Oral sedation dentistry is one of the techniques used by modern dentists to help patients who experience anxiety and dental fear in order to get proper dental care.
Oral Sedation involves the administration of sedative drugs taken from the mouth in the form of a pill or liquid, to achieve a state of relaxation and make dental procedures a comfortable experience even for fearful patients.
Oral sedation dentistry is also referred as oral conscious sedation because the patient remains conscious throughout the dental treatment but in a relaxed and anxiety-free condition.
Depending on the dosage of the oral sedation medications, it can be used for achieving different levels of dental sedation, usually light or moderate sedation. Light sedation, also known as anxiolysis, is achieved by using a small dose of a mild oral sedative drug to achieve an elevated state of comfort and relaxation.
Moderate sedation is achieved with higher doses inducing a slightly depressed level of consciousness, but you remain awake being able to breath on your own, retain your reflexes and respond to verbal instructions. It is preferred over light sedation for patients with moderate to high dental anxiety, or for very lengthy and invasive procedures.
Oral sedation dentistry should not be confused with ‘sleep dentistry’ although many dentists insist to advertise it in this way. Sleep dentistry is a form of deeper sedation characterized by depressed consciousness, partial or complete loss of protective reflexes, inability to breath independently and respond to physical stimulation and verbal commands. After an oral sedation procedure the patient may indeed feel like he was sleeping because he has little or no memory of what happened during the appointment, but that happens due to the amnesic effect of the oral sedation medicines, and not because the patient was actually under sleep.
This amnesic effect in combination with the ease of administration are some of the main advantages of oral sedation dentistry. The technique is simple, effective in relieving mild to moderate anxiety and does not require needles. On the other side, oral sedation drugs do not provide any degree of pain relief as does nitrous oxide, the other popular technique of light sedation. Additionally to the lack of analgesic effect, as the main disadvantages of oral sedation are considered the difficulty in predicting and modifying the actual level and length of sedation. If the technique is used properly, the oral sedation side effects are very limited.
Patients who can benefit from oral sedation dentistry are mainly those who continuously postpone, delay or permanently avoid dental treatment because they are afraid of the dentist or dental procedures.
Oral sedation dentistry can be used by almost all patients, but some exceptions do exist. Contra-indications for oral sedation usage include mainly patients with certain health conditions or under certain medications that may interact with the oral sedatives, enhancing their effectiveness and increasing the risk of possible dangerous complications. Combining the oral sedation medicines with alcohol or other sedative drugs can cause even death.
There is a large number of oral sedation medicines available today. Several different types of oral sedatives are used by sedation dentists, but the majority of the oral sedatives belong to the family of benzodiazepines with Valium and Halcion as the most popular. The selection of the appropriate drug for each patient depends on the evaluation of the properties of the specific drug in combination with the characteristics of each patient and treatment. Therefore the dentist must have a detailed medical history before deciding the proper drug and dosage for the patient.
The procedure for oral sedation is much simpler than inhalation sedation (N2O) or intravenous sedation. You only have to take a pill. The sedative must be taken about one hour before the procedure, because there is a delay until it actually causes the desired level of sedation. For this reason you must have a companion to take you to the dental office (and drive you home after it has ended).
Oral sedatives may cause side effects such as the depression of the cardiovascular and respiratory functions, therefore continuous monitoring of the patient’s vital signs is necessary during oral sedation procedures.
Potential risks of oral sedation are mostly related with the possibility of over sedation due to not properly following dosage instructions, or interaction with other drugs or alcohol. Elderly and medically compromised patients may react differently to oral sedatives, therefore the dentist must adjust the dosage accordingly to ensure patient’s safety.