Sedation Dentistry Information Center 

  • Many patients face their dental appointment with a degree of anxiety. Research has shown that the largest cause of this fear is the fear of pain... the fear that at some time during their dental care treatment they are going to be hurt.

    Sedation dentists have information available about a variety of drugs known as local anesthetics, which are the safest and most effective drugs in all of medicine. Local anesthetics are a resource used in anxiety-free dentistry for the prevention and management of dental anxiety resulting from dental and surgical procedures, not to put the patient to sleep.

    Local anesthetics, commonly called Novocain by patients (Novocain is no longer used, having been replaced by newer, safer, and more effective drugs), are drugs which, when injected near a nerve, prevent stimulation from reaching the brain where it would be interpreted by a person as pain. Sedation dentists interested in practicing anxiety-free dentistry know these also work very well as temporary relief of a tooth ache.

    The injectable local anesthetics, used today by sedation dentists provide complete relief about 100% of the time. The duration of the numbness varies from drug to drug -- some providing short durations, while others remain effective for up to 12 hours. A doctor will select a drug for a patient that is appropriate for the type of dental care procedure they are having done.

    In order to be effective during dental treatment, local anesthetics usually need to be injected. For many people, this is the most uncomfortable part of the entire dental appointment.

    Local anesthetics can be administered quite comfortably. Sedation dentists and dental hygienists take pride in their ability to administer local anesthesia easily and comfortably.

    The following are some of the procedures sedation dentists practicing anxiety-free dentistry might use to make this procedure more comfortable:

    - Place the patient in a reclined position during the injection.

    - Place a topical anesthetic (a gel or spray) on the patient's gums where the injection is to be given. This should remain in contact with tissues for at least one minute.

    - Use of a distraction technique, such as pulling or shaking the lip as the needle is slowly inserted.

    - Injecting the local anesthetic drug slowly. This is critical to a comfortable injection.

    - Permitting the local anesthetic drug time to work. Most local anesthetics will become completely effective within approximately five minutes after their injection.

    - If an individual is fearful of receiving a local anesthetic injection, they should tell the assistant or the sedation dentist BEFORE the procedure starts. The use of conscious sedation such as laughing gas, as part of anxiety-free dentistry, can work wonders to make this procedure more comfortable for the patient.

    By Stanley F. Malamed, DDS

  • We'd like to offer one comforting and wonderful fact about today's dentistry: it's much less stressful than it used to be.

    Technology, new procedures, and some very sophisticated approaches to dental anesthesia have all contributed to comfortable dentistry, from cleaning to cavity preparations to root canals.

    But what if you didn't grow up with modern dentistry, and remember it differently?

    If you have had difficult dental experiences, you may be among the 150 million Americans who white-knuckle their way through treatment, or avoid the dentist altogether. The fact is, about 80% of the fearful can overcome dental phobia, with a little help from conscious sedation.

    Many dentists understand dental fear and where it comes from. And many are becoming trained in forming good working relationships with fearful patients. Your dentist should encourage you to voice your anxiety and discuss your problems with him or her, before he or she touches a tooth in your mouth.

    They should listen to your needs, and agree on small things that help you maintain a sense of control - a hand signal works with some patients. But talking about fear with your dentist - being assertive and letting him or her know what bothers you - is the first step.

    If you're moderately anxious, the dental team can provide distracting diversions to put those concerns to rest. If you're extremely anxious, they can virtually put anxiety to rest via oral sedation. This approach involves taking a mild sedative before you arrive for your appointment. You remain awake, but extremely relaxed - so relaxed that many patients have all their needed dental work completed in a single office visit. If dental anxiety has kept you from making an appointment you know is needed - a sedation dentist can help!

  • Franklin D. Roosevelt was right: the only thing we have to fear is … fear itself.

    Many times, the worst part of a procedure is the anxiety a patient endures before even climbing into the chair. It's a problem that's preventable, and your dentist would like to help you with that right now.

