Oral sedation dentists choose the most suitable oral sedative to use for each patient from a large number of available sedation medicines, based on the individual patient's needs and each drug's specific characteristics. The goal of the dentist is to use the sedative drug that will maximize patient's comfort while maintaining the highest possible level of safety.
Diazepam (Valium®) is the most known drug among oral sedatives and has been the most commonly used oral sedative for many years. The long elimination half-life of diazepam (20–80 hours) is useful for long dental appointments, but it may also contribute to the daytime drowsiness and ‘hangover’ some may experience. It can also be taken on the night previous the treatment day in order to help the patient sleep better and wake up relaxed in the morning. Patients taking diazepam, or other benzodiazepines long term, become tolerant to the drugs and therefore sedating these patients with further benzodiazepines could be difficult.
Triazolam (Halcion®) is well known for the treatment of insomnia and it is one of the most commonly used oral sedation medicine due to its amnesic properties and proven effectiveness. It has a shorter half-life than Valium® and is typically used for shorter appointments. Triazolam possess hypnotic, amnesic, muscle relaxant and sedative properties, reducing anxiety and removing painful memories. Its rapid onset, short duration of action, and fast recovery due to the lack of active metabolites makes it the popular antianxiety medication of oral sedation dentists.
Lorazepam (Ativan®) has an elimination half-life of approximately 10–20 hours which makes it an effective sedative, useful for appointments that are even longer than four hours.
Midazolam (Versed®) has the shortest half-life of all of the benzodiazepines, lasting about an hour, and making it ideal for short appointments or simple procedures. It has the same anxiolytic and amnesic benefits of other benzodiazepines, but is less commonly used because of its duration. Midazolam’s other brand names are Doricum and Hypnovel. It is also used by many pediatric dentists for oral sedation in children and infants. Midazolam is also used as a drug for intravenous sedation.
Zaleplon (Sonata®) is a short-acting, nonbenzodiazepine sedative-hypnotic and it has a similar way of action with Halcion, but due to its very short half life, it is more suitable for short appointments that last less than an hour.
Zolpidem (Ambien®) is another non benzodiazepine oral sedative with similar pharmacokinetic properties as Zaleplon. Its main advantage is that it is not contraindicated in pregnancy or in patients with narrow angle glaucoma; both are advantages over the benzodiazepines.
Hydroxyzine (Atarax, Vistaril) is an antihistamine drug with sedative properties. The incidence of side effects with hydroxyzine is low, but it has no amnesic effects.
|Type||Trade Name||Generic Name||Onset||Peak||Effective
|Half Life (hours)|
|Benzodiazepines||Valium||Diazepam||30-60 min||1-2h||6-8||> 24h|
|Benzodiazepines||Halcion||Triazolam||15-30 min||1 hour||2-3||1.5-5|
|Benzodiazepines||Ativan||Lorazepam||15-45 min||2 hours||6-8||10-20|
|Benzodiazepines||Versed||Midazolam||15-30 min||20-50 min||1||1-3|
|Non-Benzodiazepines||Sonata||Zaleplon||15-30 min||1 hour||1||1-2|
|Non-Benzodiazepines||Ambien||Zolpidem||30 min||1 hour||1||2-3|
|Antihistamines||Atarax||Hydroxyzine||15-30 min||2 hours||3-4|
|Antihistamines||Vistaril||Hydroxyzine||15-30 min||2 hours||3-4|