Common FAQs About Sedation Dentistry

Question: What is a dental phobia and where does it originate from?

Answer: The word phobia is described as an irrational and sometimes disproportional fear that causes the sufferer to avoid the feared experience. In this case the feared experience is the dental visit or the actual treatment. Depending on the severity of the phobia, physical symptoms can be present. Such symptoms might include nausea or "butterflies", increased heart rate, sweating and the inability to concentrate. In rare instances, it can even be to the point where even the chair cannot be reclined. Some people may even experience a full-blown panic attack at the thought of visiting a dentist.

The most common fears of the dental patient are pain, lack of control, and the unknown. Many patients present to the dentist either in pain or endured a painful dental visit in the past. This could involve the actual injection, or the treatment or even the events that follow the treatment. Some patients are nervous and fearful that they have no control over the situation and cannot participate or be interactive in the decisions of the treatment. Others simply are scared because they do not know what to expect and have nothing to compare the upcoming experience with. No matter what the issue
While it's true that phobias can be overcome, treating a phobia can be a long process. It often makes more sense to take care of much-needed dental work and deal with issues of fear as time allows. Extreme fear or phobia associated with dental care could make you the perfect candidate for sedation dentistry!

What percent of patients do you see have anxiety or fear going to the dentist? Answer: Approximately 10 million Americans avoid going to dentist due to fear and anxiety. I would say 40-50% of my patients have had or do have some fear of the dentist. This fear usually stems from a bad experience or not understanding what is going on. By simply educating the patient, much fear is eliminated when the patient knows exactly what the problem is, how to fix it, and what it takes to fix it. I take pride in most of the services I offer but the one I take the most pride in is the one you don't see listed--helping you CONQUER your fear of dentistry. I am confident I can help you not only conquer your anxiety but help you establish a routine of regular dental care that prevents you from needing frequent amounts of dental work and be proud of your oral health and smile!

Question: What are the Main Types of Sedation?

Answer: There are 3 main types of sedation:
1. - The lightest form of sedation is nitrous oxide (laughing gas). This produces a mild sense of relaxation.
2. - Oral sedation is a moderate form of sedation. This form of sedation typically uses two pills taken before the dental visit to produce a deep state of relaxation. It is best used for short appointments, because once the drug reaches its peak state of relaxation it slowly begins to wear off.
3. - The deepest form of sedation is IV sedation (sleep dentistry). This form of sedation uses pain relieving and sedative drugs to create a sleep like state where the patient is virtually unaware of the dentistry being preformed. Most patients have little or no memory of the visit.

Only about 4% of dentists have the training and licensing to provide IV Sedation. Some dentists have access to all of the above forms of sedation to help a patient feel comfortable before, during and after treatment.

Question: Is Dental Sedation Safe and Is it for everyone?
Answer: Yes and no. Dental Sedation is very safe and most of the time very predictable in the response you will get. While there are multiple forms of providing sedation such oral, IV, IM, IN, inhalation, some forms are safer than others. The type of sedation to be used is tailored to the patient that desires it as well as fitting the comfort level of the provider. For example, IV sedation is an excellent treatment for adults that have a great deal of anxiety yet not recommended in treatment for children.

Why is this?
Determining the proper type of sedation is not just evaluating the medical history of the patient, but evaluating previous dental experiences, assessing the compliance or willingness of the patient to forego treatment, and ensuring the patient has been educated about what is being done, why and how.
Back to IV sedation, children are not candidates for IV due to their inability to understand what is going on and they are less likely to be compliant to the situation. Nitrous oxide (laughing gas) or oral sedation are better options for the child because of their noninvasive nature.

The majority of patients I encounter in my practice are good candidates for sedation dentistry. The more important question is what kind of sedation do they need and what will help them achieve the experience they desire. The answer to this lies in the evaluation by the dentist. Spend time with your dentist, discussing your fears, past experiences, medical history, family history as well as your goals and expectations. The combination of all of these will establish whether or not you are a candidate for sedation!

Question: What is oral sedation and how does it help with dentistry?
Answer: Oral Sedation involves the use of oral medications in the form of a pill/tablet to relieve mild to moderate anxiety. The most commonly prescribed medications are Halcion, Ativan and Valium, all of which produce a high level of drowsiness but not a complete sleep. The medicine is generally administered one hour prior to treatment but sometimes is also administered the night before the dental appointment as well. You will, however, remain awake and alert throughout your dental treatment and be able to breathe on your own without the fear and anxiety you might other- wise experience.

