Finding sedation dentistry near you: A guide

If you are one of the millions of Americans with intense anxiety, or even fear, of going to the dentist, you may benefit from sedation dentistry. Sedation dentistry is a common solution for people with dental anxiety or dental phobia, and it is the practice of sedating the patient before their dental procedure. This allows the patient to “check out” during their dental procedure and often causes them to have no memory of the procedure once it is completed, which may help reduce future dental anxiety. Sedation dentistry is commonly used with adults who have dental anxiety or phobia, and some parents prefer that their children are mildly sedated during dental procedures, as this helps them be more cooperative and also less afraid of the procedure. Additionally, in cases where patients have medical issues that may cause tremors or involuntary movement, such as cerebral palsy or Parkinson’s Disease, sedation dentistry can significantly facilitate dental treatments. Sedation dentistry may also be used for patients who have an overactive gag reflex, or low pain threshold, or for patients who require an extensive amount of dental work. Sedation dentistry uses many different types of sedation, including nitrous oxide, benzodiazepines, and intravenous sedatives. These medications cause drowsiness and relaxation and virtually eliminate feelings of anxiety. This, in turn, helps the dental procedure go by more quickly, which may allow the dentist to accomplish more dental work in less time.

Sedation dentistry employs many different medications with a wide variety of levels of sedation. Inhaled minimal sedation uses nitrous oxide, which is inhaled by the patient through a mask, to help the patient relax. The amount of nitrous oxide gas that is administered through the mask can be controlled by your dentist, and the effects of nitrous oxide sedation wear off relatively quickly. Because of the quick recovery time, you may be able to drive yourself home following your procedure. Oral sedation, in which the patient administers a pill, ranges in effect from minimal to moderate. If minimal sedation is desired, your dentist will prescribe a benzodiazepine in pill form, usually Halcion, and you will take this pill about an hour before your procedure. Though you will remain awake, the pill will make you drowsy and relaxed. If moderate sedation is desired, your dentist will prescribe a higher dosage of pill. This dosage may be high enough to induce sleep, though patients may be easily awakened if movement or responsiveness is necessary. Moderate sedation may also be achieved with an intravenous sedative. This intravenous delivery allows the sedative to go into effect more quickly than oral administration, and it also allows the dentist to monitor and adjust the sedation level. While under mild to moderate sedation, patients will also commonly receive a local anesthetic to numb the procedure site. Finally, deep sedation can be achieved with general anesthesia. While under deep sedation, patients are nearly or totally unconscious, and you will remain deeply asleep until the effects of anesthesia wear off or are medically reversed. Deep sedation with general anesthesia is usually reserved for more complex oral surgeries.

While the dental procedures associated with sedation dentistry may be covered by dental insurance, it is unlikely that the sedation itself will be covered. This can turn into a costly endeavor, as some sedation costs as much as $1000. Certain patients are not good candidates for sedation, and it is important for you to discuss any medical issues with your dentist before you undergo sedation dentistry. Because everyone responds differently to sedating medication, some patients require more medication than others, and risks may increase as dosage increases. Your dental team will closely monitor you while you are sedated. Children under 12 may have particularly adverse reactions to sedation, though small doses of nitrous oxide are unlikely to have negative side effects. A small percentage of pediatric dentists are trained to administer oral sedation to children, which can be safe if dosed carefully by a highly trained professional. Because of the risks associated with sedation dentistry, however, you will want to carefully screen any dental teams who are signed on to perform your procedure, making sure they’re licensed and accredited and all their training and inspections are up to date.

While most dentists can administer minimal sedation, and some can administer moderate sedation, dentists who intend to use deep sedation and general anesthesia must complete an accreditation program through the Commission on Dental Accreditation. These dentists are usually specialists, either in oral and maxillofacial surgery or in dental anesthesiology. Some dentists use a trained specialist in dental anesthesia to administer any level of dental sedation or anesthesia. In most states, dentists are required to hold a special permit in order to administer sedation. As with any anesthesia, there is risk involved with sedation dentistry, though choosing an experienced dentist can mitigate this risk. Some patients, however, such as people who are obese or people who have obstructive sleep apnea, may not respond well to sedation, so be sure to discuss any medical or health conditions openly with your dentist. Before any procedure, your dentist should review your entire medical history, including asking about any medications you may be taking, to determine whether you are a good candidate for sedation. You should ask your doctor about the dosage that is recommended for you and confirm that it is within the FDA-recommended dosage range. You should also ask how many similar procedures the dentist has performed, and learn about your dentist’s specific training in sedation. The more experienced a dentist is with sedation dentistry, the better. You will receive a form that explains the risk of your procedure. Review it carefully with your dentist and don’t be afraid to ask questions if anything is unclear. Dentists who perform sedation dentistry procedures are required to have emergency medical supplies on hand, including oxygen and drugs that reverse the effects of sedation, and they will monitor your vital signs while you are under sedation, to ensure that these emergency medical supplies are not needed.

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