Sedation Dentistry is used to help people who are anxious about having dental work done feel more at ease during their procedures.  Millions of Americans face anxiety on various levels when it comes to having dental work done.  As a result, dentists have found a way to help their patients have good experiences while in their care.  While there are many tools your dentist can use to reduce anxiety, one of the popular choices is intravenous sedation dentistry.

What is Intravenous Sedation Dentistry?

Intravenous sedation dentistry uses an IV to administer the drug directly into the patient’s blood stream during dental procedures.  A very thin needle is inserted into a vein, usually on your arm or the back of your hand.  Your dentist will clean the area and may even apply a topical numbing cream to make the insertion of the IV painless.  The needle is enclosed in a soft plastic tube.  The needle is inserted with the tube, and then the needle is removed, leaving the tube in the vein.  The drugs enter directly into your bloodstream via the small tube.  This is called an indwelling catheter.  The tube will stay in place during the length of the procedure.

During your dental work, your dentist and assistant will monitor your pulse and oxygen levels using a device that fits over your finger or clips on an earlobe, this is called a pulse oximeter.  If your oxygen levels start to drop your dentist will be alerted immediately.  Your blood pressure is also taken before and after the procedure as well.

You may also hear this method of sedation referred to as sleep dentistry or a twilight sleep.  Contrary to the name, the patient doesn’t actually fall asleep while under this form of sedation.  In fact, you will still be awake and able to respond to instructions from your dentist.

The nick names for intravenous sedation dentistry stem from the fact that many patients do not remember much about the dental procedure after the dental work is completed.  The reason for this lack of memory is because the IV sedation causes you to experience such a deep state of relaxation that you aren’t bothered by the dental procedure at all.  A common side effect of this type of sedation is that time seems to pass very quickly while the patient is under the effects of the drug.  Time seems to pass very quickly while using this form of sedation which can sometimes result in partial or full memory loss for the duration of the procedure.

The Benefits and Disadvantages of Intravenous Sedation Dentistry

Intravenous sedation for dental procedures is highly favored due to the rapid sedation and the fact that it can be tailored to each individual’s needs.  Patients are able to reach a deeper state of sedation and relaxation with IV sedation than they can with oral sedation.  This method is highly effective and very reliable when it comes to keeping patients anxiety free during their dental procedure.  Since IV sedation frequently causes at least partial amnesia, it is nice for patients who want to carry as little residual stress from their appointment after it is over.  They don’t tend to remember the details about the procedure that is being done and walk away feeling at ease about their dental visit.

For patients who normally suffer from a severe gag reflex, IV sedation can relax this reflex to the point that it is no longer an issue during the procedure.  Since patients remain awake during IV sedation, they are able to respond to the dentist’s directions and questions and able to advise if they need more local anesthesia or other pain medication.

There are a few disadvantages to using this form of sedation dentistry.  As with any intravenous drug, there are always risks at the needle site of hematoma or infection.  It is important to be sure that the staff at your dentist’s office is properly trained on how to effectively use intravenous sedation.

What Drugs are used in Intravenous Sedation Dentistry?

The drugs used during IV sedation aren’t painkillers.  The drugs used are actually anti-anxiety medications.  Your dentist may add painkillers to your IV but this will be discussed with you before the procedure.  The anti-anxiety medication helps you relax and feel at ease during the procedure.  You will still need a local anesthetic to numb your mouth in the area of the dental work before your dentist can begin the procedure.  If you have a needle phobia or anxiety about injections, your dentist may choose to wait to use the local anesthesia until after the anti-anxiety medication had taken full effect.  Since you will be awake and able to respond to the dentist’s instructions and questions, you will still be able to advise the dentist if you feel any pain or aren’t fully numbed before or during the procedure.

The drug that is the most commonly used for IV sedation is called benzodiazepine.  This drug is an anti-anxiety sedative that helps you feel at ease during your dental procedure.  The drug has three primary effects including helping you relax, making you drowsy, and causing partial or total amnesia.  While you may feel sleepy, you will still be able to respond to your dentist which can be extremely important depending on your procedure.

