Sedation and Surgery

It is estimated that as many as 75% of the adult population in the United States experiences some degree of dental anxiety. All fear is real, as is your dental fear. Your personal brand of dental fear keeps you in physical pain and in dental shame.

It is relatively easy for a conscientious dentist to heal your physical pain. It is, however, a challenge for a dentist to help you heal your emotional pain associated with dentistry.

At Inland Family Dentistry, we understand this common fear, which is why we wanted to take some time to specifically address an often misunderstood part of modern dentistry: sedation & surgical dentistry.

While there is often much emotional healing and trust building that needs to take place, we’re going to explore everything you need to know about dental sedation and the three main types we use to ensure each patient is as comfortable as possible.

What is Dental Sedation?

While most think that dental sedation solely refers to being “put under” for a surgical procedure, in modern dentistry, it actually has many applications. Sedation dentistry encompasses a variety of techniques that are used to make patients more comfortable both before and during a procedure.

Dental sedation can help alleviate anxiety regardless of the type of procedure scheduled. The most common form of dental sedation that many are familiar with would be nitrous oxide, also known as laughing gas.

However, thanks to advances in modern dentistry, professionals now have a wide range of medications that can be used to help patients get the treatment they need. Depending on the level of anxiety you experience, your dentist can even prescribe a mild sedative that’s taken prior to the appointment.

That’s why we take the time to get to know each and every patient so we can work through and address their level of dental anxiety, therefore allowing us to prescribe an individualized sedation plan.

Who May Need Dental Sedation?

Almost anyone can receive dental sedation if their doctor deems it necessary. While certain health or allergy related factors may rule out some forms of dental sedation, working with your dentist will ensure you reach the desired level of comfort.

As we’ve already touched on briefly above, sedation dentistry has a variety of uses that are designed to fit each individual patient. Below, we’ve categorized sedation dentistry into two unique groups depending on what your personal comfort needs are.

Dental Sedation for Anxiety

Will this hurt? It is likely the first thing on your mind. Going to the dentist means “I’m gonna get a shot.” “I wish I could just go to sleep and wake up when it’s all over.” Well, can I go to sleep in the dentist office? Can I take a pill? Can I be hypnotized? Help! I’ve got to get this tooth taken care of but I just can’t stand the thought of going to the dentist! What can I do?

At our office, we employ a number of different sedative practices to handle the anxiety patients may experience both in and out of the office. For patients with a mild fear of the dentist, they may only need dental sedation once they’ve arrived for their appointment.

For patients with high dental anxiety, we can prescribe dental sedation measures that are taken as early as the night before to ensure a restful sleep. We will cover this more in-depth later.

Dental Sedation for Procedures

Originally, sedation dentistry was designed to help patients be as comfortable as possible during more invasive procedures and surgeries. Not to be confused with pain management, such as a shot of Novocain, dental sedation for procedures helps you enter a more relaxed state.

This is particularly helpful when patients require procedures that are more invasive. Depending on your level of comfort, our dentists will be happy to work with you one on one and create a personalized sedation plan.

Different Types of Dental Sedation

Believe it or not, there are three primary types of dental sedation. Taking into account a patient’s personal level of comfort and the procedure being done, our dentists will typically recommend one of the following methods.

Minimal Sedation

Minimal sedation easily accounts for the majority of sedation dentistry we perform in the office. This is the lightest form that we use, and only employs the use of nitrous oxide (laughing gas). While laughing gas is designed to make you feel a little woozy and giggly, you’ll remain conscious throughout the length of the procedure.

Dispensed through a breathing apparatus, the effects of laughing gas are typically felt very quickly (sometimes in as little as 30 seconds). Many patients that experience anxiety opt for minimal sedation because it’s highly effective at reducing stress and bringing them into a relaxed state during the appointment.

Another reason minimal sedation is such a popular choice is because nitrous oxide wears off fairly quickly, usually leaving patients capable of driving home afterward. For many of our patients, simply being able to go to and from their appointment without the assistance of a friend or family member is enough to make them feel more at ease!

