Sedation Dentistry: Eliminating Dental Anxiety

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Medically Reviewed
by Dr. Lara Coseo
Alyssa Hill
Written by
Alyssa Hill
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What is Sedation Dentistry?

Conscious sedation dentistry involves the administration of sedative drugs to reduce anxiety before dental procedures.

The sedative drugs can be administered orally, intravenously (IV), or through inhalation (nitrous oxide).

Sedation dentists generally administer sedatives to those who suffer from dental phobia. People with generalized anxiety, belonephobia (fear of needles), and previous dental trauma are also candidates for sedation.

Patients with high anxiety levels may be sedated before receiving an injection of anesthesia (pain control medicine), especially if they have a fear of needles.

Benefits of Sedation Dentistry

Patients with dentophobia typically refrain from visiting the dentist due to fear. However, neglecting dental treatment results in a higher chance of developing gum disease, cavities, and other oral conditions.

With sedation dentistry, more people are able to visit the dentist with less uncontrollable fears and anxieties about treatment.

Long and complex procedures typically involve sedatives, which may benefit people who have:

  • Dental phobia
  • Extreme anxiety or fear of needles
  • Sensitive teeth
  • Sensitive gag reflexes
  • Low pain thresholds

Regular Anxiety vs. Dental Phobia

Anxiety or fear of receiving dental treatment is not uncommon. It affects about three-fourths of the American population. About five to ten percent of people experience dental phobia (also called dental fear, dental anxiety, or dentophobia).

By definition, dental phobia is the intense fear of visiting the dentist. Sedation dentistry is the ideal option for those with dentophobia. Those with minor fears and anxieties about dental treatment do not typically need sedatives.

The definition of "phobia" is something that is:

  • Irrational to the demands of the situation
  • Beyond voluntary control
  • Inexplainable
  • Persistent long-term
  • Not age-specific

What Causes Dental Anxiety?

Dental phobia develops over time and may be attributed to:

  • Previous traumatic dental experiences
  • Outside influences
  • Childhood anxiety
  • Fear of the dental office environment in general

1. Childhood Anxiety and Fears

Dentophobia is a function of personality development that is associated with feelings of abandonment and helplessness. If a child grows up with anxiety and continues to experience it into adulthood, they are more likely to develop phobias.

Sufferers of dental anxiety also typically find the smells, sounds (such as drills), and sights of dental surgery overwhelming. In some cases, simply seeing a dentist in a white coat can trigger dental anxiety.

Dental fears can even be associated with extreme childhood fears. These fears may include the dark, thunder, certain animals, imaginary figures, or being alone in a dentist's chair as a child.

2. Traumatic Dental Experiences

Frightening, embarrassing, or painful dental experiences are the primary causes of dental anxiety, especially in children. If a patient had a negative experience with a dentist in the past, they may end up mistrusting all dentists.

3. Dental Office Environment

Dental anxiety can be induced by just thinking about a dentist visit or by actually experiencing one. This may include:

  • Anesthesia injections, needles, or sharp objects
  • The sound of dental drills, tools, and scraping of the teet
  • The dentist’s mannerisms, attitude, and personality
  • Fear of criticism by the dentist

3. Outside Influences

Hearing negative comments about dentistry can induce fears about treatment from a young age. This can also increase dental anxiety over time and often results in unpleasant experiences.

Types of Sedation

Sedation dentists determine which sedation is best for each patient based on:

  • The procedure type (invasive or minor)
  • The patient’s preference
  • The patient's medical history

There are three main types of sedation, including:

Laughing Gas (Anxiolysis)

Laughing gas (anxiolysis) consists of nitrous oxide that is administered through inhalation. Combining local anesthesia and laughing gas during dental procedures reduces feelings of anxiety, pain, and fear.

Laughing gas is a form of conscious sedation, which means it does not put you to sleep. The effects of nitrous oxide are almost instant after the mask is placed (about 30 seconds).

Patients on laughing gas have to breathe 100% oxygen for five minutes before removing the mask. The effects wear off quickly once your begin to breathe oxygen again.

Oral Sedation

Oral sedation is a “premedication.” Patients take this type of sedative before a surgical or invasive dental procedure.

The premedication offers a safe approach to sedation that is not administered through an injection. It is more potent than inhalation sedation (laughing gas).

Oral sedation requires less cooperation between the dentist and patient. This is because patients often fall asleep after taking oral sedatives.

