Many patients suffer from some degree of stress when visiting the dentist. But for a minority of people, the level of anxiety becomes a barrier to coming to dental surgery at all. This extreme fear may be related to a memory of an unpleasant experience at the doctor or dental surgery during childhood that the patient finds difficult to put behind them to seek the care they require. For these patients, it is more acceptable to continue to experience dental pain than to find a resolution.
Dental sedation is also helpful when a patient not normally fearful of visiting the dentist is undergoing a complicated surgical procedure.
Dental Sedation is a safe technique that can help to treat nervous patients successfully. It can help even the most dentally phobic patients achieve good oral health and a beautiful smile.
What is intravenous sedation?
Intravenous sedation is a sedative given via a vein. This makes you feel much more relaxed about the treatment you will receive; it removes your fears and anxieties. Although you will not go to sleep, you may think that you have been. Many people cannot remember very much about the treatment afterwards. During sedation, a clip on your finger or thumb will monitor your pulse and breathing. You may be given extra oxygen to breathe.
What does it feel like? Will I be asleep?
You remain conscious during conscious intravenous sedation. You will also be able to understand and respond to requests from your dentist. However, you may not remember anything at all about what went on because of two things:
- IV sedation induces deep relaxation and a feeling of not being bothered by what’s happening.
- The drugs used for IV sedation produce either partial or complete memory loss (amnesia) when the drug first kicks in until it wears off. As a result, time will pass very quickly, and it may appear as if you were “asleep” during the procedure.
Is it still necessary to be numbed with local anaesthetic?
The drugs which are usually used for intravenous sedation are not painkillers. While they relax and make you forget what happens, you need to be numbed. If you fear injections, you will not be numbed until the intravenous sedation fully kicks in. If you have a phobia of needles, you will probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (until you are numb) before starting any procedure.
But I’m terrified of all needles, not just dental injections!
You can get a topical numbing cream to make the site where the needle goes profoundly numb. Spraying some midazolam in the nasal cavity is also possible to partially sedate you.
What drugs are used? Are there different types of IV sedation?
The most commonly used drugs for IV sedation are benzodiazepines. These are anti-anxiety sedative drugs. Benzodiazepines are almost always the only drug used for IV sedation. Midazolam is the first choice because of its relatively short duration of action. This means that it will be out of your system faster.
What are the main advantages of IV sedation?
- IV sedation tends to be the method of choice if you don’t want to be aware of the procedure.
- The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a considerable advantage compared to oral sedation, where the effects can be unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
- The maximum level of sedation which can be reached with IV is more profound than with oral sedation.
- Benzodiazepines produce amnesia for the procedure.
- The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging.
- Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t introduce any compromises per se in carrying out the actual procedures because people are aware and can cooperate with instructions, and no airway tube is involved.
Are there any disadvantages?
- It is possible to experience complications at the site where the needle entered, for example, hematoma (a localized swelling filled with blood.
- While IV sedation is desired precisely because of the amnesia effect (i.e. forgetting what happened while under the influence of the drugs), there can be a downside. If you can not remember that the procedure was not uncomfortable or threatening, It is difficult to unlearn your fears.
- Recovery from IV-administered drugs is not complete at the end of dental treatment. It would be best if a responsible adult escort you.
- Sensible clothing is advised, avoiding tight sleeves and high-heeled shoes. You must not wear nail varnish or false nails as it can interfere with our monitoring.
What about eating and drinking before sedation?
It is best to have a light meal about an hour before you come in for your treatment under intravenous sedation.
After IV sedation
- Have your escort take you home and rest for the day.
- Have an adult stay with you for 8 hours after you have been treated
- Don’t perform strenuous or hazardous activities or drive a motor vehicle for the rest of the day.
- Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e.g., liquids and toast.
- Take medications as directed by your dentist.
- If you have any unusual problems, call your dentist.