Nitrous oxide inhalation sedation is the most known sedation technique, but today several other types of sedation dentistry are available for patients seeking a more comfortable and relaxed experience during dental treatment. You may take advantage of conscious sedation methods such as inhalation, oral, or intravenous sedation, or to opt for non-conscious sedation (general anesthesia) if you do not want to feel or remember anything from the procedure.
The first major distinction between the available types of dental sedation refers to the state of consciousness that the patient maintains throughout the dental procedure.
In conscious sedation methods the patient maintains an adequate level of consciousness so that he/she remains responsive to physical stimulation or verbal commands during the procedure and retains the protective reflexes and the ability to breathe without external assistance. The drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely.
In non-conscious sedation, mostly known as General Anesthesia, the patient is in a deep state of sleep, unconscious and unresponsive. While conscious sedation also provides some degree of amnesia, with general anesthesia the patient is completely unaware of what is happening and does not remember anything of the unpleasant dental procedures performed under GA.
The different types of conscious sedation dentistry can be categorized either by the different levels of sedation provided (minimal, light, moderate, or deep sedation), or by the way the sedative drug is administered to the patient. Based on the drug delivery method, the main forms of dental sedation include inhalation sedation, oral sedation, and intravenous sedation.
Inhalation sedation, also known as nitrous oxide sedation, is historically the most widely used dental sedation technique by dentists. Over 1 in 3 dentists in USA offers nitrous oxide as a method for patient relaxation. The patient breathes a mixture of nitrous oxide (N20) and oxygen through a nasal mask. The gas causes an euphoric effect (for this res is often referred as laughing gas) which not only relaxes the patient within a few seconds but also provides some analgesic effect.
The main benefits of nitrous oxide are that the level of sedation can be constantly regulated, it has very few side effects, and recovery is fast. It is the only sedation method that the patient is allowed to drive home after the procedure on his own and resume normal activities immediately. Inhalation conscious sedation is the safest and most preferred method for light to mild sedation, highly effective for patients with mild to moderate degrees of dental anxiety, and for short routine dental procedures.
Oral sedation is another popular method of dental relaxation, mainly due to the easiness of administration. The patient is given a sedative pill to take by the mouth the night before the appointment or/and few hours prior to the dental visit. By the time of the appointment, the patient is in a relaxed state and remains calm and free of anxiety during the procedure. Since the patient is already under the effect of the medication on his way to the dental office, for safety reasons someone else must drive him to the dentist.
Full recovery from oral sedation may take several hours; therefore an escort is also required to drive the patient home. Possible side effects include nausea and vomiting.
Oral sedation is an effective and low cost relaxation technique which is most suitable for the management of light to mild degrees of dental anxiety. The main disadvantage of oral conscious sedation is the difficulty to accurately control and maintain the required level of sedation, due to the delayed effect of the sedative drugs and the significant variation in their efficacy on different patients. The level of sedation cannot be increased or decreased quickly, reducing the flexibility regarding the duration of the treatment. Oral sedatives do not have analgesic action, so an injection of local anesthetic is still required for pain control.
Intravenous Conscious Sedation Dentistry, or simply IV sedation, is the most powerful method of conscious sedation for management of moderate to more severe levels of dental anxiety. The sedative drugs along with analgesics are administered directly into the bloodstream through a vein, producing deep relaxation, pain relief and partial amnesia. A needle must be initially placed into a vein; therefore patients with needle phobia may not be such comfortable with this method.
Intravenous sedation takes effect almost instantaneously and the dentist can control and fine tune the level and length of sedation by regulating the flow of the sedative drug into the vein. Continuous monitoring of breathing (pulse oximeter), blood pressure and heart rate are required for patient’s safety. Recovery after IV sedation is usually quick and with limited side effects. However, same as with oral sedation you will still need someone to drive you home following the procedure.
IV sedation dentistry is an advanced technique which is available only by a limited number of dentists (mostly by oral surgeons), due to the advanced and lengthy training required for the dentists and the strict certification regulations. For this reason and because of the cost of the extra equipment and staff needed for patient monitoring, it is much more expensive than other types of sedation dentistry such as inhalation or oral sedation. IV sedation is usually the recommended method of conscious sedation for long and invasive dental procedures.
Intramuscular conscious sedation is a less commonly used type of sedation. It is more often employed in the management of fearful children. The sedative drug is injected into the muscle of the upper arm or the thigh, producing sedation in approximately 20 to 30 minutes.
For some lengthy and very invasive dental procedures such as multiple or/and surgical tooth extractions, or the placement of several implants, or extensive oral surgery, the conscious sedation may not provide the deeper level of sedation required for the patient to be comfortable. Additionally, some patient groups with severe dental phobia or certain pathological conditions, e.g. with Parkinson’s disease that affects movement control, may need deep sedation to make possible for the dentist to perform the procedure.
Deep sedation, when the patient is completely unconscious, is known as ‘General Anesthesia’. The patient is unresponsive, immobilized, and breathing assistance is required. It is the only type of sedation dentistry that can be considered as ‘sleep dentistry’.
General anesthesia can only be administered by a highly trained professional with at least 2 years of training who is an anesthesiologist, dental anesthesiologist or an oral surgeon. The procedure is usually performed in a hospital environment. Due to the high cost of General Anesthesia and the increased risks involved, it is reserved as a last option for patients who are not suitable candidates for any type of conscious sedation dentistry.