The aim of conscious sedation in the dental chair is to make you as comfortable as possible. We can relieve anxiety and reduce pain with the safe and effective administration of drugs. From laughing gas to sedatives, or conscious intravenous sedation administered by an anaesthetist, there is a cost-effective option available for patients that have severe dental anxiety or require very complex treatment.
Sedative medication helps relax patients by slowing the action of the central nervous system. People remain aware of their surroundings but are less responsive to external stimuli like the sound of the drill or the smell of materials. This also reduces their sense of pain.
Three options are available for sedation administered in the dental practice:
- Inhalation sedation: nitrous oxide or 'laughing gas.'
- Oral sedation
- Intravenous sedation or deep conscious sedation.
Inhalation Conscious Sedation
Nitrous Oxide - Laughing Gas
Commonly known as laughing gas, nitrous oxide is the most frequently used sedation method in dentistry. All bodily functions remain normal, and the person can breathe on their own. The patient will often fall asleep and experience some degree of amnesia about what happened during their dental appointment. Dentists have used inhalation sedation safely for many years.
- Works well for mild to moderate anxiety.
- Rapid onset.
- Flexible duration can be used for any appointment.
- Absolute control - it is easy to control the level of sedation quickly.
- There is an analgesic (pain relief) effect.
- People recover quickly.
- Very few side effects.
- You can drive yourself from your appointment.
- You can return to normal activities immediately.
- Not recommended for people with respiratory problems.
- Claustrophobic patients may find it difficult to have their nose covered.
- Patients who suffer from more severe anxiety may require deeper sedation.
What to expect with laughing gas
The gas is administered through a control box, giving the dentist the ability to adjust the concentration of nitrous oxide according to the level of sedation necessary. Four levels of sedation can be experienced. During dental treatment, you should be maintained within the first three stages.
- A tingling sensation, especially in the arms and legs, or a feeling of vibration (paraesthesia).
- Warm sensations quickly follow.
- A feeling of well being, euphoria - floating or drifting. This is the ideal level for dental treatment.
- During heavier sedation, one can experience
- the hearing 'dissolving' into a constant, electronic-like throbbing;
- difficulty in keeping one's eyes open or speaking.
- Nausea or dreaming indicates oversedation.
Oral Conscious Sedation
The medication used for oral conscious sedation in dentistry is from a group of drugs known as benzodiazepines. The most commonly used product in South Africa is Dormicum. Not only do these medications have a sedative effect, but they also have some degree of amnesic effect for most people. Patients remember little or nothing about their dental appointment.
- Easy to administer - swallow a small pill
- It is safe and easy to monitor
- Works well for most people
- Low cost
- The level of sedation is not easily changed and can be difficult to predict
- Someone must drive you to and from your dental appointment.
- There is no analgesic (pain relief) effect.
IV Sedation - Deep Conscious Sedation
Intravenous Conscious Sedation (IV sedation) during dental treatment is when an anti-anxiety variety of drug, is administered into the bloodstream. Although IV sedation is often confused with a general anaesthetic, during conscious IV sedation you do remain conscious. You will be able to understand and respond to requests from your dentist. However, you may not remember much (or anything at all) about what went on because of two things:
- IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
- The drugs used for IV sedation 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 of what happened. Many people remember nothing at all. So it may, indeed, seem as though you were asleep during the procedure.
At HBDS we use the services of specialist anaesthetists to administer your IV sedation. This leaves your dentist free to concentrate only on you and the treatment you require
What are the main advantages of IV sedation?
- Benzodiazepines produce amnesia for the procedure.
IV sedation is usually 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 your individual needs.
IV sedation is both highly effective and highly reliable. This is a huge advantage compared to oral sedation, where the effects are often unreliable.
- We can achieve a deeper maximum level of sedation with IV than with oral or inhalation sedation.
- The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging.
If minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only in situations where that fails to diminish the gag reflex should IV sedation be employed.
- Unlike general anaesthesia or deep sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.
Are there any disadvantages?
- It's possible to experience complications at the site where the needle entered, for example, haematoma or bruising.
- While IV sedation is desired precisely because of the amnesia effect, there can be a downside to this.
If you can’t remember that the procedure wasn’t uncomfortable or threatening, you can't unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem.
- Some dentists may resort to IV sedation too quickly.
Sedation should not be used as a substitute for behavioural techniques, but as an additional tool if these aren't working, or if it is a potentially traumatic procedure. It would be best if you wanted to choose sedation, rather than feeling forced into it because your dentist is unwilling to explore other ways of helping you.
- Recovery from IV administered drugs is incomplete at the end of your dental treatment.
You will need a responsible adult to escort you.
- Cost is a consideration.
IV sedation is more expensive than other conscious sedation options, yet less expensive than going to the operating theatre for a general anaesthetic.