One downfall to oral sedation is that since every patient exhibits different levels of tolerance to drugs and different digestion times, there is no way to measure how much medication has been directly absorbed into the stomach. It is not effective or safe to try to make the patient more relaxed by giving more pills if the initial dose was not effective to relieve the patient's anxiety. Depending on the patient and the treatment being provided, sometimes laughing gas is used in conjunction with oral sedation to help assist with anxiety and pain control. Oral sedation is typically much more effective than laughing gas alone, but not nearly as effective as IV sedation or general anesthesia.

Question: What is laughing gas(nitrous oxide) and how it is used for dental anxiety?

Answer: Nitrous Oxide is a sweet smelling gas administered through a inhaler mask that is placed over a patient's nose. The patient simply breathes in the laughing gas and almost immediately(within 2-4 minutes) experiences a relaxed state. Nitrous oxide is administered to patients requiring relatively short dental procedures and for those with mild anxiety. Recovery time for patients receiving nitrous oxide is very brief, as the effects subside within minutes, allowing patients to drive themselves home if necessary. This is the only form of sedation that the patient can drive to and from their dental appointment. Nitrous oxide works very well with children and does well with adults but less predictable.

Question: If someone is getting sedated for their dental work, do they still need to be numb (i.e. get injections)?
Answer: Yes, even though sedation will relax the patient (perhaps even make them sleep) and cause an amnesia-like effect, injections are still often necessary. Sedation does not eliminate the perception of pain therefore the patient will still need to be numb. The combination of the sedation and the injections provide the best pain free and relaxing situation for a fearful patient. Despite the injections, however, the sedation will lessen the anxiety about the injections as well as promoting more comfortable injections. Most patients have no recollection of injections or the procedure!

Question: My child needs extensive dental work done and is quite nervous. What options are available to my child for sedation?
Answer: That can really depend on certain factors such as age, weight, medical history, previous dental experiences, etc. The majority of the time, nitrous oxide(laughing gas) is sufficient to help calm the child down and eliminate anxiety. Nitrous is great because the onset of effect takes ~ 2-3 minutes and laughing gas is completely removed from the body following several minutes of administrating oxygen. If a child is unresponsive to laughing gas and will not cooperate, I would then recommending the patient be referred to a pediatric dentist. Pediatric dentists have more extensive training in sedation techniques for children such as oral sedation or even general anesthesia.

Question: Is oral/IV sedation safe during pregnancy?
Answer: Typically sedation is not recommended during pregnancy due to the effects of the sedative drugs but also from local anesthetics. It is known that some sedatives can potentially be "teratogenic" which refers their negative effects on the fetus. Any medications that can possibly pass over the placenta can cause potential problems with normal development and nutrition. It is because of this that sedation as well as most dental treatment is typically deferred to the 2nd trimester.

It is not recommended during the 1st trimester because of early fetal development and also contraindicated late in the 3rd trimester due to the stress of the drugs/treatment than can promote premature labor. The 2nd trimester is typically the safest of the 3 trimesters but I prefer to defer all treatment until after pregnancy.

The exceptions to this is cleanings, exams and emergency treatment that would be more harmful if actually deferred. Talk to your dentist about what treatment is safe and achievable during pregnancy. If the dentist in unsure, he may consult your OB/GYN for treatment recommendations. Re: sedation, nitrous oxide is the only form of sedation/analgesia I would be comfortable administering during pregnancy.

Question: Who is not a candidate for oral and IV sedation?
Answer: The following is a list of individuals who would not be candidates for sedation and includes but not limited to:
1. Diabetics- unless blood sugar is well controlled and patient is compliant with dietary and prescription regimens. Type II are typically better candidates as patients with Type I (insulin dependent) typically experience larger fluctuations in blood sugar and need a quicker response to this fluctuation.
2. Liver and kidney diseases. Patients with liver and kidney disorders are usually not great candidates for sedation because their ability to metabolize drugs is altered or compromised. These metabolism deficiencies can lead to patients hypo or hyperresponding to medications and will also shorten or prolong the response to the medications. Patients with these disorders need clearance from their physician prior to sedation.
3. Thyroid and adrenal disorders. Patients with altered responses to stress, altered metabolisms can affect the response to sedation. Patients that are taking steroids on a regular basis can also have adverse reactions because their body is not conditioned for stressful situations. Patients with these disorders or anything else endocrine in origin should consult their dentist and physician for any proposed sedation treatment.
4. Pregnancy- Patients who are pregnant are not good candidates due to the teratogenic properties of sedation medications but also due to the altered metabolic demands of a fetus on a mother's body. If absolutely necessary, the 2nd trimester is the best choice but I would prefer to defer sedation or any unnecessary dental treatment until after pregnancy.
5. Medications/recreational drugs- Patients that take mind altering medications such as antidepressants and anti-anxiety medications can also respond very erratically or not at all to sedation medications. Patients typically don't respond as well because the body has been conditioned to process mind altering medications that fall along the same categories of sedative medications. Recreational drugs is a huge contraindication as the response is totally unpredictable and could be potentially life threatening.
6. Respiratory- This is the biggest and most frequent complication I run into. Factors such as Asthma, COPD, sleep apnea, sickle cell disease, bronchitis, sinus infections, etc. All sedation medications have some sort of respiratory depressing effects that control a person's breathing. Sedation medications can severely hamper the body's ability to maintain normal breathing and furthermore should be taken with caution. An example of someone who is not always a good candidate is someone that snores on a regular basis as this is already an indication of someone who may be developing respiratory problems.
While this is not an all inclusive list, these are the most frequent disqualifying conditions for sedation dentistry!

