Sedation Dentistry Overview

Sedation Dentistry is the practice of using nitrous oxide and other drugs to sedate a patient. Sedation dentistry is used on nervous and scared patients. Sedation dentistry is also used when a patient will be undergoing a procedure that will be very painful, such as a root canal.

Sedation Dentistry offers pain-free and anxiety-free dental procedures as the patient is in a deeply relaxed state, though fully responsive. It means something even more important: a comfortable experience – often with no recollection of the time passed. We often hear from patients who express their gratitude and delight in their first-ever visit to the dentist without fear.

All of the amazing advances in dentistry can’t do a thing for you if you don’t go to the dentist. We realize that there are a lot of legitimate reasons why many people stay away from the dentist. It’s been estimated that almost half of the population has some kind of dental fear, from people who feel a little uncomfortable, to those who are so terrified they can’t set foot in a dental office. Whether it’s fear or something else that’s keeping you away, today’s dentistry gives Dr. Michaels many options for making you comfortable throughout your appointment. Anesthesia can eliminate pain for most people, but sometimes that’s not enough. Sedation dentistry uses medications to relax patients, which makes for a totally comfortable dental experience.

Nitrous Oxide (Laughing Gas)

Nitrous Oxide Sedation is an effective way for Dr. Michaels to help you stay relaxed and comfortable during a dental procedure. It is a very light form of sedation, which works fast and wears off quickly.

What is Nitrous Oxide Sedation?
Nitrous oxide, often called “laughing gas” is a colorless gas that Dr. Michaels can give you to help you relax. It is very safe when professionally administered, and it works extremely well to reduce the anxieties in many dental patients. Approximately one-third of all dentists use nitrous oxide in their offices. It is often used to sedate a patient for a short period of time, or in conjunction with another sedation medication.

Is Nitrous Oxide Sedation for me?
Dr. Michaels has been trained as to exactly when and how to administer nitrous oxide, so feel free to ask if it is right for your situation. She wants to sedate you only as much or as little as necessary. Nitrous oxide “takes the edge off.” It delivers an excellent, light sedation for patients. An additional benefit of nitrous oxide is that is suppresses, or inhibits, the gag reflex. Sometimes it is used in conjunction with other sedatives to keep patients relaxed and totally comfortable.

What can I expect from Nitrous Oxide Sedation?
Dr. Michaels will use a nosepiece which fits directly over your nose to allow you to experience the relaxation nitrous oxide provides. It usually takes effect very quickly, and lasts for as long as it remains on. During the procedure you will feel extremely relaxed, with a sensation that has been described as “dreamy”, but you will remain awake. Once the nitrous oxide is turned off, patients usually feel normal again very quickly, and can almost always drive themselves home after the appointment.

Is Nitrous Oxide Sedation safe?
Yes, it is extremely safe when given by medical professionals like Dr. Michaels. A person actually receives more oxygen with the use of nitrous oxide than one would breathing normal air. Nitrous oxide is one of the safest medications available. While most people have no negative reaction to relatively short periods of time on nitrous oxide, it does make a small percentage of people feel nauseated. This is usually when the gas is too strong, too quickly. Dr. Michaels titrates (or customizes) the amount given for you and has rarely had a patient who has any negative side effects. Another reason nitrous oxide is so safe is because if you decide you no longer want the experience, you will be back to yourself in a matter of just a few minutes. Dr. Michaels has been trained how to best deliver nitrous oxide, and will have you under close supervision for the duration of the procedure.

Oral Sedation

Oral sedation is a wonderful option for patients who need more than nitrous oxide, but don’t need or want IV Sedation or general anesthesia. It allows many people to be comfortably sedated through an entire dental visit using just pills. Sometimes nitrous oxide is also used to sedate you more.

What is Oral Sedation?
Oral sedation is a method of conscious sedation where Dr. Michaels uses pills to sedate a patient. Most healthy adults are good candidates for oral sedation. For some, comfortable dentistry is as simple as taking one small pill.

What is Conscious Sedation?
Conscious sedation is modern dentistry that lets even the most high-fear patient have a relaxing and comfortable dental visit. Since the patient is comfortable, Dr. Michaels is able to accomplish the work of several appointments in just one, if so desired. There are a number of conscious sedation techniques, but they all have certain things in common. While the goal of general anesthesia is for the patient to sleep, in dentistry it is much more common to use conscious sedation, where the patient is sedated and comfortable. When Dr. Michaels uses conscious sedation, sometimes feel like you are asleep, even if you are not completely. That’s because sedation feels so relaxing and peaceful that you may leave the appointment, rest at home, and awaken to wonder if you even went to the dentist office. Many of the medications used in conscious sedation have an amnesiac effect as well, leaving patients with little or no memory of their dental appointment.

