Sedation Dentistry

Why is Sedation Sometimes Recommended at the Dental Office?

To make your dental visit as comfortable as possible, Dr. Skoretz may suggest anesthesia to reduce or eliminate any pain or anxiety that may be related to your dental treatment. The type of anesthesia required for any dental procedure depends on the needs or preferences of the patient.

How do I know if I'm a Candidate for Dental Anesthesia?

You and Dr. Skoretz will decide what level of anesthesia is right for you. Some patients prefer a higher level of anesthesia than others. Children, people with special needs, and those with a condition such as a dental phobia may require a higher level of anesthesia. The type of anesthesia administered by your dentist is more dependent on individual patient preferences than specific dental procedures.

The Facts on Sedation/Anesthesia

Sedation allows dentists to create a state of relaxation and thus manage the fear and pain patients may experience during dental procedures. There are several different types of sedation in dentistry.

• Local anesthesia is administered by injecting medication into tissue or by applying a medication topically to an area to eliminate sensation. Topical anesthetics are frequently used by Dr Skoretz to numb an area in preparation for administering an injectable local anesthetic. Injectable local anesthetics, such as lidocaine, numb mouth tissues in a specific area for a short period of time. Dr. Skoretz will probably inject a local anesthetic before filling cavities, preparing your teeth for crowns or for any surgical procedure. Local anesthesia is the most commonly used form of anesthesia in the dental office.
• Minimal sedation is used most frequently in dentistry and usually involves taking medications orally. Conscious sedation can be used to help you relax during a dental procedure. Dr. Skoretz may administer an anti-anxiety agent, such as nitrous oxide, or a sedative, in combination with a local anesthetic for pain. During conscious sedation, you will remain calm during treatment, yet rational and responsive to speech and touch. Antianxiety agents and sedatives can be administered by mouth, inhalation or injection.
• Moderate sedation is achieved by using medications that can be taken orally or intravenously. Patients who undergo moderate sedation are awake and respond to touch and/or verbal commands. All bodily functions remain normal, and the patient does not need assistance breathing.
• Deep sedation can be achieved by injecting medication, giving oral medications, and in combination with gases. Patients who are deeply sedated are not easily awakened but may respond to some stimulation. Patients may need some breathing assistance at deeper levels. Deep sedation and general anesthesia are used for complex procedures and for patients who have trouble controlling their movements or need a deeper level of anesthesia during treatment. During deep sedation you will be unable to respond appropriately to verbal commands. During general anesthesia you will be unconscious.

What Medications are Involved?

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 dose of an anti-anxiety (benzodiazepine) pill. In combination with nitrous gas, it is important that patients take only one type of drug under minimal sedation.

Moderately sedated patients also generally take benzodiazepines. The most common benzodiazepines prescribed by dentists include Valium®, Halcion, Xanax,and Ativan. Patients who are deeply sedated may receive benzodiazepines combined with opioids.

Is Sedation Safe?

Sedation is safe although you should talk to Dr. Skoretz and/or the specialist and gain a thorough understanding of how it works and what is expected of you before the procedure. Your medical history will be examined comprehensively 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.

How Does Sedation Work?

Patients who are minimally sedated inhale nitrous oxide through a mask during their dental appointment and/or may take a recommended dosage of a single oral sedative medication. Moderately sedated patients generally have taken a medication or a combination of medications while in the dental office. The medication causes the patient to become sleepy and feel relaxed. The dentist will give the patient specific instructions and you will be asked to avoid driving while you are on the medications.

Pro's and Con's of Sedation

Minimal and moderate sedation reduce anxiety that is typically associated with dentistry and allow the patient to relax. The amnesia usually associated with these methods also is a plus for many patients. However, sedation in dentistry does have disadvantages. Minimal sedation usually cannot be administered to patients with respiratory problems like emphysema or asthma or those who are sensitive to the class of drugs used for minimal sedation.

With moderate sedation, the level of sedation cannot be adjusted without administering additional medications and sensitivity to certain medications can be a factor. Also, the patient should be prepared for supervision after the dental visit until the effects of the medications have passed. This applies to sedation administered both orally and intravenously.

With intravenous deep sedation, a needle has to be put in the arm or hand, so it may not be the most relaxing method if you are afraid of needles. It is possible to experience complications, such as hematoma (a localized swelling filled with blood) at the site where the needle entered. In addition, recovery from IV-administered or oral medications may not be complete at the end of dental treatment, so the patient should be prepared to be escorted home by a responsible adult.

What Should I Tell Before Treatmemt

Dr. Skoretz needs to know about all the medications that you are taking, any allergic reactions you've had to medicines in the past, and your past and present health conditions. It's important that you answer his questions completely and ask about your concerns. This way he will be sure to tell you everything you need to know before receiving treatment. For example, in some cases, your anesthesia treatment may require that you suspend certain medications or abstain from eating or drinking for a period of time before the treatment.