    If you (or someone you care about) has an appointment that's beginning to darken your thoughts, try this: First focus on the specifics of your dental fear. Is it the procedure in general, or a particular piece of equipment, or a vague sense of invasion of the privacy of your mouth? Once you've got it pinned down, talk with your dentist about it. If it's general dental anxiety, your dentist can help you feel better. If it's concern over a specific instrument or technique, often your dentist can change the way he does things.

    You can help the "pre-op jitters" by avoiding stimulants (coffee, cocoa, sugar) six hours before your visit. And concentrate on breathing naturally; denying yourself oxygen increases anxiety.

    Finally, there's a matter of trust. When your dentist describes a procedure, ask him to be honest. Ask him to tell you if it will be uncomfortable or stressful, if he tells you it won't be, believe him. And spare yourself the unnecessary burden of dental phobia.

  • There are many reasons 50% of the population put dental care at the bottom of the healthcare list: Some people are downright fearful, others have suffered bad experiences in the past and now suffer from dental anxiety. Then there are those who have a very strong gag reflex, and going to the dentist is a real ordeal. Or maybe extensive care is needed and there simply aren't enough hours in the day to accomplish it.

    It's time to rest easy. Sedation dentistry is here.

    After an initial consultation, your dentist will give you a dental anesthesia to take, it's called Triazolam, before your visit. You must bring a friend along to get you home after your appointment. At your appointment, you'll be drowsy, but thoroughly responsive (conscious sedation). The sedation dentistry team will monitor your every move throughout. The big plus: Most patients don't feel anything, and all your dentistry needs can be accomplished at one time, sometimes in as little as two to six hours, from straightforward care to the most complicated.

    For anxious patients, this new treatment is a kind of miracle, a boon to dental health. For the medically compromised, it works wonders, too. Dentistry keeps getting better and better, you'll be convinced.

    Your sedation dentist understands your dental fear, where it comes from, and what health problems can arise as a result. Now you're lucky to have a means to overcome it, and dentists are so pleased to be able to offer dental sedation to their patients.

  • All too frequently, a planned visit to the dentist is looked on with a degree of dread and foreboding. This is referred to as dental anxiety.

    Dental anxiety is not unusual, for it is quite natural for a person to be uncomfortable when placed in a position in which they feel that they are vulnerable, as occurs in the dental chair.

    It is important that a patient tell the doctor if they have any dental anxiety related to their planned dental treatment. Keeping their fears hidden can only lead to a much more unpleasant experience for the patient and, in more extreme circumstances, may even increase the likelihood of certain emergencies occurring, such as fainting.

    Once the sedation dentist is aware of the patient's dental anxiety and fears, there are many ways in which they may be addressed. In some cases, simply discussing the planned procedure is all that is necessary to alleviate the patient's dental anxiety.

    When this is not enough, other highly effective and safe sedation techniques can be used to alleviate dental anxiety. If the technique involves the administration of a drug, it is termed conscious sedation dentistry.

    The most readily available routes of conscious sedation are: oral, inhalation, intravenous and intramuscular. For extremely fearful dental patients, general anesthesia may be required.

    Oral Conscious Sedation Dentistry

    Many dentists will prescribe a sedative drug to be taken by mouth prior to the planned treatment. If the individual has an even greater degree of dental anxiety, the doctor may prescribe an oral conscious sedative to be taken at home one hour prior to going to sleep on the evening before the appointment.

    If the drug is administered at home, it is IMPERATIVE that the patient NOT DRIVE A CAR to the appointment. Patients receiving oral conscious sedation are not permitted to drive a car or operate a motor vehicle for 24 hours following their appointment.

    Commonly administered oral conscious sedatives include: Valium, Halcion, Dalmane, and Versed. Oral conscious sedation dentistry is most effective in the management of milder degrees of dental fear.

