Green Leaf Dentistry’s Guide to Sedation Dentistry

Dental phobia is a very common problem, often associated with past traumatic dental experiences. For patients with dental phobias, the prospect of going to the dentist leads to severe anxiety, panic attacks, insomnia and in some instances, nausea and vomiting. Because of this, these individuals often avoid going to the dentist for regular visits, only seeking care in emergency instances when they are in severe pain and have an infection.
Fortunately, sedation dentistry has acquired increased recognition and acceptance as a viable treatment option for phobic patients. Formerly reserved primarily for pediatric and special needs patients and oral surgical procedures, increasing numbers of general dental practitioners are acquiring the necessary training to offer sedation to their patients. The fact remains that for most dental patients a visit to the dentist is an anxiety provoking experience that may or may not be associated with pain.
So, what is sedation? The first important point to note is that sedation serves to relax the patient while maintaining consciousness. The patient is able to respond to verbal cues and can maintain his/her airway. This is in contrast to general anesthesia, which puts the patient into a deep sleep or state of unconsciousness characterized by the inability to respond to verbal commands or maintain their airway.
There are 3 forms of conscious sedation used in dentistry today. The common denominator for all is that the patient remains fully conscious and can still follow the dentist’s instructions.

  • Type 1 is characterized by inhalation of nitrous oxide – also known as laughing gas. The gas creates a warm, relaxed and even euphoric feeling for the patient allowing the dentist to perform the necessary dental treatment. The advantage of inhalation sedation is that the effects are rapid onset and offset, with few side effects.
  • Type 2 is oral sedation, which involves taking an oral medication. Traditionally benzodiazepines such as lorazepam or temazepam are prescribed to the patient for use the night prior to and one hour prior to the appointment. This sedation modality has much longer lasting side effects because it can take a while for the medication to be fully metabolized and work its way out of your system. Consequently, you will need someone to accompany you to and from the dental office.
  • Type 3 is intravenous conscious sedation. The medications used depend upon the preference of the dental practitioner but are dosed in order to maintain the patient in a conscious state. Similar to oral sedation, you will require someone to accompany you to and from the office. One advantage of this approach is that you will have no recollection of the treatment.

The advantage to having three sedation modalities is that the overwhelming majority of patients can find a suitable option that will allow them to have their dental needs addressed in a relaxed state.
Naturally, there will still be individuals whose fears are so severe that simply seeking care is a major obstacle. It must be acknowledged, that phobias can be extremely complex and may require additional treatment such as a psychological consultation before they can be faced. And while sedation can help, it will not address the root cause of the anxiety or phobia.
If you have severe anxiety or dental phobia it is critical that you discuss this with your dental provider once you have finally taken the step to seek care. Ultimately, overcoming your fears and anxiety will require patience and understanding on the part of your dental provider as well as the establishment of a relationship built on trust and mutual respect in addition to the sedation options discussed herein.