Oral sedatives help manage anxious patients under conscious sedation. They may be taken:

  • The night before the procedure to help reduce anxiety
  • One to two hours before treatment to help reduce anxiety
  • Before a needle is administered (for those who are needle phobic)

Intravenous Sedation (IV Sedation)

IV sedation, also referred to as deep sedation, is a conscious form of sedation. The drug makes patients very sleepy and almost completely unaware of their surroundings. Dentists use this type of sedation during oral surgeries.

Modern IV sedatives consist of benzodiazepines, such as diazepam or valium. The drugs act in the central nervous system (CNS) to reduce anxiety and produce hypnotic sensations.

An IV sedation acts very quickly after administration and the effects can last for a few hours after treatment is complete.

Under IV sedation, most patients do not remember anything during the procedure. However, they remain completely conscious. Your dentist can also easily wake you up at any time.

Common surgeries that require IV sedation include:

How to Prepare for IV Sedation

Preparing for IV sedation is essential to help put you at ease before the surgery.

Avoid eating or drinking anything for 6 to 12 hours before your appointment. Also, wear comfortable clothes and refrain from taking any medications (unless approved). You won't be able to drive after you wake up, so make sure you have a ride set up beforehand.

After the sedative is administered, you won't feel anything during the procedure. You also won't remember the procedure when you wake up. Don't be alarmed, though, because your dentist will monitor your vitals during the procedure. They can also adjust your dose based on your needs.

After the procedure, you will feel drowsy for a few hours. This is why it's essential to have someone drive you home afterward.

You may also be tired and sore, so call out of work and rest for 24 to 72 hours. Avoid intense exercise, alcohol, coffee, unapproved medications, and driving for 24 hours as well.

Benefits of IV Sedation

Benefits of IV sedation dentistry include:

  1. The drug starts working quickly, which means you will not feel pain during the procedure
  2. You won't remember the procedure when you wake up (amnesia)
  3. Multiple procedures can be performed during one appointment
  4. Your dentist can easily adjust your dosage during the procedure

Intramuscular Sedation

Intramuscular sedation is less commonly used in dentistry. It involves injecting a sedative drug into the muscles of the upper arm or thigh. The effects occur within five minutes.

Deep Sedation and General Anesthesia

Deep sedation is achieved with general anesthesia or IV sedation. This level of sedation causes depressed consciousness. The patient may not be able to breath independently and will lose some of their reflexes. The effects can last for hours after the procedure is done.

3 Possible Side Effects of Sedation Dentistry

Sedation dentistry is a common and safe treatment. Before administration, the dentist should be aware of your full medical history and any allergies to ensure complications are avoided.

Side effects are rare, but may include:

  • Nausea (before or post-procedure)
  • Drowsiness or sleepiness (post-procedure)
  • Dizziness (before or post-procedure)

How Much Does Sedation Cost?

The cost of sedation varies depending on the type of drug needed:

  • The cost of laughing gas ranges between $50 and $60
  • Moderate sedation (IV sedation) costs between $290 to $350 for the first 30 minutes
  • Deep sedation costs $180 for the first 30 minutes

Resources

Boyle, C A, et al. “Who Is Referred for Sedation for Dentistry and Why?” British Dental Journal, U.S. National Library of Medicine, 28 Mar. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC3812064/.

Girdler, N. M., et al. Conscious Sedation for Dentistry. John Wiley & Sons Ltd., 2018.

Harbuz, Diana Krystyna, and Michael O'Halloran. “Techniques to Administer Oral, Inhalational, and IV Sedation in Dentistry.” The Australasian Medical Journal, Australasian Medical Journal, 29 Feb. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC4780209/.

Stamp, A J, et al. “Can Intravenous Conscious Sedation with Midazolam Be Effective at Facilitating Surgical Dentistry in Adolescent Orthodontic Patients? A Service Evaluation.” British Dental Journal, U.S. National Library of Medicine, 27 Jan. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5501314/.

Working Group on Guidelines Development for Intravenous Sedation in Dentistry, the Japanese Dental Society of Anesthesiology. “Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017).” Anesthesia Progress, American Dental Society of Anesthisiology, 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6318731/.

Yoon, Ji-Young, and Eun-Jung Kim. “Current Trends in Intravenous Sedative Drugs for Dental Procedures.” Journal of Dental Anesthesia and Pain Medicine, The Korean Dental Society of Anesthsiology, June 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5564087/.

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