What are the Different Types of Sedation Dentistry?

What Is Sedation Dentistry?

Sedation dentistry, sometimes referred to as sleep dentistry, is the use of medication that helps patients to relax during difficult dental procedures. The medication administered by a qualified dentist or anesthetist can also assist in the reduction of pain associated with specific dental procedures.

Where Should I Go For Sedation Dentistry?

Many dentists will advertise sedation dentistry. It pays to ask specific questions. Often practitioners will have different forms of sedation dentistry on their website, but actually only offer the milder forms. This is because the technique-sensitive forms of sedation dentistry require time-consuming training and certification. It is not uncommon for dentists to mention IV sedation or even General anesthesia on their website, but in practice, only the pill form is offered. Ideally, your practitioner should be experienced in multiple forms of sedation and offer the option that suits you best. Below is a description of those options.

What Are the Different Types of Sedation Dentistry?

1.   Laughing Gas / Nitrous Oxide

Laughing gas or nitrous oxide provides mild relaxation benefits to patients during dental procedures. The patient will be conscious while taking laughing gas, and once they stop breathing it in, it wears off quickly. When given laughing gas, patients are usually allowed to drive themselves home after their dental procedure.

A dentist will give a patient a nose apparatus when giving them laughing gas, which they use to breathe in the gas. Laughing gas has mild effects, and it is felt immediately, sometimes as quickly as 30 seconds.

Laughing gas can be used as a supplement for stronger forms of sedation. Laughing gas provides no analgesic effect; it has no effect on pain control.

2.   Oral Sedation.

Commonly referred to as conscious sedation, oral sedation involves a patient taking a prescribed dose of a sedative before their dental procedure. Oral sedation is a medication in pill form, typically in the benzodiazepine family, that produces a sedative effect. It does not have an analgesic effect (pain control) by itself, and the patient will be conscious. Depending on the qualifications of the dentist, it can be combined with other medications that provide an analgesic effect (pain control) along with a drowsy and amnesia effect of a sedative. The sedative will leave the patient feeling sleepy, but the effects will have worn off by the next day. In our practice, we use oral sedation for mild dental phobics and quick, simple dental procedures. We use it most commonly before IV sedation as a great way to ease our patients into IV sedation.

3.   IV Sedation.

Dental IV sedation is a deeper form of sedation administered directly into the vein by a qualified dentist or anesthetist through an IV catheter at the start of the procedure, enabling it to take effect very quickly.

The sedative is “titrated to effect,” allowing the patient to enter a semi-conscious state quickly and predictably, where they are “asleep” but still conscious enough to respond if needed. It is usually combined with other medications, including opioids for pain control and to achieve the desired effect quickly. IV sedation helps in relieving dental anxiety, pain control, relaxing the muscles, and relieving the gag reflex. The patient is connected to a pulse oximeter to monitor vital signs.

IV sedation is the most common form of sedation dentistry in our practice because it is safe and achieves a predictable, consistent result. 

4. General Anesthesia

General anesthesia (GA) is another option that is relatively uncommon in regard to sleep dentistry. This type of sedation is also available in IV form, used for patients who require significant oral surgery or who are resistant to other types of sedation.

A patient is totally unconscious when they are given general anesthesia. This type of sedation only occurs in a hospital or specialized clinic with either a nurse anesthetist or an anesthesiologist who will administer the sedative and monitor the patient’s vital signs. Oral surgeons commonly use general anesthesia.

A Comparison of Dental Sedation:

Laughing Gas

Pros:

• Immediate effect and immediate reversal
• Cost-effective for short procedures

Cons:

• Not effective for longer or more complicated procedures
• Offers only mild sedation with no pain control
• Cumbersome face mask

Oral Sedation

Pros:

• Relatively inexpensive compared to IV sedation
• More effective and less cumbersome than Nitrous Oxide (laughing gas)
• A good sedation alternative for those with mild dental phobias and non-surgical procedures

Cons:

• Typically, not a deep sedation like IV sedation
• Some patients don’t respond consistently to oral sedation
• Delayed desired effect
• Not as safe as IV sedation because it is not immediately reversible
• The sedation effect can linger longer after the procedure is complete
• The amnesia effect is not a potent
• No pain control without adding other medications

IV Sedation

Pros:

• Compared to oral or inhalation sedation, IV sedation delivers a stronger sedative effect.
• The patient will not remember the procedure due to the strong amnesia effect
• Immediate clinical effect
• IV sedation is safer because it is immediately reversible
• Patients who opt for IV sedation have a shorter recovery time.
• Since it delivers a strong level of sedation, it is effective in easing severe anxiety.   
• IV sedation reduces the gag reflex by suppressing that reflex, ensuring that the dental procedure is easier and more comfortable.
• It still allows patients to maintain a low level of consciousness during the procedure.

Cons:

• It is more expensive than other, lesser forms of sedation
• It does require an IV, which can be difficult for some patients
• Patients who are drug-tolerant may not respond well to IV sedation

General Anesthesia

Pros:

• Deep sedation effective for nearly all patients
• No memory of procedure
• Optimal procedure for complicated oral surgeries, such as jaw surgery

Cons:

• Overkill for most dental procedures
• Can be difficult to find practitioners who offer GA
• Expense

Conclusion:

Nitrous oxide and oral sedation are lesser forms of sedation used for low-anxiety patients to ease simpler dental treatment. IV sedation is superior for higher anxiety patients and patients with more complex and invasive treatment. General anesthesia is the preferred form for complicated jaw surgeries done in a hospital or specialty clinic.

In our Greensboro dentist office, we typically combine oral and IV sedation, using oral sedation prior to treatment to ease the placement of the IV, then complete the appointment under IV sedation. We have found this to be a safe, effective, and predictable treatment modality for even the extreme anxiety patient.

At DeVaney Dentistry, we use advanced sedation dentistry techniques to ensure that your dental procedure is a pleasurable, stress-free, and pain-free experience. If you have any other questions or concerns, call us anytime and we’ll be more than happy to answer them.

Dr. Matt DeVaney is a certified and experienced IV sedation dentist providing sedation and dental services for the Greensboro and the greater Triad area.