SEDATION DENTISTRY: OVERCOME DENTIST FEAR!

• Do you suffer from dental anxiety? Dentist fear is very common, you are not alone! 
• Are you considering a dental procedure that scares you like a root canal or wisdom tooth removal?
• Are you confused by all the words thrown about, including Sedation Dentistry / Sleep Dentistry/ Oral Sedation Dentistry/ Conscious Sedation/ Dental Anaesthesia/ IV Sedation/ Laughing Gas/ Nitrous Oxide/ Oral Sedation/ Sedation Dentist… AND The List Goes On….
• Is your child in need of dental work and you are concerned that your little one will not tolerate the procedure well?

If any of the above is true and your fear of the dentist has kept you busy searching the internet for a solution, you have come to the right place! 

No matter where you live, the information below will sort out all the confusion and guide you to not only get the dental work that you or your loved one needs, but also help you overcome dentist fear.

What is Sedation Dentistry?

Sedation Dentistry is the use of drugs to help a patient feel relaxed and be pain-free during a dental appointment. Most people refer to “sedation dentistry” as “sleep dentistry”; however they are not the same thing. There are 4 levels of sedation dentistry, only the deepest level of sedation dentistry is sleep dentistry.

Which of the 4 levels of Sedation Dentistry is right for you?

The level of sedation dentistry that is the best choice for you depends on 2 factors:

• How severe is your dental anxiety?
• How involved is the dental procedure that you will be undergoing?

The greater your dentist fear the higher the level of sedation that should be used to ensure complete comfort.

Sedation dentistry can be used for any dental procedure from simple cleaning to invasive dental surgery. The more involved the dental procedure the higher the level of sedation that should be used.

Level 1: Minimal sedation

• you are awake but feel more relaxed

Level 2: Moderate sedation

• you drift in and out of sleep, hence you will remember only parts of the dental appointment
• you can be easily awakened

Level 3: Deep sedation

• you are on the edge of being asleep, hence you will unlikely remember any parts of the dental appointment
• you can not be easily awakened but will respond following repeated or painful stimulation

Level 4: General Anesthesia = Sleep Dentistry= Dental Anesthesia = Anesthesia

• all 4 of these terms mean the same thing
• you are asleep throughout the whole procedure, therefore will not remember any part of the dental appointment
• you can not be awakened even with painful stimulation

The Most Common Sedation Dentistry Drugs and Methods of Delivery:

Nitrous oxide = Laughing gas:

• The most common form of sedation dentistry
• Nitrous oxide is an odourless, colourless, non-irritating gas
• It is administered through a mask that covers your nose
• It takes a few minutes of breathing through your nose to feel relaxed and carefree, it also reduces the ability to perceive pain
• It doesn’t put you to sleep
• It achieves Level 1: Minimal Sedation to Level 2: Moderate Sedation
• The level of sedation can be easily and quickly adjusted as the amount of laughing gas can be increased or decreased 
• It is an extremely safe form of sedation; it is commonly administered to women in labour to reduce pain and fear
• It is the only form of sedation that is completely worn off before leaving the dental office, therefore, almost always those who receive laughing gas can drive themselves home after their appointment!

Oral sedation:

• Oral sedatives are pills that can be swallowed or dissolved under the tongue
• The best class of drugs to use for oral sedation are benzodiazepines such as Diazepam (Valium), Triazolam (Halcion), Midazolam (Versed), Lorazepam (Ativan)
• Although oral sedatives don’t put you to sleep, most patients experience partial or complete amnesia after taking a benzodiazepine and hence after the effects are worn off it is common for a patient to mistakenly believe they were asleep for the dental procedure
• Oral sedatives make you feel sleepy and groggy and take hours to wear off, so you must have someone drive you to and from your dental appointment
• Achieves Level 1: Minimal Sedation to Level 2: Moderate Sedation
• The level of sedation can NOT be easily controlled as different people respond differently to oral sedatives

