Sedation Dentistry

Sedation dentistry is used to provide a relaxing and anxiety-free experience for certain people receiving dental treatment. It enables individuals too afraid to go to the dentist to receive the dental care they need while avoiding the common apprehension known as dental phobia.

According to to the Dental Organization for Conscious Sedation (DOCS Education), a professional dental organization dedicated to ensuring that patients receive safe, comfortable and anxiety-free dental care, 30 percent of the population avoids the dentist due to fear. This all-too-common “dental phobia” prevents people from receiving necessary routine dental care, potentially compromising the health and functionality of their mouth and smile.

What Is Sedation?

Sedation is a process used to establish a relaxed, easy and calm state through the use of sedatives. Sedative drugs (tranquillizers, depressants, anti-anxiety medications, nitrous oxide, etc.) can be administered in a variety of ways. In the past, intravenous (IV) sedation – sedatives delivered via injection into the blood vessels of the hand or arm – was predominantly used to sedate a dental patient.

IV sedation is both safe and effective when administered by a trained professional. Today, however, sedation dentistry has evolved to be even more conducive to a relaxing experience. Patients have alternatives to the traditional modalities of inhalation (nitrous oxide or “laughing gas”) and IVs, such as those offering a “no needle” (meaning, no injection) approach that many people find more appealing.

Oral sedation dentistry is now the most common technique used in the United States and Canada to quell patient fears. The technique is easy and requires no needles. Best of all, the medications create such a comfortable experience that most patients do not remember the visit; it is as if they slept through the treatment. In reality, oral sedation dentistry maintains a level of consciousness in the patient for safety and cooperation. To learn more, visit SedationCare.com. Note that sedation is different from anesthetic injections. Although some forms of sedation (such as nitrous oxide gas) may raise your threshold for pain, most dental treatments still require a local anesthetic injected in the mouth, even when sedation dentistry techniques are performed.

This local anesthetic will temporarily block pain impulses from the affected teeth and gum tissue. However, this injection will occur after you are already sedated and comfortable, so most likely you won’t be bothered by or remember the sensation of having the injection.

Regardless of the type of sedation dentistry you receive, it is important to have a responsible caregiver accompany you to the procedure (and drive you there if you must take oral medication before arriving for your appointment). The caregiver should drive you home after the procedure is complete and stay with you for an additional two to four hours at home.

Benefits

One of the major benefits of sedation dentistry is that people often feel like their dental procedure lasts only a few minutes, when in fact it might have taken hours to perform. Therefore, complex dental procedures such as smile makeovers or extensive rebuilding procedures that normally require multiple visits can often be performed in fewer appointments.

If you are reluctant to change the appearance of your smile because you are afraid or anxious about undergoing long or complicated dental procedures, sedation dentistry can make you feel comfortable during the treatment process and help you achieve a smile you can be proud of.

Also, because sedation dentistry addresses some of the fears that keep people from going to the dentist on a regular basis, sedation dentistry patients are more likely to receive recommended routine care. As a result, they are less likely to neglect their oral health or allow oral health problems to build to the point when drastic dental treatments become necessary.

Sleep Dentistry or Sedation Dentistry?

Sedation dentistry has occasionally been dubbed sleep dentistry, but this term is misleading. In actual fact, you do not sleep during the procedure, but because of the effects produced by the sedative, you may feel sleepy.

Sedation dentistry enables you to be kept awake throughout the entire procedure, but you will feel relaxed and likely won’t remember much about your treatment. The use of general anesthesia is not considered sedation dentistry.

Insurance Coverage

According to DOCS Education, insurance companies do not pay for sedation; however, some non-intravenous sedation procedure codes may apply to your treatment.

For example, if you are undergoing periodontal scaling and root planing of all four quadrants of your mouth, insurance companies may cover the costs of this procedure if it is completed in one appointment if you are sedated, rather than requiring you to stretch out the procedure to four separate appointments.

Sedation Dentistry Modalities

The sedative methods used for sedation dentistry vary in strength and purpose. Your dentist will select the sedation dentistry option that is best for you based on the treatments performed, how long these procedures will take and your level of anxiety. Although your dentist will ultimately determine what sedatives will be used, you can request stronger sedatives if you suffer from severe anxiety.

Levels of sedation range from mild, to moderate, to deep and are achieved through different types of sedatives. According to the Academy of General Dentistry, sedation is safe, but it is important for patients to talk to their dentist about what is involved and expected before the procedure. In order to ensure that the appropriate sedatives are used, your sedation dentist will require a medical history and list of all medications you are taking – including over the counter products and herbal supplements.

