Sedation Dentistry

I have been hearing sedation dentistry advertised to death by dentists lately. So, I think it is time to address this emerging phenomenon. Let's answer 3 key questions: 1. What are the various levels and methods of sedation? 2. Who needs/wants sedation? 3. Why are dentists advertising general anesthesia?

1. There are varying levels of sedation. Local anesthesia blocks action potentials in nerve fibers so that pain cannot be felt during treatment. Dentists typically use amide anesthetics (e.g. 2% Lidocaine with 1/100,000 epinephrine, 4% Articaine with 1/100,000 epinephrine). These are effective at blocking pain for most procedures including root canals and extractions, except when an infection is present. Nitrous oxide is a form of inhaled anesthesia effective for reducing anxiety in patients with minimal anxiety. It gives patients a sense of euphoria, setting in quickly and dissipating quickly with the administration of pure oxygen. For moderate anxiety, orally-administered conscious sedation is an effective tool for reducing anxiety in patients, who might otherwise avoid dental work. Agents frequently used for conscious sedation are midazolam, diazepam, and triazolam (all members of the benzodiapine family). These drugs can be administered safely for a wide range of patients, and the patient stays awake, reducing the risk of oxygen desaturation when properly monitored with NIBP (non-invasive blood pressure) and pulse oximetry. The key to conscious sedation is that you are able to maintain your own airway. IV sedation is a drug delivery method; it can be used to take a person into a state of conscious sedation or deeper into general anesthesia. General anesthesia is used for patients who are severely anxious, and who otherwise could not tolerate dentistry. It is most appropriate for cases where a person cannot tolerate the procedure (e.g. wisdom teeth removal when the patient does not want to feel anything).

At McFarlane Dental, we offer local anesthesia, nitrous oxide, and conscious sedation to improve patient comfort and procedural success.

2. Sedation benefits anxious patients by helping them get the care they need and want without the looming sense of doubt and concern that might otherwise paralyze them from moving forward.

3. I saw an ad by a dentist advertising the slogan, "You sleep while I work." So, from the methods described above, the only reasonable conclusion I could draw is that he or she is promoting the idea that general anesthesia is the go-to solution for dentistry. A 1: 200,000 mortality rate (associated with general anesthesia) is low, but not zero. I would like to try conscious sedation on those patients before turning straight to general anesthesia. If you have been put under general anesthesia for other surgeries, then you know that a medically induced coma is not akin to a good night's rest. I think given the risk to reward ratio, you will see other medical practices adopt the middle road of conscious sedation. [This pubmed article shows that this shift in thinking is already underway.] For most patients, effective local anesthetic that completely blocks pain is enough. For many patients, they need from medication to undergo a dental procedure. For some patients, they need general anesthetia, but conscious sedation is the gold standard to try first.