Oral Sedation Dentistry has become very popular versus other sedation methods mainly due to the ease of administration of the sedative drugs in the form of a pill. However, there are some disadvantages of oral sedation, that may make the method not the most favorable choice for some patients.
The main disadvantage of oral sedation is that it is not an accurately predictable sedation. Since the medications are administered orally, it is not possible to get a consistent level of sedation on every patient. The most important disadvantages of oral sedation method include the following:
Oral sedation can provide excellent relaxation results but it has no pain relief effect. Nitrous oxide sedation (the other of the common relaxation methods) offers adequate pain control for simple procedures, but with oral sedation you will need to take shots of local anesthesia to avoid pain.
Oral sedation can help the majority of patients with mild to moderate levels of fear and anxiety but may be ineffective in patients with higher levels of anxiety.
Most of the common sedative agents used by oral sedation dentists have a latent period of 30-60min, meaning that the full effect of sedation will appear almost an hour after taking the pill. The exact time may also vary from patient to patient. Compared to other sedation methods, it takes much longer to produce sedation through oral (30 minutes to 2 hours) versus nitrous oxide (3-5 minutes) or intravenous sedation (3-10 min).
The exact level of sedation that will be achieved for a given dosage of oral sedative drug can vary significantly between patients. This problem in combination with the long latent period is considered as one of the main disadvantages of oral sedation dentistry. Because the response to each specific drug is unpredictable, the safe recommended dosage is the one that will be safe for the 25% of people who are most susceptible to the drug, so that they won't get an overdose. Unfortunately this means that the 25% who are least susceptible won't get adequate sedation.
Unlike nitrous oxide and IV sedation where the sedation level can be easily controlled and adjusted within a few minutes, this is quite difficult for oral sedation. Although it is possible to provide an additional dose of oral sedative, this increases the risk of overdose, if the initial dose has not already reached its peak effect. You will also have to wait at least 30 minutes for the additional dose to take effect. Reversing the sedative action is also much more difficult with oral sedation.
Due to the unexpected effects that oral sedation might have on the cardiovascular and respiratory functions in case of over-dosage, both must be closely monitored throughout the procedure. This need is greater for not perfectly healthy patients who may be at greater risk of complications or side effects.
Due to the properties and the way of action of oral sedatives, several arrangements must be made prior to the dental appointment:
Oral sedation effects can last for several hours after the end of the treatment, where nitrous oxide and IV sedation can end as quickly as the procedure is done so the patient can return to normal activities immediately. Due to the long recovery time for most of the oral sedatives that may be up to 24 hours, several safety restrictions apply for 24 hours after the oral sedation procedure (e.g. do not drive, operate machinery, undertake positions of responsibility, or take important decisions...)