Main Types of Dental Sedation and Their Applications

November 20, 2023

Common Types of Dental Sedation

Seeing the dentist can often make people feel a little nervous. Around 36% of adults have some level of fear regarding dental visits. Out of that percentage, 12% deal with extreme dental anxiety. Thankfully, there are numerous ways in which dentists can help patients feel more at ease during their procedures.

Sedation is a common method used in dental treatments to help patients feel relaxed. While many associate dental sedation with laughing gas, it's important to note that dental sedation encompasses more than just this method. The decision on how to alleviate anxiety varies for each patient and case as described in safe sedation training. In this article, we’ll consider different types of dental sedation as well as cases when it’s necessary.

Need for Dental Sedation

Dental sedation helps patients maintain a calm, restful state during treatment. It involves using a soothing agent to make patients feel calm, relaxed, and at ease during dental procedures. It is a safe and effective method that is necessary for the following reasons:

• Anxiety relief: It helps patients be more comfortable and less nervous while receiving dental care.
• Pain relief: Dental sedation also provides pain-free dental care using potent sedatives.
• Gag reflex reduction: Sedation can help stop the gag reflex while the dentist works inside the mouth.
• Anterograde amnesia: This is a short-term memory loss experienced due to intravenous sedation. It can benefit patients since they may not remember what happened during the treatment. Hence, they can be more relaxed during their subsequent visits.
• Smoother procedures: The dentist can work more quickly and efficiently while the patient is asleep or moderately sedated.
So, who needs dental sedation? Individuals of various age groups can benefit from dental sedation, even children. Dentists often recommend this option for those with:
• Fear of pain
• Low level of sensitivity to local anesthesia
• Nervousness about lacking control
• Extreme teeth sensitivity or sensitive gag reflex
• Dental anxiety or phobia of visiting the dentist
• Previous bad experiences
• Aichmophobia or phobia of needles
• Feelings of claustrophobia or issues with controlling movements while in the dental chair
• Special needs such as patients with intellectual disabilities or other medical, physical, or psychiatric issues

4 Types of Dental Sedation

Dental sedation is a dependable and secure option when administered by a skilled dental professional. Dentists adhere to stringent medical guidelines that dictate the precise dosage of sedatives and employ techniques to ensure the patient's safety throughout the process.
Some aspects of a patient's background can hinder the dentist from administering sedatives. These include unhealthy lifestyles, certain medications, and various health conditions. Hence, it is crucial for dentists to thoroughly evaluate the patient's health history and background before proceeding with any type of dental sedation.

1. Oral Dental Sedation

Oral dental sedation involves the administration of sedative medication that can be in the form of a pill, tablet, or liquid. The liquid form is generally for kids; an example is the midazolam oral syrup. It is often taken about an hour before the procedure begins. Oral sedation typically lasts 2 to 6 hours. Most dentists use the following medications:

• Triazolam or a different diazepam
• Midazolam
• Zaleplon
• Lorazepam

Depending on the total dose, some patients may even fall asleep. However, oral sedation does not make a person entirely unconscious. Often, the dentist can wake the person with a gentle nudge.
Patients usually have little memory of discomfort once the procedure is completed. However, it can temporarily affect one's memory and motor skills. Therefore, patients must have somebody collect them and take them home after their appointment for safety reasons.

2. Inhalation Dental Sedation

Inhalation dental sedation involves inhaling nitrous oxide gas and oxygen through a mask or nose. Some people call nitrous oxide "laughing gas" or "happy gas" due to its euphoric effects.  It lowers sensitivity to pain, and the effects start in about five minutes. The dentist checks the amount of sedation received and adjusts the dosage if necessary.

At the end of the procedure, the dentist will administer pure oxygen to “wash out”  the laughing gas out of the body. The effects of laughing gas tend to disappear soon after dental therapy.  This inhalation of nitrous oxide is the only form of sedation where patients can go home alone after the procedure because there are rarely any adverse effects.

3. Intravenous Dental Sedation

IV dental sedation involves receiving the sedative drug through a vein. The dentist or healthcare professional gives a small injection of a sedative into an IV that has been inserted into the arm. Since the sedative medication is delivered directly to the bloodstream, it works more quickly.
Soon after the injection, the patient will feel drowsy but very relaxed. There are minimal side effects. However, patients must have someone take them home after their appointment for safety.
In a dental office setting, intravenous or IV dental sedation is the deepest level of sedation that should occur in an office setting., The level of IV dental moderate sedation is more predictable than oral sedation. It also allows the dentist to use reversal medications if necessary. The dentist can also continuously adjust the level of sedation.

Most patients might eventually fall asleep and have little to no recollection of the dental procedure when they get up. It may be an ideal option for people with severe dental anxiety or those undergoing prolonged procedures.

4. Dental General Anesthesia

Dental general anesthesia induces unconsciousness during the dental procedure. A dentist must have advanced or specialized training to provide general anesthesia. It can require the presence of an anesthesiologist to provide this type of anesthesia since there are more risks and potential complications with this type of sedation.

The key difference between dental general anesthesia and the other types of sedation include the following:

• when a person is under general anesthesia, they cannot be  awakened until the effects of the anesthesia wear off or are reversed with medication
• side effects such as nausea, vomiting, and chills occur more often
• patients can experience confusion for a few days
• use of a breathing tube that can cause a sore throat
• breathing problems during and after the dental procedure require special monitoring

However, dental general anesthesia might be necessary when treating young children, adults with special needs, or people with severe dental anxiety.

Conclusion

Considering the options for sedation techniques today, there are no reasons to take dental health for granted. Regardless of the type of dental sedation administered, the dentist must constantly monitor the patient's vital signs throughout the procedure. The dentist and other healthcare professionals should have oxygen and drugs ready to reverse the effects of sedation.

Resuscitation equipment and a trained workforce should also be available to handle emergencies. The clinic or dental office should have monitoring equipment such as ECG, pulse oximeter, ETCO2, NIBP, and defibrillator or AED should be handy and in working condition. An anesthesiologist can ensure the safety of dental general anesthesia

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