Many people dread going to the dentist because of a bad dental experience, and some people are nervous about the feeling of losing control of themselves when having their teeth treated by a dentist. Most dentists understand this concern and try to help the patient feel comfortable with deeper anaesthesia techniques such as intravenous (IV/MAC) sedation or oral sedatives, allowing the patient to complete the treatment in a more relaxed or lethargic state.
Intravenous Sedation / Monitored Anesthesia (IV Sedation)
Sedatives are drugs that are often used to monitor anesthesia. Anesthesiologists provide local or sedative anesthesia to depress the central nervous system and/or reflexes, allowing the patient to relax and calm, and to go to sleep at any time. There is no memory once the procedure is over, no lengthy recovery period is required after use, and it is a very comfortable sedation option.
Benefits of using intravenous sedation for dental sedation:
• Immediate effect: When the sedative drug is injected intravenously into the bloodstream, all tension will be relieved and worries will disappear.
• Long lasting effect: Dentists can closely monitor IV medications from start to finish to keep patients calm throughout the procedure.
• Safe and comfortable: allow the patient to complete the treatment in the deep sleep area without the pain of injection.
• Can be used in multiple ways: It can be administered to patients through oral and injection routes.
• Adjustable dosage: Dentists can monitor the patient's heartbeat, electrocardiogram, blood pressure and blood oxygen levels to ensure optimal drug dosage. The sedation and treatment program can be ended at any time if necessary.
• Multiple treatments: Dentists can perform multiple treatments at one time when the patient is comfortable and relaxed.
• No memory: For patients with dental anxiety, the real beauty is that they don't remember any of the procedures after they're done, and they are completely unaware of any sounds, sights, or details of the procedure.
Potential risks of receiving sedatives:
• Delayed body protective reflexes: Monitoring anesthesia may temporarily disable neurophysiological reflexes such as the vomiting and coughing reflexes. Monitoring anesthesia requires the patient to fast for 6-8 hours and stop drinking liquid drinks including water 2 hours before. If not fully fasted, serious consequences such as aspiration of a foreign body or aspiration pneumonia may occur.
• Affecting breathing: Sedatives depress the central nervous system and may also inhibit the muscle activity of the respiratory system, which may affect breathing, resulting in airway obstruction, hypoventilation and hypoxia.
• Affects the cardiovascular system: Some sedatives may affect the cardiovascular system, causing instability in blood pressure and heart rate, which may lead to serious complications such as myocardial infarction and stroke.
• Excessive sedative effect: The sedative effect is longer than expected, and the patient may still feel drowsy after the treatment ends.
Suitable patients for dental intravenous sedation:
• Patients who need relatively complex or multiple treatments for the full mouth
• Children
• Dentist phobia
There are always other options.
Dentists do not force anxious patients to perform any dental exams that they are not comfortable with, and when needed, they may recommend patients to receive some dental sedation (not necessarily anesthesia), which specialist anesthesiologists and dentists coordinate with each other depending on the treatment condition.
1. Oral sedatives
Oral sedatives are suitable for people who experience high levels of anxiety when visiting the dentist. The related drugs that are most commonly used in dentistry for dentist phobia belong to the "benzodiazepine" class of drugs, and they are used as sedatives and anxiolytics, by combining and reducing "fear" in the brain.
Higher doses act as sedatives and induce sleep in most cases, while lower doses also reduce anxiety without sedation. Some drugs are highly targeted to areas of the brain that focus on sleep, while others target fear centers in the brain.
Benefits of using oral sedatives for dental sedation
• Allow the patient to relax so that the treatment can be completed.
• Helps the patient to remain stable for a long time so that the dentist can complete the time-consuming treatment.
• Multiple treatments or full mouth restorations can be performed at the same time during one consultation.
• Reduce discomfort after treatment.
However, the absorption and function of oral sedatives have different effects on each patient, and the effect of oral sedatives varies from person to person compared to other sedation methods.
2. General anesthesia
Anesthesia is the use of drugs to put a patient to sleep so that dental procedures can be performed comfortably and easily. When all other options, such as oral sedation and intravenous (IV/MAC) sedation, have failed, general anesthesia will provide a pain-free, anxiety-free, and even memory-free dental experience, making even the most frightening, anxious dental experiences calm and relaxing.
However, due to the relatively high risk of anesthesia compared with other methods, it is generally only used for very long-term operations or when there are other special reasons to consider its use in dental treatment, and it is arranged at a designated hospital only when clinically required.
If you're struggling with dental anxiety and it's preventing you from getting the dental care you need, talk to your trusted family dentist for more information on dental sedation.