The most commonly used benzodiazepine drug used for intravenous sedation dentistry is called Midazolam.  The reason this is used more often is because it is the drug that leaves your system the fastest.  Valium is also popular but stays in your system longer and can sometimes cause a burning sensation in the vein in which the IV is inserted.  The other common anti-anxiety drug commonly used for intravenous sedation dentistry is IV Diazepam.  This is said to be gentler on veins and it can be mixed with a local anesthetic solution to make the patient even more comfortable.

After your dentist begins to administer the medication through your IV, they monitor you closely to check your response and the effectiveness of the medication.  Once the dentist is satisfied with your level of sedation, they will shut off the medication, leaving the IV in place during the dental procedure.  This allows your dentist to either provide you with more medication if needed or to give you the medication to reverse the effects of the benzodiazepine drug in the event of an emergency.

Some dentists may prefer to use Propofol instead of benzodiazepine drugs during intravenous sedation dentistry.  Unlike the drugs listed above, Propofol must be administered on a continual basis as the patient only takes less than 5 minutes to recover from the effects of the drug.   This is not a common option for sedation dentistry as it is very easy to cause the patient to slip into a full sleep also known as general anesthesia.  It is dangerous if this happens because the patient is no longer able to respond to the dentist and reflexes such as breathing are lost.

It is important to discuss medication options with your dentist thoroughly before undergoing any type of intravenous sedation dentistry.  This allows you to be fully aware of all risks and benefits of the options available to you.

What Other Medications are used with IV Sedation?

If you are having oral surgery or extensive work done, your dentist may suggest using strong painkillers called opioids in addition to the anti-anxiety medication.  While the local anesthesia greatly reduces most, if not all pain during the procedure, the opioids help greatly with the pain that is felt after the local anesthesia has worn off.  This medication is also sometimes used when the dentist is unable to achieve a satisfactory state of sedation with the anti-anxiety medication.  This can occur when a patient has developed a tolerance to benzodiazepine drugs.  The opioids will help ease your anxiety about the pain and make it seem much less worse.  Some of the opioids that are commonly used include Morphine, Demerol, and Stadol.

What Happens After Your Dental Procedure?

With IV sedation you will need to be sure that you have a responsible adult that is able to take you home after your appointment and stay with you the remainder of the day or until you are fully alert.  It is very important that you do not drive or participate in any strenuous or hazardous activities for the remainder of the day.

After your dental procedure, if you are hungry try to eat something light instead of a heavy meal.  If you are subject to any nausea it would be a good idea to drink fluids and lay down to rest.   Do not take any other medications unless instructed by your dentist and avoid alcohol consumption for the rest of the day.

If you start to notice any unusual problems or have questions about how you’re feeling or what you’re experiencing, call your dentist.  It is always better to be safe.

Who Should Not Use Intravenous Sedation Dentistry?

While many people are fully able to use intravenous sedation dentistry with no problems, there are some people who should not use this type of sedation during their dental visits.  People who should not undergo IV sedation dentistry include someone who is pregnant, has an allergy to benzodiazepines, someone who has glaucoma, someone that suffers from central nervous system depression, or if you have had alcohol prior to your dental procedure.  Also, if there is a chance that you might have sleep apnea then you should also speak to your dentist about which medications may be right for you.

It is also important to advise your dentist if you have taken benzodiazepines before as it is possible to build up a tolerance to these drugs.

Normal, healthy patients and patients with mild systemic diseases such as mild asthma, or well controlled diabetes are considered to be able to handle the anesthesia safely.  Of course you will want to discuss any health issues with your dentist so that they can determine the best course of action and medication.

Patients with severe systemic diseases are recommended only to be sedated in a hospital type environment where additional medical supervision and support is available.

If you have any questions about intravenous sedation dentistry or would like to know more, please call Dr. Levy for a consultation.