Sedation Dentistry

Despite the many modern advances in the dental field, some people are still anxious about seeing a dentist. This can stem from many things, however, is often triggered from a bad dental experience as a child. Unfortunately, for those who do feel apprehensive about seeing a dentist, this usually means they delay their visit or even skip their routine dental examinations altogether.

This dentophobia, the fear of dentists, can lead to serious dental health complications, as people often only come in to see a dentist when a dental issue arises and even then it will be after several days, hoping it resolves itself. Small, painless and easy to fix dental issues such as a small cavity can quickly deteriorate and lead to more severe issues such as a rotten tooth. If this occurs then more invasive treatments, such as a root canal or extraction and implant, may be required. Of course, those with dentophobia often know this and the fear of this leads to them staying away even more, creating a cycle of fear.

At CoastWide Smiles Dentalcare, our dental team are very well trained in treating people with dental anxiety and we have helped people with dentophobia, from mild cases to the extreme for years. Sometimes simple changes like breaking down a treatment plan over several shorter visits or even taking breaks during a visit can greatly help. Alternatively, we also offer sedation dentistry to aim in calming down those anxious nerves.

What is sedation dentistry?

When referring to sedation dentistry, people often use the term 'sleep dentistry' interchangeably. Technically, however, in most cases you will not be 'asleep' during the procedures, with the exception of any procedure under general anaesthesia, which is rarely the case.

In most cases, sedation dentistry refers to the use of medication to help relax a patient during a dental procedure. This relaxation is not designed to put you to sleep, however, simply to calm any anxious nerves.

Generally speaking, there are four levels of sedation that can be used, the first three being the most common. These are:

• A minimal level of sedation, whereby you are simply relaxed but fully awake.
• A moderate level of sedation, whereby you may slur your words when speaking and generally not remember the details or much of the procedure generally.
• A deep level of sedation, whereby you are effectively on the edge of consciousness, however, can be quickly awakened if required.
• General anaesthesia, whereby you are completely asleep or unconscious.

Whilst the risks of sedation dentistry are small, we will try to always use the minimal level of sedation required for the procedure required that is needed. It will always be on a case by case assessment, however, things such as the type of procedure to be done, the complications that may arise during the procedure, your medical history and of course your level of anxiety, will all be taken into account.

Can anyone have sedation dentistry?

Generally speaking sedation dentistry is for people who have a fear of dentists or a particular procedure that they require. That being said, sedation dentistry may be appropriate in other scenarios. These cases include:

• When an individual has an extremely low pain threshold.
• The patient cannot sit still in the dental chair, possibly due to another medical condition that may cause involuntary body movements.
• A low gag reflex level which may interfere with the procedure.
• The amount of dental work required is large and complex taking a significant period of time.
• Children who refuse to cooperate during a visit, however, only after full consultation with the legal guardians.

In terms of age groups who can have sedation dentistry, in general everyone from children to the elderly can have some form of sedation. The level and type will come down to a case by case basis.

How does the dental sedation process work?

Dental sedation process is usually undertaken in one of the following four ways, depending on the level of sedation that is required. Arguably the most well-known method is the 'happy gas' or 'laughing gas' method of sedation. This process involves placing a small mask over your nose that delivers a mix of oxygen and nitrous oxide. Inhaling this gas will make you relax fairly quickly, and the level of sedation can be easily controlled by our team during any procedure. The effects of the gas will wear off very quickly once the mask is removed, so much so, that after a short wait in the reception room after the procedure you will be able to drive yourself home. Of all the methods available in sedation dentistry, this is the only one whereby you are able to do this.

The second method by which sedation can be achieved is via an oral dose of medication. The level of sedation that can be achieved is from minimal to moderate depending on the amount taken. Usually this medication will come from the same 'drug family' as Valium, making you feel drowsy, however, still very much awake. If this method is used, you may need to take the dose approximately one hour before the procedure, however, our team will go through the details with you prior to the day. Given that everyone will react differently to different levels of this drug, due to things such as body weight and metabolism rates, it maybe that you actually fall asleep during the procedure. Our team will be checking throughout the process for your consciousness and may wake you up again if you do doze off. This can be simply done by giving you a gentle shake, as the level of sedation will never be high enough to keep you asleep or take you to a 'deep' level of sedation.

Still within the moderate level of sedation, however, on the upper end, IV sedation is another option available. This will involve a sedative drug being administered continuously through your veins. This method will work significantly faster than the oral medication approach and can be adjusted during the procedure. Despite this, we have found that in almost all cases this level of sedation is not required and find that either the 'laughing gas' or oral medication provide sufficient levels of sedation without requiring the added complications of an IV.

To achieve a deeper level of sedation or even total loss of consciousness, stronger medications will be administered. Whilst general anaesthesia for dental procedures is not unheard of, it is rarely used as you will not be able to be woken easily until either the drug wears off or alternatively more medication is administered to reverse the effects. For almost all but the most serious of dental procedures, such as reconstruction surgery and alike, this level of sedation is not preferred nor required.

Finally, we should point out that whether you are minimally sedated or more deeply sedated, the process from there on will be largely the same throughout. By this we mean that local anaesthetics will still be applied where required and the treatment time will be approximately the same. Naturally, additional checks will be undertaken to ensure your safety, so we may monitor things such as your heart rate and blood pressure in addition to the normal process.

Is sedation dentistry safe?

Minimal levels of sedation have almost no risk and are generally considered a 'safe' process in the dental community. Given this, there is generally speaking always going to be some level of sedation that can be administered for everyone. The medication used and the level achieved will vary, however, depending on the individual. Things such as being obese or having obstructive sleep apnea may affect the level of sedation that can be performed.

Rest assured, our professional dental team will always discuss the options with you beforehand and go through your treatment plan with you and your medical history to ensure we maintain the highest level of safety for you.