Sedation Dentistry

The use of sedatives has emerged efficient and safe for managing anxiety regarding dental treatment. The use of sedatives has established efficacy and safety for managing anxiety regarding dental treatment. Fear and anxiety regarding dentistry continue to persist despite the modern advances in local anesthetic agents. The majority of individuals admit they are fearful to some extent but many avoid dental care altogether. Using coping skills, most of the general public that have fears and anxieties are able to carry on with normal daily life. An individual with a particular phobia is defined as having a fear and anxiety that is so great it inhibits them from normal function. These patients present the greatest challenge for the dentist.

When looking at the fear and anxiety towards dentistry, majority of the people have a low level of fear, but they are able to receive dental treatment through various coping mechanisms. A small, but significant percent of the people, have fears so high that it impedes their ability maintain proper oral health care. These are the patients with a high level of fear who do not seek dental care on a regular basis. Between these groups, are those with moderate levels of fear and anxiety. This group may be able to tolerate minor dental treatment but have a higher level of anxiety for more involved treatment.

Patients with a moderate to high level of fear and anxiety are more likely to miss, cancel, or avoid a dental appointment. Adults hardly have objections to taking medications by mouth. The oral route is widely accepted, easy, painless, and inexpensive. The use of sedatives to produce minimal sedation in healthy adults is safe and effective, provided the appropriate dose is prescribed and adequate time is given to allow the drug to reach its peak effect.

What is conscious sedation?

Conscious sedation is defined as a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation.

Inhalation Sedation

Nitrous oxide/oxygen is usually the technique of choice for conscious sedation of paediatric dental patients.

What is Intravenous Sedation?

Intravenous sedation is commonly achieved by the injection of a single drug. These include the use of combinations of sedative drugs or intravenous sedatives in combination with r inhalation/ oral sedation. Intravenous sedation for children must be provided only by those who are trained in these techniques for patients of this age group.

Although the majority of pediatric dental patients could be managed by conventional behaviour management methods, a few number of them require pharmacological intervention. For these children, conscious sedation is the primary treatment options that allows comprehensive restorative dental care. Because of the risks and costs involved with general anaesthesia, conscious sedation is often the option of first choice.

Why should we offer sedation?

It is no secret that many people are afraid to go to the dentist, sometimes to the point of neglecting their oral care. Sedation, either oral or intravenous ,allows this segment of the people to be treated without stress, and often becomes the first step to their seeking regular dental care.

The primary objective of oral premedication is to reduce anxiety while maintaining consciousness, comfort, and cooperation. This objective is usually met in the mildly apprehensive patient. For the management of the moderately apprehensive patient, oral premedication can be effective when combined with either intramuscular or inhalational agents. However, it is not very effective in extremely apprehensive patients unless intravenous techniques are also used.

What medications are used for sedation?

Benzodiazepines, narcotics, and antihistamines ,are the most commonly used medications for both oral and intravenous sedation. Benzodiazepines such as midazolam ,triazolam and diazepam are very safe, have deeply calming effects on most patients and can be potently amnestic.

Narcotics such as fentanyl are also commonly employed, especially if post procedure pain is anticipated. One of the reasons that benzodiazepines and narcotics are so commonly used is that they are not only very safe when administered , but are also reversible.

What procedures commonly require sedation?

Many invasive procedures are best performed on a sedated patient. IV sedation allows us to administer medications in addition to the sedatives, such as steroidal anti-inflammatory drugs and analgesics.

Full-mouth extractions with immediate dentures, implant placements and gum surgeries are also common indications for sedation. It is often necessary to cut gum tissue and grind on bone to remove teeth, and it is less stressful , if the patient is deeply relaxed and not concentrated on the sights and sounds of surgery. When sedated, anxious patients are far less likely to wince and pull away from non-painful stimuli such as pressure, reducing the stress. However , the amnestic effect of drugs such as midazolam reduces the trauma, patients experience by rendering them unable to recollect the procedure. Surgeries are not the only indications for sedation, however. Many will express surprise that this is available and are eager to explore sedation options. A lot of patients have avoided seeing a dentist for years due to fear, and have several teeth in need of extraction. With the help of sedation, they can complete their treatment in stress-free visits. We dentists who regularly sedate patients will tell you that it changes people’s lives.

To conclude…..

1.The application of sedation should be carried out effectively and precisely so that it maintains a healthy gap between general anesthesia and unconsciousness. More concern should be taken when this process is applied on pediatric patients.

2.The provision of adequate anxiety control is an integral part of the dental practice. All patients deserve appropriate anxiety control for any dental procedure.

3.Using oral sedation techniques will allow patients to visit the dentist in a stress-reduced state, where their fear and anxiety would otherwise impede their ability to seek and maintain proper oral health care. To date, this modality has been proven to be not only safe but very effective. Proper medication selection and patient management, are paramount to maintaining this safe practice.

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