    Inhalation Conscious Sedation Dentistry

    The use of inhalation conscious sedation (nitrous oxide and oxygen) has been a mainstay of sedation techniques in dentistry for generations and still represents the most frequently employed technique. Commonly known as laughing gas, nitrous oxide-oxygen is used by more than 35% of all U.S. dentists.

    An advantage of this technique of inhalation conscious sedation is that most people receiving it recover promptly and may be permitted to leave the dental office unescorted and resume normal activities immediately.

    Inhalation conscious sedation is most effective with mild to moderate degrees of dental anxiety.

    Intravenous Conscious Sedation Dentistry

    Though not as readily available as other conscious sedation techniques, intravenous (IV) conscious sedation is a safe and highly effective technique for management of moderate to more severe levels of dental anxiety.

    Sedation dentists who employ IV conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners.

    Drugs administered intravenously are more effective than the same drugs taken orally. A major benefit of some of these IV drugs is amnesia.

    The patient will have no memory of some, or even all, of the dental treatment. This will lead the patient to think they were asleep during the treatment when, in reality, they were awake, but comfortable, at all times.

    During the procedure, monitoring devices will be attached to the patient. These devices monitor the effectiveness of one's breathing (pulse oximeter), blood pressure and heart rate, increasing the safety of the procedure.

    Patients receiving IV conscious sedation are not permitted to leave the dental office unescorted at the conclusion of the procedure.

    Intramuscular Conscious Sedation Dentistry

    Less commonly employed for adult patients, intramuscular (IM) conscious sedation is a relatively effective technique for management of moderate levels of dental anxiety and fear.

    IM conscious sedation is more often employed in the management of fearful children. Sedative drugs are injected into the muscle of the upper arm or the thigh, producing sedation in approximately 20 to 30 minutes.

    Dentists using IM conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners and will employ the same monitors described in the IV conscious sedation section.

    General Anesthesia

    Though the techniques of conscious sedation described above effectively manage more than 90% of all fearful dental patients, some may require general anesthesia in order to relieve their dental anxiety during their dental treatment.

    When general anesthesia is used, the sedation dentist will employ a person who is trained and certified in general anesthesia to manage the patient while the dentist carries out the dental treatment.

    This person will be a dentist anesthesiologist, a medical anesthesiologist, or, in some cases, a nurse anesthetist, whose sole responsibility is to ensure the safety of the sleeping (unconscious) patient while the dentistry is being done.

    Sleep dentists using general anesthesia have received a minimum of two years of specialized advanced training and have been certified by their state Board of Dental Examiners. Monitors will be employed to help ensure the safety of the procedure.

    Not all dentists employ conscious sedation techniques to relieve dental anxiety. It is important for patients to voice concerns and dental fears with their dentist during their first visit to the office.

    The dentist will seek to work out a treatment plan that will best accommodate the patients needs. In some situations it may be necessary to refer a patient to a doctor who has these techniques available.

    By Stanley F. Malamed, DDS

  • Q. Will I really be totally relaxed with Sedation Dentistry?

    A. Your sedation dentist will administer just enough sedation so that you'll be completely unaware of the treatment, as if you were asleep.

    Q. Will I remember anything after sedation dentistry?

    A. At the end of the treatment, you'll have little or no memory of what was accomplished.

    Q. Will I feel any pain during dental treatment?

    A. Most patients experience no discomfort whatsoever during treatment and feel surprisingly good afterwards.

    Q. What dental treatments can I have while under sedation?

    A. Sedation dentists can generally do it all—implants, dentures, cosmetic dentistry treatments, crowns, even gum surgery.

    Q. Is sedation dentistry safe for me?

    A. Oral sedation dentistry protocols have been used safely for 30 years. Sedation dentists will review your medical history and monitor you closely while under sedation.

    Q. Will my dental insurance cover it?

    A. Almost all sedation dentists will review your coverage and, if necessary, make financial arrangements so you get the care you need.

  • Most people are well aware of the value of dental care, but cannot bring themselves to get into their dentist's office and climb into the chair. The reason: fear.