Question: What are the most commonly used medications in IV sedation?
Answer:Typically there is a combination of medications(sedatives and narcotics) used to achieve sedation in order eliminate anxiety as well as providing pain control. The types and amounts greatly depend on the length of the procedure, the medical history of the patient, and the types of procedures.
Usually a combination of sedative(benzodiazepines) such as Versed or Valium will be given to help with anxiety control. In addition, a pain medicine is administered along with the sedative to help with pain control but to also further assist with the sedation process. Usually, Demerol or Fentanyl are the pain medications administered IV.

Other IV meds sometimes used in IV sedation are Phenergan(to offset nausea from the other medications), and Dexamethasone (steroids that control postoperative swelling/inflammation). Propofol, is also a commonly used IV medication to assist with the sedation but is only indicated in very short procedures and has very limited use in dentistry because of the dangers if not used appropriately.

IV sedation is very safe and in fact, is much safer than oral sedation as IV sedation relies on medications being placed through the IV so the effects can be felt much faster, be better controlled, and easier to reverse should an emergency occur. Ask your dentist about the types of sedation he/she offers and how it can benefit you!
Sedation is a common treatment administered nowadays in dentistry and extremely beneficial to the fearful, anxious, or time constrained patient who desires extensive work in a comfortable, short amount of time. Please see below to learn about the different types of sedation offered.

Question: Can you explain in more detail the types of sedation and what is right for me?
Answer: I would encourage you go to my sedation tab to read further regarding sedation. Bottom line is there are many different options to help make you more relaxed but the recommended choice is based on your past experiences, the work that needs to be done as well as the amount of work to be done, your medical history. More patients fear going to the dentist because of a bad experience or because they simply don't understand. Having said that, picking a dentist just because "he can sedate you" is not enough.
When looking for a dentist, you need to ask yourself several questions:

Does he understand my fears and concerns and did he offer me solutions?

Does he have up to date equipment and properly trained staff?

Did he explain everything in a manner that you understand...that is can you make an educated decision based on what he has advised you on?

Was he gentle? If you had a cleaning, was the hygienist gentle?

Was the front desk gentle and receptive to your needs?

I believe with a friendly staff and a dentist who takes the time to explain your problems as well as what caused them, offer solutions and alternatives along with the pros and cons, is just as important for helping with anxiety and fear.

What is the difference between oral and IV sedation?
An ABSOLUTE ton!! While I do all forms of sedation in my dental practice, I would much prefer IV sedation over oral sedation. Before I discuss the differences, I will discuss the similarities:

1. Both will put the patient in a more relaxed state with possible "sleepiness"
2. Both will produce some amnesia so that the patient has very little recollection of what happened.
3. Both will dull a patient's perception of noisy drills, painful injections, and having your mouth open for a long time.
So oral sedation can work roughly the same as IV sedation except:

1. It takes much longer to produce sedation through oral (1 hour to 2 hours) versus IV sedation (3 min to 10 min).
2. Oral sedation can last much longer than needed where IV sedation can end as quickly as the procedure is done so the patient is not incapacitated for the duration of the day.
3. It is much easier to treat an emergency or reverse a sedation with an IV vs oral sedation. In oral sedation, each person will metabolize oral medicationsdifferently, so it is difficult to predict what it will take to make the patientcomfortable. Also, the patient can be oversedated with oral sedation and much more difficult to reverse since an IV is not started.

These are significant differences between oral and IV sedation. While oral is an acceptable way to provide relaxation to the patient, IV sedation is more efficient, does not last as long, and is ultimately more safer than other forms of sedation. This is also why the majority of specialists such as oral surgeons use IV sedation as a preferred method of sedation!!

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