For some people with an intense fear of going to the dentist, the idea of being “out of it” and having no memory of the dental visit afterward is quite appealing. Parents might feel that their anxious children will feel better and will be much more cooperative if they are sedated during their procedures. Called “sedation dentistry”, it’s the type of dental practice that utilizes medication which may include nitrous oxide. These medications allow you to feel drowsy and less anxious. For people who put off having dental work done due to their anxiety, sedation dentistry might seem like the perfect solution. The visit goes by quickly, and the dentist might be able to do more work at one time, reducing the number of office visits.
Types of Medications Used in Sedation Dentistry
Sedation dentistry can employ a variety of medications with varying levels of sedation, including:
Inhaled minimal sedation. You breathe nitrous oxide — otherwise known as “laughing gas” — combined with oxygen through a mask that is placed over your nose. The gas helps you relax. Your dentist can control the amount of sedation you receive, and the gas tends to wear off quickly. This is the only form of sedation where you may be able to drive yourself home after the procedure.
Oral sedation. Depending on the total dose given, oral sedation can range from minimal to moderate. For minimal sedation, you take a pill. Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it’s usually taken about an hour before the procedure. The pill will make you drowsy, although you will still be awake. A larger dose may be given to produce moderate sedation. This is the type of anesthesia most commonly associated with sedation dentistry. Some people become groggy enough from moderate oral sedation to actually fall asleep during the procedure. They usually can, though, be awakened with a gentle shake.
IV moderate sedation. You receive the sedative drug through a vein, so it goes to work more quickly. This method allows the dentist to continually adjust the level of sedation.
Deep sedation and general anesthesia. You will get medications that will make you either almost unconscious or totally unconscious — deeply asleep — during the procedure. While you are under general anesthesia, you cannot easily be awakened until the effects of the anesthesia wear off or are reversed with medication.
Sedation Dentistry Risks
There are a few major disadvantages to keep in mind when thinking about sedation dentistry. First, it is generally not covered by any insurance policy and the costs of the anesthesia can run up to $800 per visit. Certain people, such as those who are obese or who have obstructive sleep apnea, should talk to their doctor before having sedation. Those patients are more likely to develop complications from the anesthesia.
Another problem is that everyone reacts differently to sedating medication and the different types of medications that are used. With some people, it may take just a little bit of medication for them to fall asleep and wake up and not remember anything, while other patients may take the medication, not feel anything at all, but be awake for the entire procedure. Still other people might need more medication to be sedated enough to relieve their anxiety, and then it is up to the dentist and his/her staff to monitor that patient very closely and even with close monitoring, things can go very, very wrong.
Sedation Dentistry Deaths
Children under the age of 12 are particularly susceptible to having extreme adverse reactions to sedation and anesthesia. According to Virginia’s state board of dentistry, several high-profile and critical incidents involving children have been reported since 2007. Each of those incidents resulted in the death of a child. The board found that the treating dentists failed to properly monitor and record vital signs and pulse oximetry readings. In at least one of the cases, excessive medication was administered, the sedatives were administered by unlicensed personnel and the parents were left alone with their unmonitored children following administration of the pre-operative medications.
New VA Regulations for Sedation Dentistry
Because of these deaths, and because of 7 other incidents that were reported, the board proposed new state regulations regarding sedation dentistry, which mainly involve the number of hours a dentist must have be trained (at least 18 hours of instructive classroom training with 20 clinically-oriented patient experiences) and other rules for safe administration and monitoring of sedation and anesthesia in a dental office. Those state regulations stipulate that essential emergency equipment must be on hand, that recordkeeping procedures are followed, that emergency management protocols are followed, and that pediatric patients are sedated and monitored in accordance to established guidelines. Dentists now have to obtain sedation or anesthesia permits, and the board periodically inspects dental offices to ensure there are qualified personnel and essential equipment and practices in place as necessary for patient health and safety. It is important to make sure that your dentist is trained and qualified to administer the type of sedation you will be receiving.
Oral versus IV Sedation Dentistry
Oral sedation, where you take pills of sedatives, is a slow and risky procedure for several reasons. First, it may take hours for the pills to become fully effective. And, if you become too sedated, the dentist will not be able to reverse the process and wake you up. Nor will this oral sedation dentist have complete emergency medical knowledge, experience and advanced training to treat the various emergency medical conditions they may arise during the sedation dentistry process. Blood pressure problems or insufficient breathing are just two examples of potential issues. With IV sedation, a properly trained and certified dentist can usually adjust the levels administered before the patient has received too much of the drug.
Overcoming Your Fear of Visiting the Dentist
While sedation might make you initially feel as if you have overcome your fear of seeing the dentist, it actually does just the opposite, for a number of reasons. In the case of IV sedation, because you will not remember the treatment, you cannot learn that dental treatment is nothing to fear. Oral sedation can have the same effect because the class of drug used can impair memory and interfere with the acquisition of new information and your brain’s process of establishing new memories. You may believe that the drugs are solely responsible for your ability to cope while at the dentist, but your success could very well be due to the dentist’s techniques and the professionalism of the dental office staff. Our patients do well without sedation dentistry and they are a typical cross-section of local demographics. We have found that there are many more healthy and safe ways to alleviate pain and anxiety associated with dental work that do not rely on sedating the patient.