What is Sedation Dentistry?

Sedation dentistry is a common practice among dentists. There are advantages and disadvantages to sedation.  It is always important for you to know the facts so you can make the best decision for yourself.

Sedation dentistry is the practice of using nitrous oxide (Laughing Gas), oral sedation, and IV sedation.  Sedation dentistry is used primarily to relieve the stress and pain of dental procedures.  Your Medical history can help you choose the best for you.  

Tree Types of Dental Sedation

Nitrous Oxide

The most common form of dental sedation is with the use of nitrous oxide, also called laughing gas.  Nitrous oxide is used with a blend of oxygen.  Nitrous oxide is administered by placing a mask over your nose and/or mouth and by the patient starting to take deep breaths.  The laughing gas starts to work very quickly.  Patients report a calming effect and may feel “giggly”.  Many dental patients have phobias to dental procedures.  Using laughing gas can help you relax while the dentist is performing your dental procedure.  Nitrous oxide is safe for children and adults.  When using nitrous oxide the patient will remain awake and aware during their procedure.

Laughing gas is quick to start working and it is also quick to wear off.  Many patients report that they are able to drive home after their procedure or return to work.  Children that have used nitrous oxide for a dental procedure should also be able to return to school.

Nitrous oxide can be used for all dental procedures from typical teeth cleanings to root canals and more.  Laughing gas alone will not be enough to prevent pain during your dental procedure.  You will still need the help of a local anesthetic to numb a tooth that needs a filling.

Oral Sedation

Oral sedation is also called “conscious sedation”.  Oral sedation requires you to take prescribed medication before your procedure.  This oral dose may be taken the night before your procedure or maybe as little as one hour before your procedure.  Oral sedation will make you feel drowsy or sleepy.  It is likely that you will have to fast for several hours before your dental procedure.  This is why many patients prefer to have their dental procedures that use oral sedation done in the morning.  

During your dental procedure using oral sedation, it is possible for you to fall asleep.  But you don’t have to worry.  It is easy for the dentist or dental assistant to awaken you in order for you to comply with simple commands.  An example of a simple command can be as easy as tilting your head to one side to give the dentist the access needed for a particular area of the mouth.  Most patients report after the procedure that they remember nothing or very little from their procedure.  

While under oral sedation you may be attached to monitors for your heart rate, breathing, and blood pressure.  The effects of the sedation will leave you feeling sleepy.  You will not be able to drive yourself home after your procedure and if your child is having a dental procedure using oral sedation they will not be able to return to school.      

IV (intravenous) Sedation

There are two types of IV sedation.  The first type of IV sedation is referred to as “twilight”.  This is when you are in the dental chair and your dentist or dental professional inserts an IV into your arm.  The IV will be used to insert medications into your body like pain medicine, steroids, or anti-inflammatories.  While under IV sedation the dentist will monitor your pulse, breathing, blood pressure, and other vital signs throughout your procedure.  

During this IV sedation, you are conscious but are not overly aware of your surroundings.  Much like the oral sedation, you will likely not remember much from your dental procedure.  Also, like oral sedation, you will be able to respond to simple commands from your dentist or dental assistant. 

The second type of IV sedation is general anesthesia.  This procedure is uncommon for performing dental procedures.  This type of procedure will need to be administered in a hospital or a specialized clinic.  A nurse anesthetist or an anesthesiologist will be administering your sedative and monitoring your vital signs.

General anesthesia will render you totally unconscious.  Patients that generally need general anesthesia are usually those that are in need of significant oral surgery or suffer from severe dental phobia or those that may have trouble following directions.  Many times these are our loved ones with special needs.  

This type of sedation is the same type of sedation used with the surgical removal of the tonsils.  Like oral sedation, it is likely that the patient will need to fast by going without eating or drinking after midnight the day before the procedure.

What Dentists Are Allowed to Give Sedation? 

Nitrous oxide or oral pill sedation is allowed to be administered by almost all dentists.  It is best to check with your dentist if you wish to have dental sedation.  The types of dentists that are usually certified for general anesthesia or deep sedation are oral and maxillofacial surgeons and dentist anesthesiologists.  The dental board in each state heavily regulates the use of sedation techniques.  In addition, states may require dentists to have permits in order to perform sedation.  

What Happens During Sedation Dentistry?

During sedation dentistry, you will be monitored the entire time you are sedated.  The medications you receive will put you in a relaxed state.  With nitrous oxide and oral medications, you will be in a semi-conscious state.  You will be able to reply and respond to simple commands from your dentist or dental assistant.  You will be able to breathe on your own, unlike if you were undergoing major surgery.  You will likely not remember anything from your dental procedure and certainly will not experience any pain.    

Does Sedation Put You to Sleep?