Anxiolysis: Anxiolysis is defined by minimal or mild sedation and is associated with relieving anxiety. Inhalation analgesia (also known as nitrous oxide or “laughing gas”) is one of the more commonly requested types of anesthesia from people who have anxieties about their procedure. It is administered via a small nose-hood placed over the nose through which nitrous oxide is delivered prior to and throughout treatment. In addition to some tingling and numbness, nitrous oxide typically evokes an overall feeling of well-being. Pills can also be used to create a feeling of anxiolysis. It is important for you to be open and honest with your dentist about any past drug use or current medical conditions so that an appropriate medication may be selected. The cost for anxiolysis (inhalation of nitrous oxide) ranges from $50 to $60.

Moderate Sedation: Moderate sedation is defined by a depressed level of consciousness, meaning you can breathe independently, retain your reflexes and respond to verbal/physical stimulation. Oral sedation or oral conscious sedation (OCS) – most often associated with sedation dentistry – produces moderate sedation via oral medication dispensed to the patient before the appointment to diminish awareness of pain, sounds and smells. The patient is instructed to take the medication prior to being driven to the appointment by a responsible caregiver and, once at the appointment, may receive additional medication as needed to ensure comfort.

• Intravenous Sedation: Intravenous sedation can also make people feel as if they are actually asleep, much like oral sedation. The difference between oral and intravenous sedation is the route of administration. Administered via injection, intravenous sedation has an almost instantaneous effect and is best used for shorter dental procedures. Amnesia is a common side effect of intravenous sedation and oral sedation, often leading people to believe that their procedure lasted mere minutes. The cost for intravenous sedation ranges from $290 to $340 for the first 30 minutes, and $100 for each additional 15 minutes.  The cost for non-intravenous conscious sedation is approximately $175.
• Intramuscular Sedation: Intramuscular sedation, which involves an injection of sedative drugs into the muscles of the upper arm or upper thigh, can result in sedation within five minutes. Its use in dentistry is less common.

Deep sedation: Deep sedation, which is not considered a sedation dentistry modality, involves depressed consciousness in which a patient may not breath independently, loses some of his/her reflexes and is unable to respond to verbal/physical stimulation. This level of sedation is typically achieved with IV sedation or general anesthesia medications, the effects of which may linger for hours after the procedure is completed. The cost for deep sedation is approximately $180 for the first 30 minutes, and $115 for each additional 15 minutes.

General Anesthesia: General anesthesia is commonly used for surgery and a small percentage of people who are not good candidates for sedation dentistry.

Patients receiving sedation dentistry treatments must be accompanied by a responsible driver/caregiver who will drive them home. After the appointment this individual should stay with the patient until the effects of the sedation have worn off.

Selecting a Sedation Dentist

Sedation dentistry treatments should be performed under the guidance of a dentist and staff specifically trained in sedation procedures. In the case of oral conscious sedation, for example, such training typically involves between 18 and 25 hours of education.

The American Dental Association and most state dental boards and colleges (the government entities in U.S. and Canada that oversee professional licensing) require dentists to have specialized training in sedative techniques, equipment, medications and medical history analysis to ensure that they are appropriately skilled in the practice of sedation dentistry.

If you consider yourself an anxious patient and are apprehensive about routine dental visits, let alone any necessary dental treatment, you might consider looking for a qualified sedation dentist. You may find the following considerations helpful:

Education: Inquire about the dentist and staff members’ specific level of education in sedation dentistry. There is limited training provided by dental schools specific to sedation dentistry. However, continuing education programs provided by organizations such as the DOCS Education offer more specialized training programs. Additionally, specialty training in anesthesia can be obtained during a dentist’s post-graduate study.

Ongoing Training: Participation in organizations such as DOCS provides opportunities for ongoing education and training in sedation dentistry techniques, practices and related procedures. Additional training opportunities are also available through the American Dental Society of Anesthesiology and the American Society of Dental Anesthesiologists. Ask if the dentist regularly attends education programs sponsored by these groups.

Your Medical History and Medications: Bring a complete list of your medical history, including any medications and supplements you are taking, and review the list with the dentist to ensure that sedation dentistry is the right choice for your particular situation.

In-Office Patient Monitoring: The safe practice of sedation dentistry requires the use of monitoring equipment – including a pulse oximeter, oxygen equipment and reversal medication agents in case of an adverse reaction (a very rare occurrence) – while a procedure with sedation is performed. – Be sure to check that monitoring equipment is readily available in the procedure room where your treatment will be performed.

Once you have made the decision to move ahead with sedation dentistry, be sure to review the Informed Consent form for additional details about the procedure, equipment, advantages and risks associated with your treatment. Experienced sedation dentists should have a comprehensive form and be willing to spend time with you to discuss any aspect of sedation dentistry. Inquire about pre- and post-procedure instructions. This list will better prepare you and your companion for the day of the procedure.