At Inland Family Dentistry, after the procedure is complete, your dentist will switch you to oxygen so that the nitrous oxide in your system gets flushed away, leaving you feeling clear headed and ready to tackle the rest of your day. On top of being extremely safe, laughing gas has no lingering side effects. Minimal sedation is most commonly used during minor procedures (such as a cavity) and routine cleanings or periodontal treatment.

Moderate Sedation

Moderate sedation uses a combination of nitrous oxide and oral sedation with varying dosage depending on the patient’s level of anxiety. For this reason, moderate sedation is typically recommended for patients that experience higher than usual anxiety when visiting the dentist. For instance, do you happen to find yourself losing sleep the night before your appointment? If so, moderate sedation can help.

With this type of treatment plan, patients are prescribed an oral sedative that they can pick up from their local pharmacy. Thanks to the flexibility of oral sedation, patients can work directly with their dentist to determine the best treatment approach whether that be accounting for sleep anxiety a day or two prior to the appointment or anxiety experienced a few hours leading up to their visit.

Oral sedatives can also be prescribed in different dosages depending on the level of anxiety you experience personally. To determine what will work best for you, we recommend communicating any and all concerns to our team to ensure you’re as comfortable as possible. Unlike minimal sedation, oral sedatives will make you drowsy, so you’ll need to have a friend or family member present to drive you to and from the appointment.

At our office, Dr. Douglas Coe works one on one with all patients that opt for moderate sedation. The first step is scheduling a consultation appointment with Dr. Coe to review the treatment plan, your medical history, and answer any questions you might have. Once you’ve arrived for your appointment, you’ll be administered nitrous oxide (laughing gas) to take care of any lingering anxiety so you’re as comfortable as possible.

Some patients become so relaxed between the oral sedation and laughing gas that they actually sleep through the procedure! The procedures conducted under moderate sedation are very similar to those done under minimal sedation. The main differentiating factor is your personal level of comfort, which we are more than happy to accommodate. Under moderate sedation, you are still breathing on your own and able to respond to instruction; however, it does offer an amnesia effect.

Full/IV Sedation

Full or IV sedation is the highest level of dental sedation that we offer. Here at IFD, we work with a licensed anesthesiologist that will come and administer the IV sedation while one of our doctors performs the procedure. Full or IV sedation is actually quite common, especially when working with patients that require more invasive procedures or longer restorative appointments.

General Anesthesia

General anesthesia renders the patient entirely unconscious. This type of sedation is less common in modern dentistry, primarily being used when patients require significant oral surgery or if they’re resistant to other forms of sedation. While under general anesthesia, the anesthesiologist will be constantly monitoring your vital signs to ensure everything goes as smooth as possible.

General anesthesia uses a combination of intravenous medications and inhaled gasses to bring the patient into an unconscious state. While unconscious, patients do not feel anything and will have no recollection of the surgery at all.

Before patients are administered any form of anesthesia, they will first meet with the surgeon performing their procedure to go over medical history, a brief physical examination, and address any concerns or expectations.

Circumstances & Procedures for Dental Sedation

Sedation dentistry has come a long way in the last few decades, helping tens of thousands of patients get the treatment they need at a comfort level of their choosing. Even so, many patients continue to avoid the dentist altogether because of a past childhood experience or negative images of dentistry conjured up by the media.

In addition, many patients have the misconception that sedation dentistry is an option only available to those that require more invasive surgery, which isn’t the case at all. Below, we’ve outlined some of the most common reasons and procedures that call for dental sedation. Always feel free to ask questions about sedation. Understanding your treatment options with regard to knowing your options available to make the experience more comfortable is often an critical first step in working toward managing your oral health.

1. Dental Fear

As we were just touching on above and throughout this post, fear and anxiety associated with dental treatment are real emotions. Rather than just being told to “get over it” by a friend or family member, dental sedation offers a welcome alternative for patients that experience crippling fear or anxiety about the dentist.

