A vast number of people do not make a single visit to their dentist over the course of a year. Why? People are mostly fearful of any pain or discomfort that may accompany any dental treatment. It is now quite common to see advertisements or signs that indicate a dental office provides “sedation dentistry” or “sleep dentistry”, and this is intended specifically for those who avoid the dentist for the above reasons. Both sedation dentistry and sleep dentistry are used to describe the same procedure, though “sleep” isn’t quite right. Those who choose to have their dental work done while under sedation can be awake or in a light sleep, where they are still in control of their airway and respond to instructions from the dentist. Depending on the extent of the dental treatment involved a dental practitioner can choose from one of three types of sedatives: oral sedation, intravenous or IV sedation and inhalation sedation (nitrous oxide). A patient who wants absolutely no awareness of any part of their office visit may opt for an intravenous (IV) sedation where they often fall into a light sleep, while someone who is just overanxious may opt for an oral sedative.

In the intravenous method of sedation, the sedative is introduced directly into the vein of the patient rendering them into a “twilight sleep”. The patient is technically conscious throughout the procedure, but will not be aware of the experience because the medications relax them. IV sedation causes patients to lose track of time, and procedures that in fact took nearly an hour might feel like they happened in a matter of a few minutes. Is there any downside to IV sedation? Those who avoid dental appointment because of a fear of pain or needles may prefer an alternative treatment to IV sedation since this form of sedation involves use of needles. IV sedation does not address the issue of pain, so a dentist will still need to “freeze” the area with a numbing agent. Most dentists will do this once the patient is sedated, but the effects of the numbing drug won’t wear off until up to several hours after the patient goes home.

IV sedation is not recommended for those who are pregnant, of advanced age, who have allergies to certain sedative medications, or whose lungs, kidneys or liver are not in optimal condition. IV sedation also requires the patient to be accompanied on their visit, because the effects of the drugs do not wear off immediately, and they will need a family member or friend to drive them home where they must rest for the remainder of the day. The next method of sedation, “inhalation sedation,” involved the inhaling a mixture of nitrous oxide and pure oxygen, commonly called simply, “nitrous.” The normal dosage is thirty percent nitrous oxide and the rest oxygen. Patients are administered different levels of the gaseous cocktail over time, the highest level of sedation producing a sense of elation and comfort. The inhalation sedative is administered mostly by a mask known as a nasal hood that is fitted over the patient’s nose, or by cannula, which are prongs inserted into the patient’s nostrils. It only takes about twenty to thirty seconds for the patient to begin to feel the effects of the nitrous oxide. Within two to three minutes the gas produces painkilling effects and the dental work can begin.

One of the main benefits of inhaled sedation is that it can be readily controlled, either deepened or lessened, and a patient can be brought out of sedation quite quickly. Since the nitrous oxide is mixed with oxygen, the patient can inhale it throughout the dental procedure without any possibility of it wearing off as can happen in the case of IV or oral sedation. The gaseous mixture also has no continuing effect or “hangover” associated with the other two methods. While some patients might feel a bit dizzy or lightheaded at the initial stages of inhalation this does not last long. Patients treated under “nitrous” can be released on their own recognizance since the sedative’s effects diminish almost as soon as inhalation stops. Does inhalation sedation have any disadvantages? The good news is that few safeguards are needed for this method, as no side effect or allergy to the gas is known, and only people who have been extensively trained are allowed to administer it. It is safe enough for those with heart lung or kidney ailments, and even pregnant women in the first trimester of their pregnancy.

The third method of sedation dentistry is oral sedation where the patient swallows sedative pills to reduce their apprehensiveness and nervousness. Depending on the procedure and the patient, a sleeping aid or sedative the evening before the dental visit may be ordered. If the patient requires an oral sedative the morning of their visit, they will require an escort to drive them to the dentist’s office. The oral sedatives commonly used in this method belong to a group called benzodiazepines, or “benzos”, and have two main consequences. The benzos can make the patient feel calmed and drowsy.They can also make the patient feel free from anxiety and apprehension. The biggest differences between the types of “benzos” used are the areas of the brain targeted by the chemicals, with some inducing a sleep-like state rather than simply an overall sense of calm. Is oral sedation safe for everybody? No, because the drugs have a number of side effects and are not appropriate for all patients. The drugs used in oral sedation dentistry can badly affect those with heart and liver ailments, can cause allergic reactions or harm the lungs, kidneys or the heart, and could be particularly harmful for pregnant women. Oral sedatives cannot be fully relied upon to be effective sedatives, because they do not always work fully for some patients, while they have almost no impact on others.

It is important to remember that all oral sedatives will be through prescription only, because of the strength and potential for addiction. Oral sedatives should be taken exactly as per the doctor’s directions, and restrictions on alcohol or drugs affecting the central nervous system have to be followed. Patients should not be ashamed of being afraid of pain or experiencing panicky reactions when faced with dental treatment. Dentists understand patients’ fears to this type of medical intervention and try to offer sustainable dental health maintenance in a relaxed and calm environment.