An Introduction to Dental Sedation

Four Types of Anesthesia/Sedation:

Sedation allows dentists to create a state of relaxation, managing any fears patients may experience during dental visits. Several different types of sedation are commonly used, including: local anesthesia, minimal sedation, moderate sedation, and deep sedation.

Local anesthesia is administered via injection of medication into tissue or by applying a medicated topical gel to an area to eliminate sensation.

Minimal sedation is the type of sedation most frequently used during dental procedures; it usually involves a patient orally taking a medication prescribed by the dentist. With minimal sedation, all bodily functions remain normal; the patient can generally respond to verbal commands and may be amnestic of specific details of the dental procedure. Nitrous oxide, nicknamed "laughing gas," may be used to achieve minimal sedation in combination with a dentist-prescribed oral medication.

Moderate sedation is achieved through medications that may be administered orally or intravenously (IV). Patients electing for moderate sedation are awake throughout the dental procedure and are able to respond to touch and verbal commands. Just as in local anesthesia and minimal sedation, all bodily functions remain normal.

Deep sedation is achieved through administration of dentist-prescribed oral or injected medication in addition to use of gases, such as nitrous oxide. Patients who are deeply sedated are not easily awakened during the dental procedure, but may respond to some stimuli. At deeper levels of this type of sedation, a patient may require breathing assistance.

How Sedation Works:

Patients electing for minimal sedation either inhale nitrous oxide ("laughing gas") through a mask during their appointment or take a dentist-prescribed dosage of a single oral sedative medication. Moderately sedated patients are generally prescribed single-doses of one or more sedating medications, which are orally administered at the outset of the dental appointment; in these instances, patients are to avoid driving while on the medications.

Medications Used for Sedation:

To reach a level of minimal sedation, a mixture of nitrous oxide and oxygen (30-50 percent) may be used, possibly in combination with a minimal does of an anti-anxiety (benzodiazepine) pill. In combination with nitrous gas, it is important that a patient only take one type of drug under minimal sedation.

Moderately sedated patients are also generally administered benzodiazepines. Among the most commonly utilized benzodiazepines are Valium, Halcion, Xanax, and Ativan. Patients who are deeply sedated may receive benzodiazepines combined with opioids.

Advantages and Disadvantages of Sedation:

Minimal and moderate sedation reduce anxiety that may be associated with dental visits, allowing patients to relax during procedures. In addition, the amnesia usually associated with these methods is often viewed favorably by many patients.

However, sedation does pose several disadvantages. In general, minimal sedation cannot be administered to patients with respiratory problems or sensitivities to the class of drugs used in minimal sedation.

Similarly, in moderate sedation, a patient's level of sedation cannot be adjusted without administering additional medications, for some of which a patient may possess sensitivities. In addition, patients undergoing moderate sedation should anticipate the need for supervision following their dental procedure until the effects of the medication(s) have dissipated; this applies to sedation achieved through both oral and intravenous administration.

Intravenous deep sedation requires insertion of a needle into the arm or hand, a necessity likely unfavorable by patients uncomfortable with needles. In addition, rare complications such as hematoma, a localized swelling filled with blood at the site where the needle entered, are possible. Just as in moderate sedation, recovery from the IV-adminstered sedation of deep sedation may not be complete at the end of the dental appointment; in such instances, patients should be prepared to be escorted home by a responsible adult.

Sedation and Safety:

Although sedation is safe, you should talk to your dentist and/or specialist to gain a thorough understanding of how it works and what is expected of you before a dental procedure. Your dentist will conduct a thorough examination of your medical history to ensure safe sedation, and your vital signs will be monitored throughout the entire procedure to confirm that your blood pressure, pulse rate, and blood oxygen levels are normal.