Combination of Laughing gas and Oral Sedation:

• Achieves Level 2: Moderate Sedation to Level 3: Deep Sedation
• Some control over the level of sedation

IV sedation:

• Achieves Level 2: Moderate Sedation to Level 3: Deep Sedation
• The Level of sedation is controlled by the type and dose of sedation drugs
• The drugs are administered directly into the bloodstream through an I.V. line in the vein of the hand or arm
• Moderate Sedation is achieved by using a benzodiazepine, most commonly midazolam or diazepam
• Deep Sedation is achieved using a benzodiazepine and an opioid
• Deep IV sedation puts you in a state, where you fade in and out of consciousness, but you are unlikely to feel pain or remember the procedure

General Anaesthesia:

Going to sleep for dental work or a medical procedure is not like going to bed at night! General Anesthesia is the administration of medications that make a person lose consciousness.

A person’s ability to maintain an airway is commonly compromised, protective reflexes are often absent and breathing is often depressed. As such, to maximize safety, general anesthesia should be administered by a medical doctor that is specifically trained in anesthesia. Furthermore, choose a medical anesthesiologist that has extensive experience in the administration of general anesthesia at a dental office!

The recommendation of General Anaesthesia should NOT be taken lightly. This deepest level of Sedation Dentistry should be reserved for patients:

• With high dental anxiety
• Patients undergoing an involved and/or lengthy dental procedure
• Young patients who are unable or unwilling to have dental work done any other way
• Patients with severe gag reflexes
• Patients that are unable (allergy) or unwilling (fear) to have dental freezing
• Patients for whom dental freezing does not work

Regardless of the type of sedation you receive, your dentist will administer a local anesthetic (dental freezing) to ensure your comfort during and after the procedure.

Consumer Beware: Pitfalls With Sedation in Dentistry

Most of the dental offices that do offer sedation dentistry ONLY offer Level 1: Minimal Sedation and Level 2: Moderate Sedation. These dentists often refer to themselves as “sedation dentists”. You are at risk of not getting a high enough level of sedation and your level of comfort may be compromised as the higher levels of sedation are not available at these dental offices.

Administration of Level 3: Deep Sedation and Level 4: Sleep Dentistry requires specialized training and equipment and as such these offices are rare and tend to do ONLY these levels of sedation dentistry. Furthermore, these offices are often restricted to performing only certain dental procedures. Here you are at risk of having a level of sedation that is deeper than you need for your level of dentist fear and the type of dental procedure that you are undergoing. Which may not seem like a big deal, but the deeper the level of sedation the more costly it is and the longer the recovery is.

It is in your best interest to choose a dental office that offers all 4 levels of sedation for dentistry and offers all dental procedures. The level of sedation will be tailored to your specific needs for the specific procedure that you are getting done.

CONCLUSION: STEPS for YOU to Take to Conquer Dentist Fear

1. Find a dental office that administers all 4 levels of sedation dentistry
2. Make sure that the highest level of sedation: General Anesthesia is being administered by a medical doctor trained in anesthesia and has extensive experience working at dentist offices
3. Meet with the dentist that will be performing the dental work for you:
   • Is the dentist only interested in getting the dental work done or has a higher goal for you: CONQUER DENTIST FEAR?
   • Is the dentist attuned to your emotional state?
   • Does the dentist want to use the lowest level of Sedation Dentistry to ensure your comfort OR will always be using the highest level of Sedation Dentistry to maximize the cost of sedation dentistry?

Being dependent on sedation dentistry to get your dental work done does not give you an opportunity to be free of dental anxiety. A compassionate dentist will help you conquer dentist fear by skillfully and over time decreasing the Level of Sedation as your trust and comfort level increases so that one day you can have dental work done fully awake without the help of Sedation Dentistry! 👍😀

In the best interest of your health and well-being,

Dr. Joanne Baldos and Dr. Adam Szymczak