Prepare for a Visit

Sedation is the process of administering a drug to produce unconsciousness, or various states of calm, loss of sensation, awareness of the procedure, or loss of memory. There are many reasons to choose sedation. There are different types of sedation that produce different levels of sedation. The goal is for you and your dentist to agree on the appropriate type and to use the minimal amount needed to produce the necessary comfort and safety to successfully complete your dental procedure.

Intravenous (IV) sedation is typically administered through a vein in your hand or arm. Not all dentists are certified to administer intravenous sedation. Those that are must have current sedation administration and advanced cardiac life support (ACLS) certifications. Some dentists contract with anesthesiologists or certified nurse anesthetists to provide IV sedation in their offices. Different types of sedation also require specific sedation safety protocols.

With IV sedation, you remain conscious but may have the impression you are asleep and will most likely not have any memory of the procedure. Your dentist controls the amount of medication by administering it slowly and continuously measuring its effects. This allows your dentist to monitor your response and achieve the precise dosage. Doing so reduces the chance that you will be under or over-sedated.

With many IV sedation forms, your dentist can also rapidly reverse the sedation if they notice any complications. One such exception is propofol, which is commonly used for IV sedation in dental procedures. Although doxapram may accelerate awakening in cases of oversedation or overdose, if you receive propofol you must continue to receive life-supporting measures until the medication wears off.

Before the procedure

• For some types of IV sedation, your dentist may require you to go without eating or drinking for a period of time.
• It is important to arrange for someone to drive you to and from your dental appointment. Most IV sedatives impair your ability to drive, operate machinery, or perform other activities requiring normal motor function. Depending on the medication used, this effect may last hours or as much as an entire day.
• Before you are sedated:
  • You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment, and provide appropriate post-care guidance. Get important information here: Health history and current health status.
  • You should have a thorough understanding of the risks and complications of oral sedation. Ask about the specific medications your dentist will use, and the steps that will be taken in the event complications occur.
  • You should discuss the treatment plan for your procedure(s) and review your options with your dentist in advance of the dental procedure. You will not be able to comprehend informed consent forms or questions describing your dental procedure while sedated and cannot legally provide informed consent at that time.

During the procedure

• Your dentist will disinfect the injection site and insert a catheter (a needle with tubing attached) into a vein in your hand or arm. Once the tubing is in place, the needle is withdrawn. The catheter is connected to a bag of fluid, which is typically a sterile mixture of dextrose (a type of sugar) and water. Your dentist can control the flow rate of fluid with a valve on the tubing.
• The sedative is dripped into the fluid slowly so your dentist can observe changes in your behavior as the medication begins to take effect.
• Your dentist or a trained assistant will monitor your heart rate, respiration rate, blood pressure, and oxygen levels throughout the procedure to be sure you remain safely sedated.
• When you are appropriately sedated, your dentist will perform the dental procedure(s).
• Several minutes before the procedure ends, your dentist will stop dispensing the sedative into the IV tubing.

After the procedure

• Following the procedure, you will generally be allowed to "awaken" on your own. You will be supervised while you 'awake' from the sedation. In rare cases, the medication may be rapidly reversed with a drug administered under your tongue, as a nasal spray, or injected into a muscle.
• Even if you feel fully alert, you must have someone take you home.
• Your dentist may recommend or prescribe medication to help with pain management from the procedure.

• Your reaction to IV sedation: IV sedation requires a needle to be inserted into your hand or arm. If you are excessively anxious or fearful of this process, IV sedation may not be a good option for you. If you decide to get sedation for your dental procedure, keep in mind that you will most likely not remember it. The inability to remember what happened can make some people uncomfortable or anxious.
• Breathing risks: In rare cases, IV sedation can depress spontaneous breathing and present a life-threatening situation in cases of over-sedation. Some IV sedatives do not have a rapid reversal drug in case of over-sedation or overdose. This may present additional risks.
• Individuals with special needs: People with special needs may not have the ability to cooperate during dental procedures. Even with capable dental staff and a relaxed setting, special needs patients may require some form of sedation. If you have concerns, be sure to share your questions and concerns with your dentist.
• Diminished capacity: IV sedation can impair your ability to safely drive, operate machinery, or perform other motor functions. It may take up to 24 hours for you to fully recover from the effects. You may not be fully aware of your impaired abilities and should be supervised until your motor function is normal. Your dentist can help determine how long the period of sedation should last.
• Drug interactions: When combined with other sedatives or opioids, IV sedation can depress breathing and present a life-threatening situation. It can also have a life-threatening effect when combined with other central nervous system depressants you may be taking, including narcotic pain relievers, insomnia medications, and alcohol.
• Over-sedation: Sometimes, more than one sedative may be given (for example, nitrous oxide in conjunction with IV sedation), causing a potential risk of over-sedation. Be sure you understand the purpose of all medications that may be used to control your level of sedation. While IV sedation is intended to calm and relax you while still conscious, it is possible to be over-sedated to the point where you lose consciousness. If you lose consciousness, your dentist or trained anesthesia professional will stop the sedation and take measures to revive you to a conscious state. In some cases, a reversal drug may be used. Propofol, for example, has no rapid reversal drug, although doxapram may accelerate its reversal significantly.
• Sleep apnea and obesity: If you are obese or have obstructive sleep apnea, you may be more likely to develop complications.

• Hypoventilation: There is a risk of slow and ineffective breathing (hypoventilation) during IV sedation. Your breathing and blood oxygen will be constantly monitored throughout the sedation. If hypoventilation occurs, your dentist or anesthesia professional will encourage you to breathe. In some cases, they will administer supplemental oxygen.

While not direct alternatives to sedation, there are some things you can do to help you relax for your dental procedure.

• Get a massage or other treatment before the procedure to provide a relaxed feeling.
• Bring something that comforts you to the dental office.
  • Many people like to listen to music.
  • You may want to bring a comfortable pillow, a warm blanket, or a stuffed animal.
  • A dentist's chair-side manner can make a big difference. A dentist with a soothing voice, sincere compassion for your dental needs, and a gentle, unhurried pace can go a long way toward making you comfortable and less anxious.

If you delay or avoid necessary dental care, it can have significant consequences, including pain, periodontal disease, abscesses, tooth decay, missing teeth, and jaw problems. In rare cases, life-threatening infections can occur.

Delayed treatment and poor oral health can also lead to complications in other parts of your body. For example, periodontal disease can lead to subsequent development of cardiovascular disease, strokes, or other conditions of the body.

• Which IV sedation medicine do you recommend for me and why? What are the risks and benefits?
• Is there a rapid reversal agent available for the type of sedative you plan to use? Do you have it in your practice, and what is its expiration date?
• If there is no rapid reversal agent available for the type of sedative you plan to use, why is it being recommended, and what will happen in the event of overdose or over sedation?
• What sedative dose is appropriate for my age and health status?
• What are the effects of this sedation? How long will I 'be out'?
• Will this type of sedation counteract my medications or complicate any medical conditions?
• Can you show me your certification to administer this type of sedation? If the dentist will not perform the sedation, what are the credentials of the person who will?
• Can you describe the training and monitoring equipment you have in place?
• What are your procedures in the event of an emergency?
• If a complication from the procedure occurs, will the sedation make it more difficult to address?
• Will you recommend or prescribe pain medication to use after the procedure? Will it have an additive sedation effect on the sedative? When will it be safe to begin taking these pain relievers?
• How soon after the sedation will it be safe to return to work, drive or use machinery?