Sedation

We aim to provide dental care without fear, pain, or anxiety for our patients.  We use a wide range of techniques to provide the most comfortable dental care possible.  Some patients find that dental care with intravenous anesthesia may be the most comfortable and relaxing solution to their dental problem.

Here we try to answer some of your questions.  If there is something that you would like to know that is not covered by this information please contact the practice.

 

 

 

 

 

 

 

  

 

 

 

 

 

What dental treatments are available under Intravenous Sedation?

We can use sedation techniques for any level of dental treatment from simple hygiene treatment to more advanced surgical procedures and cosmetic dentistry.

 

What is IV (intravenous) sedation?

Conscious sedation is a form of anxiety control that makes treatment more pleasant for the patient.  It is effective, predictable and safe and is the modern alternative to general anaesthesia for most dental procedures.

Sedation Dentistry is an ideal solution for those patients who suffer from dental phobia.  It is used by dentists to perform dental surgery on patients in a stress and worry free way.  It helps many patients overcome their fear of visiting the dentist, as they do not feel the stress and
anxiety that they may usually feel prior to visiting the dentist.

Intravenous sedation (aka “IV sedation”) is the most commonly used form of sedation in adults.  Intravenous Conscious Sedation is where a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment.  Conscious sedation will make you feel sleepy and relaxed.  Most patients can remember little or nothing of the procedure, but it does not affect any part of your memory before the drug is given.

 

What does it feel like?  Will I be asleep?

During IV sedation, you will remain conscious and will be able to understand and respond to requests from your dentist.  After treatment, you may not remember much about what went on.

 

Will it be necessary to be numbed with local anaesthetic, if so will my dentist numb my gums before or after I am sedated?

The drugs used for IV sedation are anti-anxiety drugs, not painkillers.  They will relax you and make you forget what happens, but you will still need a local anaesthetic before treatment begins.

 

If I have a fear of injections how will the anaesthetic be administered?

If you have a fear of injections, administration of the anaesthetic occurs after the IV sedation has fully kicked in.  You will probably be relaxed enough not to worry by this stage.  Before starting any procedure your dentist will wait until the local anaesthetic has taken effect (ie until you are numb).

 

How is IV sedation given?

“Intravenous” means that the drug is administered into a vein.  An extremely thin needle, wrapped up with a soft plastic tube, is put into a vein close to the surface of the skin (either in the arm or in the back of the hand).  The needle is then removed leaving the soft plastic tube in place.  The drugs are administered through the tube.  The tube stays in place throughout the procedure.

 

What drugs are used?

The most commonly used drugs for IV sedation are benzodiazepines.  These are anti-anxiety sedative drugs.  The most commonly used drug for IV sedation is Midazolam, but occasionally Diazepam is used.
Midazolam is the first choice because of its relatively short duration of action (meaning that it will be out of your system faster).

 

Valium is longer acting and a bit “harder” on the veins, so you may feel a burning sensation in your arm/hand when the drug first enters.

 

Diazepam can be mixed with a local anaesthetic solution to make things more comfortable.  The latest IV Diazepam is an emulsion, which is claimed to be easier on the veins.

 

Is it safe?  Are there any contraindications?

IV sedation is extremely safe when carried out under the supervision of a specially trained dentist.  Purely statistically speaking, it is even safer than local anaesthetic on its own.

 

Contraindications include:

  • Pregnancy
  • Known allergy to benzodiazepines
  • Alcohol intoxication
  • CNS depression
  • Some instances of glaucoma

Cautions (relative contraindications) include:

  • Psychosis
  • Impaired lung, kidney or liver function
  • Advanced age
  • Sleep apnoea

 

Heart disease is generally not a contraindication.

 

Inform your dentist if you have been taking benzodiazepines for many years, as your tolerance may be very high.

 

What are the main advantages of IV sedation?

  • IV sedation tends to be the method of choice if you do not want to be aware of the procedure.
  • It allows the patient to visit their dentist without any pre-visit nerves.
  • The dentist is able to complete the course of treatment in fewer visits than would normally be necessary for phobic patients.
  • It is both highly effective and highly reliable.
  • The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging.
  • Unlike General Anaesthesia or Deep Sedation, Conscious IV Sedation does not 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 is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood).

Recovery from IV administered drugs is not complete at the end of dental treatment.  You will need a responsible adult to escort you home.

You should want to be sedated.  If you are unwilling to “let go”, (eg because you are terrified of not being in control) it will be more difficult to be successfully sedated.

 

Can I take Valium tablets or other Benzodiazepines beforehand?

Yes.  If the medication has not been prescribed by your dentist, you must notify him in advance that you will be taking these.

 

What about eating and drinking before sedation?

Your dentist will advise you beforehand whether you are able to eat or drink prior to treatment.

 

Advice for post IV Sedation care:

  • A responsible adult will need to escort you home, either by private car or by taxi.  Do not travel on public transport.
  • An adult must stay with you until you are fully alert.
  • Rest for the remainder of the day.
  • Do not perform any strenuous or hazardous activities.
  • Do not drive a motor vehicle for the rest of the day.
  • Do not eat a heavy meal immediately.  If you are hungry, eat something light (eg liquids and toast).
  • If you experience nausea, lie down for a while or drink a glass of coke.
  • Do not drink alcohol or take medications for the rest of the day, unless you have contacted your dentist first.
  • Take medications as directed by your dentist.
  • If you have any unusual problems, call your dentist.