    Dental anxiety, unfortunately, is sometimes a shared family experience. Whether it's just a bout of sweaty palms or acute anxiety, the fears and attitudes of parents can easily be passed along to children unintentionally. Perhaps you grew up without the technical advantages available today. Your unpleasant memories can be fierce enough to interfere with family dental education - and health.

    Parents can begin to allay phobias - and keep from spreading them around - by examining the source of apprehension. Dental phobia generally hinges on fear of pain, choking, or loss of control. The dental environment might feel overwhelming. Invasion of personal privacy - the mouth - can be frightening. When you schedule an appointment, how do you feel about it? Do you find yourself cancelling appointments at the last minute? Do certain pieces of equipment make you uneasy? A little soul-searching can help pinpoint your fears.

    You need to speak frankly with your dentist. Chances are, he'll understand. He'll take time with you to describe new techniques - and there are many - to overcome fear. His dental staff will take special care to respect your feelings and dispel any misgivings.

    With some effort, nearly everyone can learn to overcome dental anxiety and relax. The direct benefits - you'll feel more comfortable when you visit, and, if you or your family have been avoiding the dentist altogether, your dental health will begin to improve. Indirectly, you'll offer a positive role model for your family. Take this step for yourself, and the family will follow. Call your dentist today to find out how he can help.

  • Patient comfort and care is a top priority for a sedation dentist. They recognize that dental anxiety or discomfort can be associated with some dentistry procedures. Fortunately, a variety of dental procedures using dental anesthetics are available to relieve both anxiety and discomfort. Talk with your dentist to find out which is right for you.

    Dental Anxiety Relief

    Local Anesthetic: This is the most frequently used type of dental anesthetic for sedation dentistry procedures. Although often referred to as "Novocain," this once popular painkilling drug has actually been replaced by more effective anesthetics such as Lidocaine for a comfortable dental care treatment. It also works very well for temporary relief of a tooth ache.

    However, the name has become so much a part of the American vocabulary, it's now used in generic terms. Prior to injecting the local anesthetic, the dentist often swabs a topical anesthetic over the injection site to prevent the patient from even feeling the needle.

    Conscious Sedation Dentistry: Patients seeking comfortable dentistry can consult with their dentists to choose anti-anxiety agents either administered by mouth, inhalation or injection. Nitrous oxide, often referred to as laughing gas, helps to ease patient anxiety. The gas is inhaled by patients, inducing relaxation, so they can approach dental procedures with less stress.

    Deep Sedation: This may be required for complex procedures or for dental patients with special needs. With the administration of general anesthesia, the patient is unconscious; with deep sedation dentistry or sleep dentistry, dental patients are deeply relaxed and not fully aware of their surroundings during their dental treatment.

    Consult With Your Dentist

    Prior to treatment, your dentist will need to know a few things regarding your health history such as:

    - allergies

    - your current health condition

    - any medications you may be taking.

    Some medicines may interfere with the efficiency of an anesthetic requiring an adjustment in your medication schedule. Your health history is very important information for the dentist. During the consultation, you can ask questions about any dental procedures that may be of concern during your dental procedure.

    A Concern for Safety

    The drugs used as dental anesthetics are approved by the Food and Drug Administration and are safe. Anesthetic providers are professionals with a commitment to patient safety and comfort.

    A dental anesthetic can be administered by a general dentist, a dental anesthesiologist or an M.D. Certification is required and is regulated on a state-by-state basis. Discuss sedation with your dentist at your next visit.

    By Brian J. Gray, DDS, MAGD, FICO

  • If you are afraid to go to the dentist, relax! Sedation dentistry and a trained sedation dentist can change your life for the better with a light sedative!

    You can have the beautiful smile and the good dental health you’ve always wanted with sedation dentistry. Ask your dentist about more benefits of conscious sedation.

