Sedation dentistry
Sedation dentistry uses a combination of techniques, ranging from nitrous oxide or "laughing gas" to general anesthesia, to relax a patient during surgeries or otherwise uncomfortable appointments. For even the most severe dental phobias, there is no longer a reason to avoid the dentist altogether. The dental office has long been the most common setting for routine dental procedures that use sedation and anti-anxiety techniques. These techniques can be used for any type of dental procedure depending on the needs of the patient. Ultimately, your fears and phobias can be managed so that you can receive the dental care you require no matter where the treatment takes place.
Are You a Candidate for Sedation?
Your overall health, as well as physical and mental conditions you may be battling at the time, are important to be able to safely undergo certain types of sedation especially in the dental office. Certain of these conditions may require clearance from a physician: cardiac disease, hypertension, diabetes and respiratory diseases should all be addressed prior to a given type of sedation. Your dentist will take a thorough medical history and physical assessment before proceeding, He or she may also ask you to receive medical clearance from your physician.
Types of Dental Sedation
1) Laughing Gas
Probably the most common form of sedation in the dental office is nitrous oxide, or "laughing gas." Also called inhalation analgesia – and used to alleviate pain when giving birth, according to the National Institutes of Health (NIH) – nitrous oxide does not put you to sleep, and is effective at reducing your anxiety about a dental procedure. It is very safe and provided in most dental offices. Local injections of anesthesia, which are still used in combination with nitrous oxide, now see consistent effectiveness, and some are practically painless. Nonetheless, the gas can be administered by a machine to further
2) Enteral Sedation
The next type of sedation comes in the form of a pill or liquid that you take orally. This is called enteral sedation. Like local anesthetics, oftentimes it is used in combination with nitrous oxide. You may still be awake, but not nervous about the dental work.
3) IV Sedation
Intravaneous (IV) sedation is another common method of anti-anxiety wherein the sedative is directly injected to a vein. This technique will allow the dentist to provide a deeper sedation, although you will still be awake but less aware of the procedure. The process requires recovery time after you leave the office.
4) General Anesthesia
General anesthesia is a form of sedation by which you will be asleep for the entire procedure. It is practiced using drugs that are directly injected into a vein, along with the possible inhalation of a gaseous anesthetic. A thorough recovery time in the office may be required before leaving.Sedation in dentistry has been a controversial topic due to questions being raised over its safety, especially in dental chair. Dental fear and anxiety are not only common in children but also significantly prevalent among adults due to high intensity of pain. Sharing of airway between the anesthesiologist and the dentist remains the greatest challenge. The purpose of this review is to study the recent trends in conscious sedation in the field of dentistry from an anesthesiologist's perspective. It will provide a practical outline of the pharmacokinetics, pharmacodynamics, and routes of administration of the drugs or gases used.
5) Conscious Sedation
Conscious sedation is a technique in which the use of a drug or drugs produces a state of depression of the central nervous system (CNS) enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely. Conscious sedation retains the patient's ability to maintain a patent airway independently and continuously.
CHALLENGES OF DENTAL CONCIOUS SEDATION
The challenges in dental conscious sedation are as under:
- Shared airway between the dentist and the anesthesiologist
- Phobia and anxiety
- Coexisting medical conditions such as cardiac anomalies, mental instability, and epilepsy
- Chances of arrhythmias during surgery due to trigeminal nerve stimulation
- Enlarged tonsils and adenoids in children likely to precipitate respiratory obstruction
- Risk of patient losing consciousness, respiratory, and cardiovascular depression
- Vasovagal syncope due to the dependent position of legs in dental chair.
The anesthesiologist should be well prepared to face and tackle all the anticipated challenges as enumerated above. A detailed and thorough pre-sedation checkup comprising assessment of airway, cardio-respiratory system, any congenital abnormality, medication history, and allergy must be done. The operating area should be well equipped with all the resuscitation drugs/equipment required to resuscitate the patient in case of emergency.
INDCATIONS FOR CONCIOUS SEDATION
- Dental phobia and anxiety
- Traumatic and long dental procedures
- Medical conditions aggravated by stress such as angina, asthma and epilepsy
- Children more than 1 year of age
- Mentally challenged individuals
- Ineffective local anesthesia due to any reason.