What is Sedation Dentistry?

Sedation dentistry refers to the use of medication during dental treatment for the purpose of reducing anxiety, stress, and/or the patient’s memory during a dental procedure. Sedation is most commonly used during extensive procedures, for patients with dental phobia, or for patients who find it difficult to sit still. There are different types of sedation and can range from the use of nitrous oxide (“laughing gas”) to calm a patient to general anesthetics used to put patients to sleep. Patients with dental phobia, low pain tolerance, major dental treatment, physical handicaps, or strong gag reflexes may require sedation to provide quality treatment in a safe and humane manner. Procedures like fillings, crowns, root canals, extractions, cosmetic procedures, and periodontal treatments often require sedation.

Sedation is endorsed by the American Academy of Pediatric Dentistry and is an effective way to make many patients comfortable during their dental visits. Before using a sedative or anesthetic, it is important to tell your doctor about any medications or medical treatments that your child is receiving.

General Anesthesia is recommended for apprehensive children, very young children, and children with special needs that would not work well under conscious sedation. Anesthesia is defined as the loss of feeling or sensation with or without a loss of consciousness. In reality, anesthesia does more. In addition, to keeping your child pain-free during surgery, anesthesia controls the body’s reaction to stress and relieves anxiety almost always associated with surgery. Anesthesia is provided by using medications and monitors. A close, continuous watch is kept on the heart rate, blood pressure, respiration, and patient reactions.

Types of Sedation

Sedation dentistry is closely regulated by law, and there are three sedative states at which your dentist can administer your treatment: mild sedation, moderate sedation, and deep sedation.

Mild Sedation– Anxiolysis is the lightest form of sedation dentistry and is often used for patients with mild anxiety, longer procedures, or more complex situations. Mild sedation is usually administered orally or inhaled through your nose. You remain awake throughout the entire procedure and are able to breathe on your own, but you will feel a great sense of relaxation. Patients typically recover from anxiolysis sedation within a few hours after the procedure is complete. Nitrous oxide inhalation (laughing gas) is another form of mild to moderate sedation that results in relaxation during treatment.

Moderate Sedation– Used for patients with moderate dental anxiety and for patients who need longer or more complex procedures, conscious sedation often refers to the use of oral medications or light IV sedation. With conscious sedation, you will remain awake throughout your procedure but will be in a deep state of relaxation.

Deep Sedation and General Anesthesia– Patients receiving deep sedation are almost unconscious to completely unconscious during their dental procedure. Patients often have no recollection of the treatment and are unable to respond to commands even if they are awake at times during the procedure.  Deep sedation is typically through an IV and should have an anesthesiologist present.

How are Sedatives Administered?

Inhalation – Nitrous oxide, or laughing gas, is the most frequently used method for easing mild to moderate anxiety. Administered through a small mask that fits over your child’s nose, it is an effective way to calm anxiety and make it seem that time is passing quicker than usual. Recovery is quick so your child can resume his/her normal activities immediately.

Oral – An extremely common technique for dental sedation is oral sedation. It is easy and does not require the use of needles. Your child will be given a prescription pill or liquid which, taken about 45 minutes before your appointment, will have your child fully relaxed by the time the doctor sees him.  Depending on the dose, oral medication results in mild to moderate levels of sedation.

IV– IV sedation is a safe and effective way for many patients to receive complex dental treatments. An anesthesiologist will gently place an IV and administer medication to help your child into a deeper state of relaxation.  IV access also provides immediate access for drug administration to reverse the effects of sedation.

Why Would a Child Need General Anesthesia Just to Have Teeth Fixed?

Unfortunately, many children suffer from serious, painful, potentially life-threatening dental diseases. Unlike such health conditions as colds and flu, dental diseases will not go away on their own. When treatment is required for a serious dental condition or the well-being of the child, general anesthesia may be recommended to make delivery of that required treatment possible in a safe and comfortable manner. The American Academy of Pediatric Dentistry, the American Dental Association, and the U.S. Department of Health and Human Services support this standard.

General Anesthesia is an accepted standard of care for situations involving children who have limited comprehension, are unable to cooperate, and require dental care that is technically difficult to deliver. Dr. Tomlin evaluates the amount of treatment needed, access to care, the type of treatment, the child’s ability to cooperate, and the child’s medical and dental history, prior to recommending general anesthesia. If Dr. Tomlin has recommended that your child receive dental treatment under general anesthesia, we will schedule an Anesthesiologist to provide the sedation.

Dr. Tomlin reserves multiple days a month for our General Anesthesia patients. During this time, the doctor and his staff will give your child their complete attention.

A physical examination by your Pediatrician is required prior to general anesthesia for dental care. This physical examination provides information to ensure the safety of the procedure. Parents are instructed to report any illness that occurs prior to the general anesthesia appointment.

Sometimes for your child’s safety, treatment may be required in a hospital setting depending on your child’s medical history or at the request of your Pediatrician.   Your child will be discharged when alert and ready to depart. You will be instructed to let your child rest at home with minimal activity planned for the next day. Post-operative instructions will be given to you, along with dietary instructions and a 2-week follow-up appointment with Dr. Tomlin at the office. Please call the office with any changes in the child’s health or pain he/she may be experiencing.