Sedation ("pain free dentistry")
Millions of people forego needed dental treatment due to past experiences or a false perception that going to the dentist automatically means pain.
We recognize that many people have anxiety
about dental visits, usually as a result of painful and lengthy procedures
experienced with a previous dentist.. Rather than being afraid of going to
the dentist, we believe that people should be excited at the prospect of
improving their appearance and health.
There are several levels of Sedation (Sleep Dentistry) which will reduce
the level of anxiety.
1) Nitrous Oxide a form of conscious inhalation sedation. A very mild sense
of relaxation.
2) Oral Sedation a tiny pill taken orally the night prior to an appointment
then 30 minutes prior to the appointment depending on the level of anxiety.
Best when used for short a appointments. Once the drugs reaches it’s
peak state of relaxation it begins to wear off.
3) Intravenous (IV) Sedation this form of sedation is used to create a sleep
like state where the patient is virtually unaware of the dentistry being
performed. This technique is usually administered in office by a specially
trained and licensed dentist .
Only about 4% of dentists have the training and licensing to provide IV (sleep)
Sedation.
What does it feel like? Will I be asleep?
A
lot of dental offices use terms such as "sleep dentistry" or "twilight
sleep" when talking about IV sedation.. This is confusing, because it
suggests that IV sedation involves being put to sleep. In reality, you remain
conscious during IV sedation. You will also be able to understand and respond
to requests from your dentist.
However, you may not remember much about what went on because of two factors:
firstly, in most people, IV sedation induces a state of deep relaxation and
a feeling of not being bothered by what's going on. Secondly, the drugs used
for IV sedation can produce either partial or full memory loss (amnesia)
for the period of time when the drug first kicks in until it wears off. As
a result, time will appear to pass very quickly and you will not recall much,
or perhaps even nothing at all, of what happened. So it may, indeed, appear
as if you were "asleep" during the procedure.
Is it still necessary to be numbed with local anaesthetic? Will
my dentist numb my gums before or after I'm sedated?
The drugs which are usually used for IV sedation are not painkillers (although
some pain-killing drugs are occasionally added, see below for a more detailed
discussion), but anti-anxiety drugs. While they relax you and make you
forget what happens, you will still need to be numbed.
If you have a fear of injections, you will not be numbed until the IV sedation
has fully kicked in. If you have a phobia of needles, you will very probably
be relaxed enough not to care by this stage. Your dentist will then wait
until the local anaesthetic has taken effect (i. e. until you're numb)
before starting on any procedure.
How is IV sedation administered?
Intravenous" means that the drug is put into a vein. An extremely
thin needle is put into a vein close to the surface of the skin in either
the arm or the back of your hand. This needle is wrapped up with a soft
plastic tube. The needle makes the entry into the vein, then is slid out
leaving the soft plastic tube in place.. The drugs are put in through that
tube (which is correctly referred to as an "indwelling catheter",
but more commonly known by the tradename of Venflon). The tube stays in
place throughout the procedure.
Throughout the procedure, your pulse and oxygen levels are measured using a "pulse oximeter". This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you're getting dangerously low on oxygen, although if your dentist and the nurses are paying attention they should see it before the machine does =). The warning signs are unresponsiveness and slow breathing. Blood pressure before and after the procedure should be checked with a blood pressure measuring machine (a tongue-twister called "sphygmomanometer", which for obvious reasons is referred to as "sphyg").
What drugs are used?
Good question!! The most commonly used drugs for IV sedation are benzodiazepines,
or "benzos" for short. These are anti-anxiety sedative drugs. In
the UK, a benzodiazepine is almost always the only drug used for IV sedation
(although I have heard of fentanyl being used as well).
Mostly the drug used for IV sedation is a short acting benzodiazepine, or "benzo" for
short. This is an anti-anxiety sedative.. IV administered benzos have 3 main
effects: they reduce anxiety/relax you, they make you sleepy, and they produce
partial or total amnesia (i. e. make you forget what happened during some
or, less frequently, all of the procedure).. Total amnesia is more common
with midazolam compared to diazepam (see below).
By far the most commonly used drug for IV sedation is Midazolam (tradenames:
Versed in the US, Hypnovel or Dormicum in the UK), but occasionally Diazepam
(tradename: Valium) can be used.
If you have dental fears please give our office a call and we'll schedule an appointment to discuss the type of Sedation needed in your case.
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