Oral Sedatives
Oral Sedation Dentistry medications

Oral Sedatives

Oral sedatives are drugs which are used to offer a state of relaxation and comfort to patients during dental treatments, by utilizing oral conscious sedation techniques. The choice of the appropriate oral sedation medicine for each patient from the list of available oral sedatives is very important for maximizing the effectiveness and safety of the procedure.

Oral Sedatives characteristics


Oral sedation is a technique that is used in dentistry to reduce the fear and anxiety people have about dental treatment, and the side effects and consequences of avoiding dental treatment. A variety of different types of oral sedatives and anxiolytic medications have been developed over the years. Each of the drugs used today by oral sedation dentists has been under rigorous research and testing, having demonstrated a long safety record after many years of usage. However, each oral sedation medication (or family of drugs) has some specific characteristics that have to be considered before it is selected to be used in an oral sedation procedure.

Although all oral sedatives can offer the expected anti-anxiety effect in some degree, their pharmacokinetic properties may differ significantly. The main differences between oral sedation medications that play an important role for their selection in each case include:

  • anti-anxiety effectiveness
  • amnesic properties
  • duration of effect
  • contra-indication for certain health conditions or other drugs
  • risk and severity of potential complications
  • drug's half-life (how long it remains in the body)

How dentists select oral sedatives?

The oral sedation dentist will decide the most suitable oral sedative drug by evaluating its characteristics in combination with the specific requirements of the specific patient and dental treatment, including:

  • Patient’s health status, medical history and medicine usage – in order to exclude oral sedatives which may be contra-indicated due to possible side-effects.
  • Patient’s level of anxiety (mild, moderate or severe) – is oral conscious sedation needed or anxiolysis is enough?
  • Invasiveness of the planned dental treatments – amnesic effect is highly desired to prevent developing dental fear for next appointments.
  • Expected duration of the treatment – which must be covered by the amount of time that the oral sedation medicine is adequately effective.

Another important factor in the selection of an oral sedative is the experience and familiarity of the dentist in using the specific drug.

How oral sedation medications are used?

Oral sedation dentistry medicines are taken by mouth either as a pill or a liquid. The patient must take the sedative around 1 hour before the appointment, so that minimal to moderate sedation is induced by the time the treatment will start. In some cases an oral sedative may be used on the night before treatment to help the patient get a good and undisturbed sleep. An incremental dose of the oral sedative may also be administered at the dental office immediately before the appointment and/or during treatments to ensure that a patient’s comfort level is maintained in case of very long dental procedures.

Types of oral sedatives

The medications that could be used for oral sedation procedures belong to the following groups of drugs:

  • Benzodiazepines (Valium®, Halcion®, Ativan®, and Versed®)
  • Non-benzodiazepine GABA agonists (Ambien® and Sonata®)
  • Antihistamines (Vistaril®, Atarax®, Benadryl®, and Phenergan®)
  • Barbiturates
  • Herbal alternatives
  • Chloral hydrate

Deep understanding of the differences between the various sedative drugs is important for the sedation dentist to select the right drug at the right dose for the right patient and for the right procedure.

Benzodiazepines

Benzodiazepines are the category of oral sedation medicines that is most commonly used today. They are prescribed for the treatment of anxiety, insomnia, agitation, seizures, and muscle spasms.

Benzodiazepines are very effective in decreasing anxiety by promoting the binding of the major inhibitory neurotransmitter, gamma-amino butyric acid (GABA) with its receptors in the brain which results in the Central Nervous System becoming less responsive to excitatory stimuli. The final benefit is that the patient becomes relaxed and more co-operative during dental treatment.

In addition several benzodiazepines have an interesting side-effect which is currently considered as a significant advantage over other types of oral sedatives. Many of them have “amnesic” properties, meaning that patients will remember little to nothing after the end of the oral sedation procedure.

Barbiturates

Barbiturates are also generalized CNS depressants with sedative action, but they are rarely used today for oral sedation due to the increased risk of complications. Compared to benzodiazepines, barbiturates have a much narrower margin of safety. their effectiveness is greatly increased when taken concurrently with other CNS depressants or alcohol, so that it's much easier to overdose, which can cause dangerous depression of the respiratory or/and cardiovascular action, resulting in coma or even death. Due to the safety concerns and their addictive properties, barbiturates are not recommended any more as oral sedatives.

Antihistamines

Antihistamines are primarily used to manage allergies, but some of them such as Hydroxyzine or Promethazine can also cause sedation as a side effect. However, their sedative efficacy is generally less than that of benzodiazepines.

Chloral hydrate

Chloral hydrate was the first oral sedative acting as a generalized CNS depressant, synthesized in 1832. In recent years chloral hydrate has been the form of oral sedation used primarily for young children and infants. However, many pediatric sedation dentists have replaced chloral hydrate with midazolam (Versed) which is also in liquid form for easier administration to children mixed with water or fruit juice. Oral sedation effects in children are more intense, therefore constant monitoring is necessary.

Homeopathic sedatives - Herbal alternatives

Patients, who are concerned about using oral sedation medication, can seek for homeopathic sedation if they want to be relaxed during their dental appointments, using one of the homeopathic sedation remedies. You will have to find a homeopathic dentist who will recommend the right remedy for your case.

next page -> Common Oral Sedation Medications

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