Conscious Sedation Dentistry Explained by Dr Dimitri Salin
Conscious sedation is used in dentistry as a means to alleviate anxiety and ensure a more relaxed experience for anxious patients undergoing dental procedures. Dental anxiety can lead to some patients avoiding dental office visits, which results in delayed treatments and potential oral health complications.
There are several options when it comes to conscious sedation dentistry. Understanding the levels of sedation and techniques dentists use will put you at greater ease about your next dental appointment.
What Is Conscious Sedation in Dentistry?
Conscious sedation dentistry is used at our Bakersfield, CA office to help patients relax while dental work is performed. Unlike general anesthesia, which induces a state of unconsciousness through deep sedation, conscious sedation allows you to maintain a level of awareness and responsiveness throughout the procedure.
This type of dental sedation is achieved through the administration of sedation drugs, either by inhalation, orally, or intravenously, that induce a state of deep relaxation and calmness. Conscious sedation is particularly beneficial for patients with dental anxiety, fear of needles, or sensitivity to dental procedures such as professional teeth cleaning.
There are two levels of conscious sedation that we use in our dental office:
Minimal Sedation: You'll feel relaxed, possibly a bit lightheaded, and your coordination could be affected.
Moderate Sedation: You'll notice your speech may become slightly slurred, your coordination could be affected, and you'll have little memory of the procedure. However, you'll still be able to respond to any requests or questions from the dental team.
Please note: At Salin Dentistry, we bring in an anesthesiologist to perform general anesthesia for patients who want to be completely out.
Conscious Sedation Options and Techniques
There are several types of sedation options commonly used, each offering varying levels of relaxation and control. It's worth mentioning that local anesthesia is always used alongside sedation for localized procedures, guaranteeing a relaxed and comfortable experience.
Each sedation medication works for a different length of time, known as its "half-life." Your dentist will select the type of drug based on your medical history and how long your procedure is expected to take.
Nitrous Oxide Sedation
Nitrous oxide (also known as "laughing gas") is a widely used form of minimal sedation. It is administered through a small mask placed over your nose. This colorless, odorless gas swiftly produces calming effects, promoting a sense of relaxation during dental procedures.
The dentist will carefully regulate the level of sedation you receive throughout your procedure. The effects of nitrous oxide take hold quickly and dissipate just as rapidly once the mask is removed. As a result, there's no need for anyone to accompany you home after your dental appointment, and you can even head back to work or school right after your appointment (well... if you really want to!).
Nitrous oxide is remarkably safe with minimal side effects. Some patients may experience sensations of heaviness and tingling in their limbs, along with a mild lightheaded feeling. On the rare occasion, a patient may experience nausea and a headache.
Oral Conscious Sedation Medications
Oral sedation involves the administration of sedative medications, typically in pill form, to induce relaxation and reduce anxiety. This can range from minimal to moderate sedation, depending on the dosage and the patient's response to sedative drugs. Some individuals undergoing moderate oral sedation may become groggy enough to drift into sleep during the procedure, yet they can typically be gently awakened with a shake.
As a precaution, patients receiving oral medications for conscious sedation should not drive themselves home after their dental appointment.
Benzodiazepines
Benzodiazepines work by calming your central nervous system to promote relaxation. They are typically administered orally or through IV and have a longer-lasting effect compared to nitrous oxide. Benzodiazepines may have side effects such as dizziness, drowsiness, and confusion.
Triazolam (Halcion®) is an excellent oral sedative option with a medium half-life, offering effective mild to moderate sedation lasting between 2 and 4 hours.
Lorazepam (Ativan®) is well-known for reducing anxiety and calming nerves. It also has amnesic properties so that you forget what happens during the procedure. Ativan has a long half-life, making it suitable for lengthy procedures over 3 hours.
Alprazolam (Xanax®) has been used since the 1970s. It is a mild anti-anxiety drug that is short-acting and has a fast onset. It also has some anti-nausea effects.
Intravenous (IV) Sedation
We often get asked, "What is IV sedation?" IV sedation involves the administration of a sedative medication directly into your bloodstream, resulting in a rapid onset of relaxation and a moderate level of sedation. When medication is given intravenously, the effects are seen very quickly, within 30 seconds usually. The treating doctor can adjust the dosage of the medication to the patient and customize the treatment to what the individual patient needs.
Your dentist will carefully monitor your vital signs such as heart rate, blood pressure, and oxygen levels throughout your procedure. This allows them to adjust your dosage as needed and administer reversal medications if necessary.
Please note: For safety reasons, patients who undergo IV sedation need a reliable driver to take them to their appointment and drive them home.
These are some common IV sedation drugs usually given to patients undergoing complex or lengthy dental procedures:
Midazolam (Versed®). This drug has an amnestic effect, meaning that you may have little to no memory of the procedure afterward. This can be particularly beneficial for individuals who experience dental phobia or have had traumatic experiences in the past, as it helps to mitigate fears associated with future dental visits. Midazolam has a short half-life, making it suitable for relatively short dental treatments.
Diazepam (Valium®). This medication, given via IV, has great sedative effects. It has been in use for over 6 decades and is a safe and effective drug that can be used in combination with other sedative agents.
Hydromorphone (Dilaudid®). This drug is sometimes given during sedation to act along with a benzodiazepine to increase the level of sedation. It is also a great way to minimize post-operative discomfort from surgeries.
Who Can Benefit From Conscious Sedation?
Conscious sedation may be recommended for patients who have:
Dental anxiety or phobia
Extremely sensitive teeth
Fear of needles (aichmophobia)
Extensive dental treatment needs and surgical procedures
Very sensitive gag reflexes
Reduced sensitivity to local anesthesia rendering it ineffective as a stand-alone anesthetic
Difficulty sitting still in the dental chair or remaining calm during procedures
Special needs or medical conditions (including cognitive, physical, or behavioral) that may affect their dental treatment
Patient Preparation and Safety
Before undergoing conscious sedation, you'll be thoroughly evaluated to ensure you are a suitable candidate for sedation. This includes a comprehensive medical history review, assessment of current medications, and discussion of any allergies or medical conditions that may impact sedation. You'll also be informed of pre-sedation instructions, such as fasting requirements and transportation arrangements, to ensure a safe and comfortable experience.
Conscious Sedation Can Put You at Ease
Conscious sedation dentistry offers a ray of hope if you're gripped by dental anxiety. It allows you to get the essential dental care you need to prevent oral health complications resulting from postponed treatments. It also ensures a more comfortable experience during dental procedures by inducing a deep state of relaxation while you maintain your awareness.
To ensure a successful experience with conscious sedation, it's vital to choose an experienced dentist who can tailor the sedation method to your specific needs. With their expertise, you can approach dental appointments with confidence, knowing your comfort and safety are in capable hands.
