Sedation Dentistry – “Know the Types”

Dec 08
2010

It’s important to know that a visit to the dentist can be a positive experience, even when treatment is necessary. Millions of Americans, nearly 30%, are afraid of the dentist. They avoid dental care at all costs, even when they are in pain or discomfort. But it no longer has to be that way. Modern dentistry offers safe, effective, and comfortable treatments to anxious and fearful patients.

 

You may have heard this treatment described in many ways: anxiety-free dentistry or relaxation dentistry, moderate sedation, oral conscious sedation or even sleep dentistry, though this last should be applied only to general anesthesia. The best and most accurate name is “sedation dentistry”.

These terms describe a way for you to get the care you want while you remain comfortable. Ask your dentist which level of sedation dentistry he or she is qualified to provide. The levels are:

Nitrous Oxide – smell a faint, sweet aroma and experience a sense of well-being and relaxation. Since it may produce a feeling of giddiness or euphoria, it is often called “laughing gas.” People sometimes report dreaming and their arms and legs may feel “tingly.” It raises the pain threshold and may even make the time appear to pass quickly.

Oral Sedation – In dentistry, the most commonly prescribed drugs for anxiety belong to the “benzodiazepine” family. You’ve probably heard of them by their trade names – for example, Valium, Halcion, Xanax, or Ativan. These medications directly and efficiently decrease anxiety by toning down activity in those parts of the brain responsible for fear. Benzodiazepines come in two flavors:
1) Sedative-Hypnotics: drugs which induce a calming effect, including drowsiness (“sedation”). In higher doses, they induce a state resembling physiological sleep (“hypnosis”).
2) Anti-Anxiety Drugs: drugs which act primarily to relieve anxiety and make you feel calm.

While all benzodiazepines act as sedatives AND anti-anxiety drugs, some are more targeted at brain areas which control sleep and wakefulness, while others are more specifically targeted at brain areas which control emotions such as fear. The classification of whether a benzodiazepine is sedative-hypnotic or anti-anxiety is to some extent an arbitrary one, as the boundaries are quite fluid. As a rule of thumb, in higher doses benzos act like sedatives and may promote sleep, while in lower doses, they simply reduce anxiety without sedation.

IV Sedation – When a drug, usually of the benzodiazepine variety, is administered into the blood system during dental treatment, this is referred to as Intravenous Sedation.  This method has a faster effect and can be controlled much better than oral sedation.  IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on. The drugs used for IV sedation can produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much, or perhaps even nothing at all, of what happened.

General Anesthesia – this is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anesthetic agents. A variety of medications may be administered, with the overall aim of ensuring hypnosis, amnesia, analgesia, relaxation of skeletal muscles, and loss of control of reflexes of the autonomic nervous system. The optimal combination of these agents for any given patient and procedure is typically selected by an anesthesiologist or another provider such as a nurse anesthetist, in consultation with the patient and the medical or dental practitioner who is performing the operative procedure.

Trained sedation dentists have a variety of protocols available to customize to each patient’s physiological and pharmacological needs. So even if you have a unique medical condition, there still may be options. A number of medications that can be taken by mouth or administered by IV have been developed especially for these purposes, subjected to rigorous research and testing, are safe and have been used for decades.

Knowledge about oral sedation treatment is not only powerful—it is empowering. It is important to talk to your dentist about your fears and concerns during your consultation before any dentistry is ever performed. Request information on your dentist’s training, credentials, and the protocols they will use prior to the appointment.  You must know at which sedative level your dentist is licensed to practice. It is critical that you provide your dentist with an updated health history including any medications you are on, including vitamins and supplements. Factors like smoking and alcohol consumption can alter the effectiveness of sedation medications, so be sure to tell your doctor about any habits you may have. Even something as seemingly insignificant as drinking grapefruit juice can have an effect on sedation.

Dental fear is a hidden phobia, like many people, you may be embarrassed to admit your fears and even more afraid to confront them. Often times not even your loved ones are aware of your apprehension. Worse yet, you may have never known that sedation dentistry was an option. Not anymore! Sedation Dentistry is not scary and can be pain free dentistry.

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