Sedation


Dr. Brian Wilson and the staff at Valley Endodontics understand that it is common and perfectly normal to have some degree of apprehension or anxiety prior to receiving dental treatment. Some people however, have stronger feelings in this regard than others. These feelings may have been produced by a less than pleasant past experience, stories told by family or friends, or by the nature of the dental procedure itself. We understand that dental treatment may be especially frightening to young children and patients with developmental disabilities.

At Valley Endodontics we have an unwavering commit to you and provide a range of dental sedation options for your wellbeing, comfort and safety. Dr. Brian Wilson has advanced training in sedation and is licensed to provide minimal to moderate sedation using intravenous (IV), oral (liquid or pill form) and inhalation (nitrous oxide) sedative medications. All of the surgical assisting staff at Valley Endodontics have advanced education and training in anesthesia monitoring and certification through the American Dental Society of Anesthesiology.

Whatever the cause, apprehension or anxiety can produce many unpleasant effects including heart palpitations, high blood pressure, upset stomach and trouble sleeping the night before the appointment. Many highly apprehensive patients avoid dental care for many years until their problems become so severe that they are forced to seek emergency care. Sedation dentistry is used to provide a more pleasant, relaxing and safer experience for the apprehensive patient.

What is Sedation and Anesthesia?

Sedation and anesthesia can make practically all dental and oral surgical procedures more pleasant and safer for the apprehensive patient. The anxiety that many people experience during a procedure can be controlled by administering sedative medications. A sedated patient will not only be more relaxed but may also have limited memory of the procedure performed. In some instances the patient may also receive additional medications which will place the patient deeply asleep in a state of general anesthesia. Sedation is different from local anesthesia. Although some forms of sedation (such as nitrous oxide inhalation) may raise your threshold for pain, a local anesthetic (such as Lidocaine) is also required to block the pain sensations during the procedure and to keep the mouth numb and comfortable during recovery.

Levels of Sedation

The levels of sedation ranges from minimal, to moderate, to deep sedation / general anesthesia and are achieved through the different types and amounts of sedative medication used.

Minimal sedation (Anxiolysis) means a minimally depressed level of consciousness, produced by non-intravenous methods, that retains the patient’s ability to independently and continuously maintain an airway (breath) and respond normally to tactile stimulation and verbal command. The most common approaches used to obtain minimal sedation included inhalation of nitrous oxide (laughing gas) or a single dose of a sedative medication given orally (a pill or liquid form). The maximum dose of the oral sedative medication that is given is no more than the maximum recommended dose (MRD) of the drug that can be prescribed for unmonitored home use. The reason for this is that oral medications take time to work and can buildup in your system when multiple doses are given over time. Excessive doses or multiple doses given over time, that exceed the maximum recommended dose (MRD), limit how safely you can be sedated.

Moderate sedation (Conscious sedation) means a moderate depressed level of consciousness in which a patient is able to maintain a patent airway (breath independently), maintain their protective airway reflexes, and respond purposefully to verbal commands and light tactile stimulation. Patients with this level of sedation often have minimal to no memory of the procedure due to the amnesia effects of the medication and many patients feel that they were asleep. Patients under moderate (conscious) sedation will often close their eyes and sleep during the procedure due to the relaxing effects of the medications being administered. What this means is that patients are able to respond to verbal commands (like “open your mouth” and “turn your head”) and light stimulation (like gentle shaking of the shoulder).

Deep sedation is a depressed level of consciousness in which patients are not easily aroused and may require repeated or painful stimulation to respond purposefully. The ability to independently maintain ventilatory function (breath) is frequently impaired and patients may require assistance in maintaining a patent airway and require assistance in breathing.

General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function (breath) is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation. Cardiovascular function may also be impaired.

How is the Medication Administered

Sedative medications can be administered by breathing (nitrous oxide – laughing gas), orally (in liquid or pill form), intranasal, intramuscular (IM) or intravenously (IV). Nitrous oxide is the most common agent used to treat apprehensive patients and can be used either by itself or in combination with other medications.

Nitrous Oxide

Nitrous Oxide / Oxygen Inhalation “Laughing Gas” is one of the most common medication used to treat mild anxiety and apprehension people experience with dental treatment. Nitrous oxide is a gas mixed with oxygen that is inhaled through a small silicone mask placed over your nose. The effects of nitrous oxide are to help produce a feeling of well being (euphoria), relaxation and comfort. Some patients will experience a sensation of heaviness, warmth, tingling or a feeling of vibration in the extremities. Some patients may also experience auditory effects in which their hearing may dissolve into a constant electronic like hum. The benefits of nitrous oxide inhalation included the following:

  1. It is extremely safe.
  2. The dose given can be titrated to a persons individual needs and the effects wear off quickly, typically within 5 – 10 minutes. If the only sedative medication used was nitrous oxide a patient may drive themselves home after their dental appointment.