Is Oral Sedation for me?
Oral sedation is wonderful and incredibly effective for most healthy adults. For many, it is the answer they have been looking for all their life. Discuss sedation with Dr. Michaels if any of the following sounds like you

  • You are uncomfortable in the dentist’s office
  • You are too scared to even call the dentist and make an appointment
  • You can’t stand the smell and sounds of the dentist’s office
  • You are delaying treatment you know you need
  • You are in pain when you eat, but too anxious about the dentist to take care of it
  • You are unable to find a dentist that you feel you can trust
  • You have trouble getting numb – the anesthetic doesn’t seem to work on you
  • You are afraid to smile
  • You are concerned about how many dental appointments you know you’ll need
  • You are looking for a way to have the work of several appointments done in just one or two
  • You remember bad experiences with a dentist in your past
  • You need your wisdom teeth removed
  • You have sensitive teeth
  • You have a strong gag reflex, especially when the dentist is working in your mouth
  • You have trouble with jaw soreness when you have to keep your mouth open
  • You have back or neck pain when you sit in a dental chair
  • You have sensitive teeth
  • You are afraid of needles

What can I expect from Oral Sedation?
There are many different medications and sedation techniques, so it is best to get specifics from Dr. Michaels. Generally, you will be given a prescription for a pill to take before your appointment. Since this is sedative medication, you will need a companion to drive you to the appointment. Once you arrive, Dr. Michaels will begin monitoring your vital signs, including heart rate and blood pressure, to make sure that you stay completely safe through the procedure. She will then assess your level of sedation, and ask how you feel. She may use more medication at this time. The dentistry will all be performed while you are relaxed and totally comfortable. When it is safe for you to travel, your companion will take you home, and then you will rest comfortably for the rest of the day.

Is Oral Sedation safe?
While all methods of sedation are very safe, the history of oral sedation has been especially safe as well as very effective. Dr. Michaels uses common medications that are extremely safe and widely prescribed. These are the same type of medications used for some outpatient surgeries and procedures like colonoscopies. Your health and reactions to the medications will be constantly monitored from the moment you arrive at the office, through the appointment, and until Dr. Michaels is certain you are ready to leave. In fact, the entire dental team is highly trained in safety and emergency procedures, making the dentist office one of the safest places you can be!

IV (Intravenous) Sedation

What does it feel like? Will I be asleep?
IV sedation is very safe. You are not asleep during IV sedation, and maintain the ability to breathe on your own. You will feel like you are sleeping! Most people do not remember any of the appointment, not even walking in the door. If you were more sedated, this would be considered deep sedation, classified as general anesthesia which should be performed in a hospital or outpatient surgical setting. 

Almost all the time, the patient does not remember much (or anything at all) about what went on because of two things: 

  1. IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
  2. The drugs used for IV sedation 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 of what happened. Many people remember nothing at all. So it may, indeed, appear as if you were “asleep” during the procedure.

Is it still necessary to be numbed with local anesthetic? Will my dentist numb my gums before or after I’m sedated? 

The drugs that are usually used for IV sedation are not painkillers but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed. 

If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will be relaxed enough not to care by this stage. Your dentist will then wait until the local anesthetic has taken effect (i. e. until you’re numb) before starting on any procedure. 

Is it safe? Are there any contraindications? 
IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it’s even safer than local anesthetic on its own! 

However, contraindications include: 

  • pregnancy
  • known allergy to benzodiazepines
  • alcohol intoxication
  • CNS depression, and
  • some instances of glaucoma.

Cautions (relative contraindications) include psychosis, impaired lung or kidney or liver function, advanced age, and sleep apnea. Many people who have sleep apnea haven’t been officially diagnosed – if you are overweight and you snore, do mention this. 

Heart disease is generally not a contraindication. If you do have cardiac problems, you are safer sedated than without sedation.

If you have been taking benzodiazepines for many years, your tolerance may be very high – so let your dentist know that you’ve been taking them! 

Can I take valium tablets or other benzodiazepines beforehand? 
Only if Dr. Michaels prescribes them. It is imperative that Dr. Michaels knows what drugs you have taken so she can keep you safe. 

What about eating and drinking before sedation? 
In the U.S., the standard advice appears to be no eating or drinking for 6 hours beforehand. 

After IV Sedation: 

  1. Have your escort take you home and rest for the remainder of the day.
  2. Have an adult stay with you until you’re fully alert.
  3. Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
  4. Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e.g., liquids and toast.
  5. If you experience nausea, lie down for a while or drink a glass of cola.
  6. Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.
  7. Take medications as directed by your dentist.
  8. If you have any unusual problems, call your dentist.