Sedation Dentistry

Millions of people every year—including many in the Somerville area--avoid the annual dental check-up. Why is that? For the most part, people are afraid of dental procedures because they can occasionally be uncomfortable or painful. It is now quite common to see advertisements or signs in and around the Somerville-area that indicate a dental office provides "sedation dentistry" or "sleep dentistry", and this is intended specifically for these patients.

Both sedation dentistry and sleep dentistry are used to describe the same procedure, though "sleep" isn’t quite right. The use of sedation dentistry may render a person asleep, but it is not the same type of sleep experienced by a person under general anaesthetic (like that used for removal of tonsils or an appendix).

Depending on the extent of the dental treatment involved a dental practitioner can choose from one of three types of sedatives: oral sedation, intravenous or IV sedation and inhalation sedation (nitrous oxide). A patient with a bout of nerves may only require an oral sedative, but someone undergoing more extensive treatment and does not want to recall anything about the procedure (eg: wisdom teeth extraction) might need intravenous sedation.

With intravenous sedation, a sedative is injected into the patient’s bloodstream, inducing what is called a "twilight sleep". The patient is often so relaxed with the IV sedation that they may fall into a light sleep, and the patient will not remember anything about the procedure. IV sedation causes patients to lose track of time, and procedures that in fact took nearly an hour might feel like they happened in a matter of a few minutes.

What are the disadvantages of IV sedation? IV sedation involves the use of a needle to inject the sedative into the arm or back of the hand, which some patients are afraid of. IV sedation does not address the issue of pain, so it is standard procedure for Somerville dentists to "freeze" the area with a numbing agent. The freezing agent is normally administered after the patient has been sedated, but its effects will last for quite a while after the procedure has been completed.

Somerville patients planning to be sedated will need to be driven home by an adult because they will not be allowed to drive for at least 18-24 hours following the procedure, and they will need to rest for the rest of the day.

The next method of sedation, "inhalation sedation", involves inhaling a mixture of nitrous oxide and pure oxygen, commonly called, “nitrous.” The normal dosage is thirty percent nitrous oxide and the rest oxygen.

Nitrous oxide is inhaled through a nasal hood or mask that fits over the nose, or through nasal prongs (cannula) that are inserted into the nose. It only takes about twenty to thirty seconds for the patient to feel the effects of the nitrous oxide.

The greatest advantage of inhalation sedation is the fact that it can be raised or lowered by the dentist, as needed, and the sedation wears off shortly after the mask is taken away. Since oxygen is included in the sedative cocktail, it can be used throughout the duration of the dental treatment and rules out the possibility of the sedative wearing off mid-procedure as sometimes happens with either IV or oral sedation. Additionally, there are no lingering effects of the gas, unlike the common "hangover" feeling from other techniques. A few patients have been known to feel lightheaded when the gas is first administered, but this is only temporary. Patients treated under "nitrous" can be released on their own recognizance since the sedative’s effects diminish almost as soon as inhalation stops.

Does inhalation sedation have any disadvantages? There are few contraindications for the use of inhalation sedation, because those who provide it as a treatment alternative must undergo extensive training, and because there are no known lingering side effects or allergies to the gas. Women in the first trimester of pregnancy can choose this method of sedation, and it presents no danger to anyone with heart, lung, kidney or liver problems.

The final method of sedation dentistry involves the swallowing of oral medications to reduce fear, anxiety or nervousness in the patient. Depending on the procedure and the patient, a sleeping aid or sedative the evening before the dental visit may be ordered.

The oral sedatives commonly used in this method belong to a group called benzodiazepines, or "benzos", and have two main consequences. The first is a feeling of being soothed and perhaps a bit sleepy. They can also make the patient feel free from anxiety and apprehension. The biggest differences between the types of "benzos" used are the areas of the brain targeted by the chemicals, with some inducing a sleep-like state rather than simply an overall sense of calm.

Can anyone use oral sedation? No, because the drugs have a number of side effects and are not appropriate for all patients. Some of these drugs can create problems for patients with liver and heart disease; others can cause allergies or affect the kidney, heart or lungs; and pregnant women should avoid them altogether.

Oral sedatives cannot be fully relied upon to be effective sedatives, because they do not always work for some patients, while they have almost no impact on others.

It is important to remember that all oral sedatives will be through prescription only, because of the strength and potential for addiction. When they have to be taken, the prescribed directions as to dosage and consumption of alcohol must be followed faithfully.

Somerville patients should not be ashamed of being afraid of pain or experiencing panicky reactions when faced with dental treatment. They are realistic reactions to certain situations, and many Somerville-area general and cosmetic dentists have responded to the need of their patients.