects.
https://www.healthline.com/health/conscious-sedation#takeaway
http://southwestdentalanesthesia.com/sedation-dentistry-before-and-after-the-dental-procedure/
Anesthesia or Sedation for Your Child’s Dental Work?
Many parents have questions about whether they should I have their anxious and frightened child sedated during dental treatment?
The short answer to this is: not unless it’s absolutely necessary. Given the proper explanation, most children can understand the need to take care of their teeth. Provided the dentist is gentle and is careful not to inflict pain, most young boys or girls will be able to sit through a dental appointment, especially one that is relatively short.
There are, of course, exceptions to this guidance.(1) Some dental procedures require the child to lie completely still. In other instances, there may be a significant amount of dental work to be accomplished at one time and it would be unrealistic to ask a young child not to move around for a long a period.
Therefore, when all the behavior management techniques such as, explanations, demonstrations, supportive discussions, distractions, rewards, and parental presence have failed or proven insufficient, sedation may become necessary.
The dentist or dental anesthesiologist will want to use the least invasive treatment and the lowest amount of sedation possible. If larger doses of sedative drugs are used, the child may go into a deeper level of sedation than intended, increasing the risk of adverse events.
The goal of sedation dentistry in children is the same as it is for adults – make the patient calm enough to allow the dentist to provide the needed treatment and care.
An experienced pediatric dentist will know which type of sedation will work best given the extent of treatment needed and the personality of the child. Oral sedatives and nitrous oxide can both be used successfully and safely during dental procedures. Appropriate patient evaluation and proper sedation techniques are an important part of successful dentistry with children.
It is important to manage a child’s pain and anxiety early in their treatment and to be extremely kind and gentle when working with young children. Inadequate pain control early on in a child’s relationship with a dentist can make subsequent visits more traumatic.
Sedation should never be used simply because it’s easier on the adults in the room. And no matter whether sedation is used or the type of sedation chosen, the goal is always to provide the safest, most pain-free treatment for that individual child. The patient is always the first and only concern.
1. https://www.healthychildren.org/English/healthy-living/oral-health/Pages/Anesthesia-or-Sedation-for-Your-Childs-Dental-Work.aspx
2. https://www.oralhealthgroup.com/features/1003918978/
This article is not intended as a substitute for medical or dental advice from a professional practitioner. It is intended to promote a general knowledge about and understanding of oral health topics. This information is not to be regarded as advice on diagnosis or treatment. For medical or dental diagnosis and treatment plans, always see your healthcare professional.