Sedation Dentistry: Introduction and Myths

Not everyone — in fact, it wouldn’t be far off to claim that only some people — look forward to visiting their dentists. The thought of laying down on a dental chair with your mouth open, and having no control over the proceedings can terrify most people. In fact, according to an article entitled Don’t Fear the Dentist as published on WebMD, five to eight percent of Americans “avoid dentists out of fear.” The article tapped Dr. Peter Milgrom of Dental Fears Research Clinic at the University of Washington in Seattle, and he quoted in the article, “A higher percentage, perhaps 20%, experiences enough anxiety that they will go to the dentist only when absolutely necessary.”

This means that a large percentage of the American population has a debilitating—nay, concerning—fear of the dentists, so much so that they would rather suffer toothaches and other oral problems than to go to the dentist. Some of these people have dentophobia, dental anxiety, or dental phobia, from a previous unpleasant experience at the hands of a dentist. For most of them, this fear accompanied them to adulthood. 

Understanding Sedation Dentistry

This is where sedation dentistry comes in handy. As the name suggests, sedation dentistry utilizes sedation or medication that helps patients relax during their dental procedures. It uses different forms of anesthesia, and can be used in both simple and complex procedures. If you are concerned about being asleep while the procedure is going on, however, it is worth pointing out that sedation dentistry does not automatically mean you would have to be asleep during the procedure—although you may very well be, if you are under general anesthesia.

To explain this further, there are four levels of sedation:

1. Minimal sedation – you are awake, fully conscious and aware of what is going on, but relaxed.   
2. Moderate or conscious sedation – a stronger sedative is given to you, where you awake but not fully conscious. There may be instances wherein you do not remember much of the procedure after it has been performed.
3. Deep sedation – you are tethering between conscious and unconscious. However, the dentist can wake you up with a gentle tap.
4. General anesthesia – you are fully asleep or unconscious, and will have no memory of the procedure.

The level of sedation given to patients depends on the severity of the fear of the dentist or the need for it. Likewise, while most dentists are allowed to administer the milder forms of sedation, only a few dentists are allowed to administer deep sedation and general anesthesia. They have to complete the Commission on Dental Accreditation to perform such. If not, then they use the services of an anesthesiologist who is specially trained to give out sedation at appropriate levels for both adults and children.

Myths about sedation dentistry

• Sedation dentistry puts you to sleep.

As explained above, there are varying levels of sedation, which are administered based on the needs of the patient. For example, if the patient is so stressed out by going to the dentist, then the dentist can give him moderate or deep sedation. Likewise, if the patient is just anxious but does not have a strong gag reflex and can withstand staying awake while the procedure is going on, then he can be given a mild sedative. For complex procedures like surgeries or implantation, a patient can have a general anesthetic.

• Sedation dentistry is only given to people who have dental phobias.

This is not true at all. Sedation dentistry is usually administered due to the following reasons:

• The patient is anxious or nervous about the procedure
• The patient cannot stop fidgeting
• The patient has a low pain threshold and cannot withstand the amount of pain associated with the procedure
• The patient has very sensitive teeth that will cause him pain if the procedure is performed without an anesthetic
• The patient has a bad gag reflex and would therefore have difficulty keeping his mouth open during the procedure, as well as make it difficult to perform
• The patient requires a large amount of dental work, such as surgery
  
• Sedation dentistry is only used for complicated dental procedures.

In actuality, a patient is given a sedative based on his or her needs. It can be used for any dental procedure – from the simple, such as a prophylaxis or a regular dental checkup, to the complex, such as a root canal or a surgery. Dentists are giving their patients the choice of whether they want a sedative or not, depending on what would make the procedure more comfortable for them. Likewise, most dentists would actually go out of their way to make sure the patient is comfortable — such as by talking to them before the procedure, understanding the patients’ concerns, soothing their fears, and reassuring them so that the procedures can be performed without a hitch.

• All patients can get sedatives.

Unfortunately, this is not always the case. Pregnant women, patients with medical conditions that can be aggravated or affected by the sedatives, and patients who have high tolerance for the sedatives cannot have sedation dentistry performed on them. However, it is generally safe for most people, and even children can take advantage of this kind of dentistry.

• There is only one kind of a sedative.

This is another statement that, while it may be very popular, is also very false. There are several kinds of sedatives, the most popular of which are:

• Inhaled minimal sedation – patients are given nitrous oxide to help them relax
• Oral sedation – patients are prescribed to take the sedatives at a certain time before the procedure
• IV moderate sedation – patients are given the sedative through an IV, the level of which the dentist can adjust throughout the procedure
• Deep sedation and general anesthesia – This kind of medication is administered through various ways. The medication renders patients unconscious and asleep.
• Local anesthetic – This is applied to the site at the mouth where the dentist is working, so that patients do not feel more discomfort and pain.