Dental sedation doesn’t put you to sleep, but it certainly relaxes you and sleep is a possibility.  Even though you are not asleep, the likelihood of you remembering anything from your procedure is low.  If you do fall asleep don’t worry, you will still be responsive to your dentist’s requests.  For example, your dentist may request for you to move so they can gain access to a different part of your mouth.  You will be able to respond to these simple requests, but it is not likely you will remember any of them.     

How Much Does Sedation Dentistry Cost?

Dental sedation is usually charged by the hour.  Nitrous oxide or laughing gas costs in the area of $100 to $150 for the first hour.  If you are needing to be sedated for more than an hour, then most dentists will charge you in 15-minute increments.  Each 15-minute increment for nitrous oxide sedation will be in the range of $25 to $50 per 15 minutes.  

Intravenous IV sedation is a lot higher than nitrous oxide sedation.  IV deep sedation dentistry usually ranges in the are of $300 to $1000 per hour.  This depends on the complexity of the dental procedures being performed.  When complex dental procedures are being performed sometimes the dentist may group the dental procedures and the IV sedation into one price.  For example, the case of having multiple implants and extractions at the same time may result in pricing that includes the dental work and the IV sedation.

Oral Conscious Sedation is generally in the range of $500 per hour.  Because of the cost of oral conscious sedation, most patients will choose to have IV sedation.  Another reason to opt for IV sedation over oral sedation is IV sedation is much more predictable and safer than oral sedation.  

How Long Does Sedation Last?

Nitrous oxide sedation only takes a few moments to take effect.  Nitrous oxide sedation will last as long as the gas is flowing.  There are no long-lasting effects with nitrous oxide.  When the gas stops the patient will return to normal in only a few minutes.

Oral sedation and IV sedation last much longer than nitrous oxide gas. They can last from about two hours to up to eight hours.  Also “coming out” of these types of sedation takes a long time and the patient certainly will not be able to drive themselves home. 

Here is a list of the types of oral sedation medications:

• Valium
• Sonata
• Versed
• Galcion
• Ativan

Who Needs Sedation Dentistry and Why

Those that will benefit from sedation dentistry are multiple people.  The number one candidate for dental sedation is those that have a high fear or anxiety of dental procedures.  Those that have high anxiety also tend to need the most dental work.

Here are some other types of people and why to choose dental sedation.

1. Those that find it difficult to sit still for at least a limited amount of time.
2. Patients that need to overcome fear & anxiety.
3. Patients that have had a bad experience with dental work in the past.
4. Those that have a low threshold of pain.
5. Using dental sedation makes treatment much easier for the patient.
6. Those that have a small mouth that becomes sore during dental work.
7. Can finish extensive dental in fewer appointments.
8. Patients that have a hyperactive gag reflex.
9. Patients that are in need of a lot of dental work can have it all done at once.
10. The need to feel comfortable.  
11. Those that are allergic or resistant to local anesthetic.

Will You Benefit From Sedation Dentistry?

If any of the above describes you, then you might be the right candidate for dental sedation procedures.  Especially if you are putting off dental work because of the fear and anxiety you have of going to the dentist.  If you are delaying dental work for any of these reasons or others you should probably seek out the services of a sedation dentist.  If you have read any of our other blogs you know that our overall health really starts with our mouths.  How we take care of our mouth is as important or more important than our other health care routines. 

What Are the Risks of Dental Sedation?

The risks of dental sedation are very low.  But much like being malled to death by your golden retriever, the risks are never zero.  Dental sedation risks do arise from those that are taking certain medications or using a substance that depresses the central nervous system.  Examples can be narcotic pain relievers and alcohol.  Using these types of drugs or alcohol can greatly intensify the effects of sedation.  This can also lead to the slowing of breathing to dangerously low levels.  In extreme cases, this can stop respiratory functions altogether.  Obesity and obstructive sleep apnea can also lead to dangerous complications from sedation.  It is very important you communicate with your dentist the medications you are currently taking and how often you use drugs and alcohol.  

Here is a list you and your dentist should go over.

• Make sure you and your dentist talk about your medication history.  Your dentist should be making sure your overall health is well enough for sedation.
• Go over any current medications you are taking.  Also, have a candid chat about drug and alcohol use if it applies to you.
• You should ask if the sedative procedure they will be performing is recommended by the Food and Drug Administration (FDA).  Also, ask what dose of the sedative(s) you will be taking.
• Go over the amount of training your dentist has in these types of procedures.  Just having a conversation will give you a better idea of your dentist’s qualifications.  It is highly likely your dentist will have performed many of these procedures.  Just having your dentist talk about their experience should help put your mind more at ease for your procedure.
• Go over the form your dentist provides that outline the risks of your procedure.  This is an excellent opportunity to ask any additional questions and get clarification of anything on the form you don’t understand.
• Make sure your dentist will be monitoring your vital signs during your procedure.  Your dentist should be following the guidelines laid out by the American Dental Association.  The dentist should have present artificial ventilation, oxygen, and drugs to quickly reverse the effects of sedation.