    Imagine being able to smile with confidence and chew your food without pain. A sedation dentist and conscious sedation dentistry makes it possible to be totally relaxed during your dental treatment.

    You won’t feel any discomfort and likely won’t remember the treatment itself. Because you’ll be completely comfortable, your sedation dentist can do many dental care procedures during the same visit, including:

    - whitening yellow or stained teeth

    - replacing crowns or dentures

    - fixing chipped or damaged teeth

    - restoring sore gums to good health

    Best of all, you’ll probably only need one or two appointments with a dentist using sedation dentistry. So in hours you can start enjoying the confidence that comes with a bright new smile and good dental health.

    Plus sedation dentistry is safe. Before your sedation dentist begins work, he or she will thoroughly review your medical history, and then monitor you closely during your conscious sedation dental treatment.

  • The most commonly employed technique used in conscious sedation dentistry is inhalation sedation with nitrous oxide and oxygen (N20-02) or "laughing gas". It is estimated that approximately 35% of U.S. dentists use this technique to relieve dental anxiety.

    The goal sought when laughing gas is used is to eliminate dental anxiety, making the patient more comfortable while the sedation dentist is able to more effectively complete the planned dental care procedure while the patient is sedated. Consult with your dentist to find out if this procedure right for you.

    A small rubber inhaler will be placed over the patient's nose and adjusted so that the patient is comfortable. At this time, the patient will be breathing 100% oxygen.

    Some patients at their first laughing gas visit will feel that they are not getting enough "air." The patient should tell the sedation dentist and he or she will provide them with even more oxygen to breathe.

    Once the patient is comfortable breathing oxygen, the dentist gradually will introduce nitrous oxide. Over the next three to five minutes, the patient will be asked, "What are you feeling?" as the amount of nitrous oxide is slowly increased.

    The signs and symptoms that most patients experience when receiving laughing gas include an initial feeling of lightheadedness, which gradually leads to an all-over feeling of warmth. Many persons mention a comfortable "vibrating" or "humming" sensation. It is common to feel one's fingertips and hands become "numb."

    This same sensation may develop in the mouth - a benefit to the sedation dentist (and patient) during the dental care treatment. Some patients will mention that their arms and legs feel "very light." Interestingly, other patients will say that their arms and legs feel "so heavy I can't even move them."

    If either of these occurs to the patient, it is perfectly normal. The individual might notice that they are perspiring a little, too. This is a normal effect of nitrous oxide and oxygen dentistry.

    The sedation dentist will talk with the patient throughout the dental care procedure and the individual will be able to respond without any problem. This is a major advantage, and a safety feature, of conscious sedation using laughing gas.

    If, at any time during the procedure, the patient feels that they are getting too much nitrous oxide or if they begin to feel uncomfortable, they should tell the dentist immediately and within seconds the dentist can adjust the flow of gases, and the patient will feel more comfortable again.

    At the conclusion of the sedation dentistry treatment, the patient will once again receive 100% oxygen (for a minimum of three to five minutes). At the end of this time, the person should feel absolutely back to normal. If they still feel even a little bit sedated, the dentist should give the patient oxygen for a few more minutes.

    Most dentists permit the fully-recovered laughing gas patient to leave the dental office unescorted and to resume their normal activities. In some situations where a patient recovers more slowly, they might be required to have an escort (friend or relative) drive them home.

    Laughing gas inhalation sedation is highly effective in the management of mild to moderate levels of dental anxiety. It also is an excellent technique in persons who are extreme gaggers; laughing gas usually eliminates or minimizes gagging in most patients.

    Finally, laughing gas is highly recommended for apprehensive patients who have medical problems such as angina pectoris, persons who have had a heart attack, or persons with high blood pressure, asthma or epilepsy.

    Inhalation sedation dentistry should not be used with persons who are claustrophobic or with persons who are unable to breathe through their nose. Please discuss these with your dentist before treatment using laughing gas begins.

    By Stanley F. Malamed, DDS