This allows you to get the dental treatments you need without the detrimental effects of procrastinating and letting the problem get worse. You’d be surprised to learn that most of our patients who undergo dental sedation fall into this category, so don’t be shy about it!

2. TMJ Problems

Temporomandibular (TMJ) issues can make it difficult and extremely uncomfortable to go to the dentist. Often characterized by having the inability to open your mouth fully without experiencing pain, TMJ dysfunction makes it hard on both the patient and dentist to fulfill what needs to be done on a given appointment.

Dental sedation can help on two fronts by relaxing the muscles under strain and blocking pain so that the patient can experience their desired level of comfort. This also greatly helps our dentists by allowing us to fully perform the checkups and procedures that leave you with a healthy mouth.

3. Resistance to Local Anesthetics

Even though they get the job done most times, local anesthetics can actually work to varying degrees on different patients. This is because nerve endings don’t actually sit in the same spot from person to person. When nerves are in unusual locations, administered local anesthetics may not be very effective, which can cause the patient to experience more discomfort than expected for even the simplest of procedures.

On the other hand, because sedation dentistry works on a deeper level (intravenous, inhaled, or ingested), these types of patients tend to respond very well. Depending on the severity of discomfort, our dentists will work one on one with patients that are resistant to local anesthetics to determine the best treatment plan.

4. Wisdom Tooth Removal

Wisdom tooth removal is more often than not a patient’s first experience with dental sedation. Though primarily taken care of between the ages of 17-25, some patients may choose to wait until they get older.

Because each patient is different, some may only need moderate sedation while others may opt for full sedation. Click here to see our list of preferred surgeons for this type of procedure. Dr. Coe does most of our oral surgery at our office. Depending on the location and eruption of the teeth determines whether or not we perform these services in our office or make a referral to the specialist.

How Safe is Dental Sedation

One of the biggest concerns we get from patients that may need some form of dental sedation is whether or not it’s safe. While there is always some level of risk involved with sedation dentistry, the large majority of patients never experience an adverse reaction.

Though there are various factors dentists must consider, it also depends on the type of dental sedation you will be receiving, which we’ve outlined again below.

Minimal Sedation

Because minimal sedation only involves the use of nitrous oxide, it is widely considered the safest form of dental sedation. Not only does it allow you to experience the level of comfort you need while in the office, but, more often than not, you can easily drive yourself home at the end of your appointment.

Thanks to modern dentistry, our deep understanding of the way laughing gas works in combination with cutting edge technology greatly limits any risk of an adverse reaction.

Moderate Sedation

Moderate sedation is also widely considered a very safe form of dental sedation since it involves the use of nitrous oxide in combination with an oral sedative. Depending on the patient’s desired level of comfort, the oral sedative can range in strength from minimal to moderate.

Patients are typically prescribed Halcion, which is in the same drug family as Valium. Unless you have a specific allergy to oral sedatives, the risk of experiencing adverse effects is very small.

Full/IV Sedation

Full sedation, being the highest level of dental sedation we offer, is also widely considered safe when all precautionary measures are taken. Prior to scheduling the appointment, your surgeon will review your medical history to ensure there aren’t any risk factors that would otherwise rule out anesthesia.

Once you’ve been administered the anesthesia, your vital signs will then be carefully monitored during the entire length of the procedure. Here at IFD, we understand that this can make patients a little uncomfortable which is why we work with an experienced anesthesiologist that will administer the anesthesia.

Additional Measures

In addition, we strongly encourage all patients to ask as many questions as they want in order to feel comfortable and educated before receiving any form of dental sedation. We are more than happy to share all of our credentials and information to ensure you feel confident and safe at all times whether coming it for a basic checkup or for longer restorative procedures.

Closing Words

We want to empower you to be in control of your dental health. We are a team. Through open communication, we proudly make it our mission to give you the best experience possible. There are a gambit of tools available that we can discuss at your appointment to make the right choice for you. Building a trusting relationship with your dental provider will no double make an impact on your oral health for a lifetime.