Inhalation Sedation by Nitrous Oxide
Nitrous oxide – laughing gas
Nitrous oxide sedation is a very safe and it is best utilized for patients with very mild degree of dental fear and anxiety. Patients are generally able to carry out normal daily functions (i.e. driving home or going to work) after their dental appointment. Only a few minutes of oxygen breathing is required for recovery.
What is nitrous oxide “laughing gas”?
Sometimes this method of sedation is referred to as “inhalation sedation”. A mixture of oxygen and nitrous oxide gas is inhaled via a mask until the desired level of sedation is achieved. Nitrous oxide is considered the mildest dental sedation method.
How do you feel under nitrous oxide “laughing gas”?
The feeling that you experience is euphoric mild relaxation. You are aware of your surroundings, you are not sleeping and your senses although altered are active.
What are the limitations of nitrous oxide sedation?
Nitrous oxide sedation is very mild. It tends to provide better and deeper level of sedation on children than adults. When utilized on adults, nitrous oxide is reserved for patients with very mild dental anxiety.
Oral Dental Sedation
What is oral dental sedation?
Oral dental sedation refers to utilizing an oral sedative in the form of a pill. Usually a benzodiazepine like Halcion (Triazolam) taken one hour prior to the procedure. The oral sedative is usually taken at the office under pulse oximetery monitoring that measures pulse, blood pressure and level of oxygen in the body (oxygen saturation) periodically.
How do you feel under oral dental sedation?
Oral sedation provides a deeper sense of relaxation and sedation than nitrous oxide depending on the dosage of oral sedative given. In addition, Halcion which is considered the most common and effective oral sedative can provide amnesic effect during sedation. You may or may not sleep during oral sedation; in either case you can be awakened and responsive to verbal instructions under this type of sedation. Oral sedation is best utilized in patients with mild to moderate dental anxiety. There is a delayed recovery period up to 5 hours. The patient undergoing oral sedation must be accompanied by an escort to drive them home.
What are the limitations of oral dental sedation?
Generally the oral sedative is given to the patient and then they will wait in the treatment room for 45-60 minutes until the sedative takes effect. This period of delay makes it very difficult to predict the level of sedation because most patients are given a standard dose and we all respond differently to medications. There can be the tendency to under and over sedate.
IV (Intravenous) Dental Sedation
What is IV “intravenous” dental sedation?
IV dental sedation is a sedation type where the sedative is introduced to your body through your veins, also known as the intravenous route. The sedative is titrated or “mixed with saline” to increase the margin of safety. There are several IV sedative drugs used but Versed (Midazolam) and Fentanyl (Sublimaze) are the most commonly used drugs for dental IV sedation.
How is IV dental sedation used?
IV Sedation can be utilized for patients with mild to severe dental anxiety. With IV sedation, the level of sedation is readily and easily controlled and customized by your dentist in real time. This immediate ability to control and customize the level of sedation makes IV sedation safer and much more effective than oral sedation method. The amount of sedative is titrated to the desired effect which can be achieved within minutes. An escort is required to drive the patient home and there is a delayed recovery period for up to 5 hours or more depending on IV sedatives used. With IV sedation, anti-inflammatory and pain medication can easily be given since the IV route is available which translates to a much more comfortable recovery especially if surgery was part of the dental treatment provided under sedation.
How do you feel under IV sedation?
IV Sedation can provide a deeper feeling of relaxation and sedation particularly when your dentist is licensed to provide deep sedation. You are more likely to sleep under IV sedation, however, you can be awakened and responsive to verbal instructions. IV dental sedation is much more effective than oral sedation due to the higher margin of safety and the ability to control the level of sedation.
What are the limitations of IV sedation?
It can difficult to obtain IV access on certain patients (i.e. patients with an extreme phobia of needles, developmentally challenged patients, etc.). In such cases an anti-anxiety drug may be given prior to dental appointment or the sedation may start as oral sedation then the IV access can be obtained once the patients sedated. In some situations, general anesthesia may be utilized with a general anesthesia specialist “Anesthesiologist”.
General anesthesia in the dental office
General anesthesia is a state of sedation where the patient is completely unconscious and unresponsive. In a dental setting this level of sedation is usually reserved for developmentally challenged and severe needle phobic patients with severe dental anxiety. This sedation method must be administered by a licensed anesthesiologist and can be provided at our office.