Sedation

“IV sedation will turn your dental fears into carefree daydreams.”

Dr. Smith and his team realize that many people are terrified to get the dental work they need. They often say that they just want to close their eyes and have it be over. That is why Dr. Smith does everything he can to make his patients comfortable. Some people just do not want to be awake for their dentistry which is why Dr. Smith is one of a handful of general dentists in Fresno trained and certified to perform intravenous sedation dentistry. Dr. Smith has found that IV sedation is far more effective than oral sedation at calming the fears of his patients and allowing them to get the work that they need done with only a hazy memory of having been in the chair.

The three techniques are nitrous oxide, oral sedation, and IV sedation.

NITROUS OXIDE

The patient breathes a combination of nitrous oxide and oxygen reaching a very mild state of sedation.

Pros of Nitrous Oxide

Patient does not need a driver. After 5-10 minutes the effects will completely wear off

• Patient can eat prior to the appointment without any danger
• Very few side effects
• Rapid onset
• Excellent for mildly scared patients or for minor procedures
• Easy to stop the sedation(just take the mask off the patient)

Cons of Nitrous Oxide

• The level of sedation is quite limited and on some people they will be only mildly sedated
• Not very good for scared patients or patients undergoing surgery like implants or extractions.
• Patient will have complete memory of everything that happened during the dental appointment.

ORAL SEDATION

The patient takes a pill (triazolam) one hour prior to the appointment. A driver brings them to the office, and they are often given a little more medication. Most patients will then begin to feel sedated and the dental work is started. Dr. Smith will attempt to give enough medication to prevent them from getting too sleepy, but it is difficult to control how sleepy the patient gets because people react so differently to the different levels of medication. In the interest of safety, Dr. Smith will lean towards safety and not oversedate the patient. Sometimes the patient does not get as sedated as they want to be. The medication lasts for about 2 hours and the patient has a driver to take them home. The medications are longer acting than either of the other two methods, so the rest of the day you will feel out of it and you will not be able to work.

Pros to oral sedation

• Easy to administer: Swallow a small pill
• Safe and easy to monitor
• About half the people will have limited memory of the procedure

Cons to oral sedation

• Difficult to control the level of sedation so a little higher chance of over sedation and a much higher chance of patient feeling like they were not sedated enough
• Must have a driver to and from the office
• Patient must not eat or drink prior to the procedure
• Not great for longer surgical cases because the sedation level cannot be predicted
• More difficult to administer reversal drugs

IV CONSCIOUS SEDATION

The patient often takes a small amount of oral medication to relax them for the start of the IV. The IV is started and medications are given that will bring them to a level of sedation where they are very sleepy, but still able to respond if we talk to them or shake them. Monitors are placed on the patient to measure breathing, oxygen levels, blood pressure and pulse. The level of sedation is very well controlled. If the patient starts to become a little more awake, a little more medication is given. If the patient becomes a little bit too sleepy, reversal agents may be given to quickly get them back to a more moderate level of sedation. All medications used have reversal agents. Through the IV, pain medications are given which will significantly reduce the amount of pain after the procedure. The medications used wear off much more quickly than the oral sedatives, so the patient feels better when they get home.

Pros of IV Conscious Sedation

• Patient will have little or no memory of most of the dental work done
• Patient will have a predictable level of sedation
• Patient can reach a deeper level of sedation with a greater degree of safety

Cons of IV Conscious Sedation

• Patient must not eat or drink 8 hours prior to procedure
• Patient must have driver to and from the appointment