Sedation dentistry – overcoming dental fear and pain free dentistry

For over 25 years, we have helped thousands of patients overcome dental fear and anxiety. Dr Justin Tan is certified by  Australian Dental Board to administer intravenous sedation and has undergone extensive training and obtained a postgraduate degree in Sedation and Pain Control with Sydney University. He is highly experienced in all forms of sedation including intravenous sedation, oral sedation and nitrous oxide sedation.

How can sedation help me overcome dental fear and get the treatment I need?

Dental fear is a debilitating condition that affects many adults and children. It can originate from past traumatic dental experiences, physical or sexual abuse. The fear can result in someone not seeking dental treatment or regular check ups leading to untreated decay, gum disease, infection, broken teeth and severe pain.

Dental sedation can take the form of intravenous sedation, oral sedation and nitrous oxide sedation. All forms of sedation work on the central nervous system to produce feelings of calmness, reduce pain and anxiety. Some of the drugs use can also produce amnesia which can be very useful as there is little to no memory of the dental procedures performed. There is also a muscle relaxant effect with most of the sedative drugs used which helps to ease any muscle tension  during and after the procedure.

Dental Sedation is very beneficial for:

• All levels of dental anxiety. The form of sedation will be dictated by the level of anxiety/fear and also the patient’s overall health and treatment needs
• Needle phobia
• Fear of the sound of the drill, fear of dental instruments or the dental environment
• A strong gag reflex
• Complex and long procedures like extractions, wisdom teeth removal, root canal therapy, dental implants, gum and one grafts, deep cleaning and multiple crowns and fillings. Pretty much all dental procedures!
• Sensitive teeth
• Severe dental infection and the inability to numb up the area/tooth
• paediatric dentistry including extraction of baby or permanent teeth, fillings, fissure sealants and root canal therapy.

What forms of sedation are used in dentistry?

Intravenous sedation (IV)

Intravenous sedation involves administering sedative medications into the veins via a cannula inserted in the arm. The patient is sedated but is still conscious and is able to respond to verbal  instructions. Importantly, the patient is able to breath on their own and maintain their airway reflexes. IV sedation is commonly referred to as “sleep” dentistry which is incorrect. If the patient is asleep, they would have achieved a very deep level of sedation or general anaesthesia which is very dangerous in a dental setting. The probable reason most patients feel they have been asleep during procedures because of the IV drug  cause memory loss from the time the drugs are administered till the time the patient is recovered.

The advantages of intravenous sedation are:

• sedation is achieved quickly after administration of the sedative agent.
• the level of sedation can be very predictable compared to other forms of sedation like oral sedation
• the level of sedation can be titrated or adjusted to suit the patient and the procedure being performed. This requires experience so that the patient is not over or under-sedated
• the sedative drugs used have a strong analgesic (pain killing), amnesic (no memory) and muscle relaxant effect. This makes the appointment very comfortable and relaxing for the patient, both during the appointment and after the appointment
• very effective for highly anxious patients and severe gaggers
• Multiple procedures can be achieved including extractions, fillings, crowns, wisdom teeth removal, gum disease treatment and root canal therapy

The disadvantages of intravenous sedation include:

• Need to be fasted at least 6 hours prior to the procedure
• Not suitable for patients who have complex medical problems where a general anaesthesia or nitrous oxide sedation might be a safer option
• Adverse outcomes like apnoea, oversedation, drowsiness post-operatively. These factors can be minimised by careful administration of the sedative agents by an experienced sedationist and proper monitoring of the patient during and after the procedure
• no driving, going to work after the IV procedure for at least 12 to 24 hours after the procedure as the sedatives can affect your judgement and consciousness
• need for a responsible escort to take you home after the procedure

Oral sedation

Oral sedation is normally achieved by administering the sedative drug orally in tablet or syrup form. The most common class of drugs administered are benzodiazepines.

The advantages of oral sedation include:

• relatively cheap and easy to administer orally
• can be very effective in achieving good levels of anxiety control and relaxation in the right patient who is moderate to slightly anxious
• sedation can be achieved 30 to 60 minutes after taking the oral sedative
• the drug used have an amnesic and muscle relaxant effect depending on the dosage administered
• no need for a strict fasting protocol compared to IV sedation

The disadvantages of oral sedation include:

• inconsistent sedation levels in some patients due to variations in your genetic make up, physiology and general health.  it is harder to achieve a consistent and predictable compared to IV sedation
• no driving, going to work after an oral sedative has been administered for at least 12 hours after the procedure as the sedative can affect your judgement and consciousness
• need for a responsible escort to take you home after the procedure

Nitrous Oxide sedation

This is one of the oldest forms of sedation in medicine and dentistry. it is also known as “laughing” gas as  nitrous oxide has the ability to induce euphoria, muscle relaxation and has analgesic properties. Nitrous oxide and oxygen is administered through a mask. Nitrous oxide works quickly and induces a state of relaxation, euphoria and has a small degree of analgesia.

Advantages of nitrous oxide

• Quick acting  and  quick recovery after the nitrous oxide/oxygen mixture is stopped as the gas quickly leaves your body. You can drive and resume normal activities after nitrous oxide sedation
• Excellent for mild anxiety and simpler procedures 
• airway reflexes and consciousness are maintained – good safety record
• suitable for even patients with complex medical problems (subject to a proper medical assessment by the dental sedationist)

Disadvantages of nitrous oxide

• Not usually suitable for moderate to highly anxious patients
• Not effective if you have a respiratory illness, blocked nose and cannot breath through your nose or you are a mouth breather
• occasional nausea and headache/dizziness 

What dental procedures can be done with the help of sedation?

Virtually, all types of dental procedures can be performed when the patient is sedated. We often perform multiple procedures on our very anxious patients so that multiple problems can be addressed in the one visit. There will be instances where multiple visits will be needed due to the complexity of the problems that the patient presents with. Our priority is to keep the sedation procedure safe and comfortable for the patient.

Am I suitable for sedation dentistry?

This can only be answered by the sedationist performing a thorough assessment of the patient’s medical and dental history. As a rule, patients who want to undergo IV sedation will have to be classified as an ASA 1 or ASA2 patient. Generally healthy patients or patients with well controlled medical conditions are deemed suitable. However, we always conduct a thorough assessment of the patient’s physical, medical and dental condition before deciding whether someone is suitable for sedation dentistry. We may sometimes refer you to your GP for management of your medical conditions before proceeding with sedation dentistry, in particular IV sedation. Alternatively, nitrous oxide sedation is generally safe for almost all patients.

If you would like to know whether sedation dentistry can help you overcome your dental fear and anxiety, book an appointment with us today