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. If sedation is recommended, 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.

Depending on the type of sedation, dentists require different levels of training or additional assistance in the process of administering sedation. Different types of sedation also require specific sedation safety protocols, medications, and equipment.

Oral sedatives are medications you swallow, usually as a pill, but some are liquids. Oral sedatives are the most efficient means of providing minimal to moderate sedation and can be a good alternative when prescribed and taken responsibly. You continue to breathe on your own. You may or may not remember the procedure depending on the medication used.

Oral sedatives must be taken in advance of your dental procedure to give them time to take effect. Some oral sedatives may even be taken the night before the procedure. It is not possible to adjust the dosage during the dental procedure as can be done with other forms of sedation.

Never take other substances such as alcohol, narcotic pain relievers, or insomnia medications when taking oral sedatives. Always consult your dentist to understand other possible risks.

Before the procedure

• For some types of oral sedation, your dentist may require you to go without eating or drinking for a period of time.
• It is essential to arrange for someone to drive you to and from your dental appointment. Most sedatives impair your ability to operate machinery, drive a vehicle, or perform other activities requiring normal motor function.
• Your dentist may prescribe certain medications that you can take the evening before your procedure to help you get a good night's sleep.

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 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. You may not be able to comprehend informed consent forms or questions describing your dental procedure while sedated.
• Your dentist will prescribe the minimum effective dose to allow you to be comfortably treated. You should not take more than the prescribed amount, even if you don't feel "sedated enough." If you still don't feel "sedated enough" when you get to the dental office, let your dentist know. Generally, they will recommend a different dose or medication to be taken, and your appointment will be rescheduled for a later date.

During the procedure

• For more extensive treatments, your dentist may give you a local anesthetic in the region of the dental procedure. If you experience any pain as the local or oral sedation wears off, let your dentist know.
• Once you are appropriately sedated, the dentist will perform the dental procedure(s).

After the procedure

• Your dentist will ensure that you become fully awake from the sedation.
• Your dentist will tell you how long the sedation should last based on the medication that was administered.
• 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 dental procedure. It is important that any pain medications not interact with or add to the sedative effect of the one you took for the procedure.

• Medication control: Oral sedatives cannot be administered a little at a time until the right dose is reached (titrated). This can result in under-sedation or over-sedation. In addition, it is difficult for your dentist to predict how you will respond to an oral sedative accurately. As a result, it is more difficult to achieve the exact dose that will provide you safe and effective sedation.
• Breathing risks: In rare cases, oral sedation can depress spontaneous breathing and present a life-threatening situation in cases of over-sedation.
• Diminished capacity: Oral sedation can impair your ability to safely drive, operate machinery, or perform other motor functions. You may not be fully aware of your impaired abilities and must be supervised until your motor function is normal. Your dentist can help determine how long the period of sedation should last.
• 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.
• Drug interactions: When combined with other sedatives or opioids, oral 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, or alcohol.
• Sleep apnea and obesity: If you are obese or have obstructive sleep apnea, you may be more likely to develop complications.
• Over-sedation: If you take an oral sedative before your dental appointment, there is no way for your dentist to be completely certain that you ingested the appropriate dosage of medication. The only way for your dentist to be certain is if they administer the oral sedative in the office. This may be inconvenient since it requires you to arrive early for your appointment and time for the sedative to take effect.
• Under-sedation: If you are under-sedated at the time of the appointment, you may need to have your appointment rescheduled and have your dentist adjust the dose or the medication used. In general, you should not be given more oral sedatives on the same day.

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.
  • Some dentists have videos you can watch during a procedure.
  • You may want to bring a comfortable pillow, a warm blanket, or a stuffed animal.
  • Some dentists may allow you to bring a candle or potpourri to help you relax. If oxygen is in use in the office, a candle may not be an option.
  • 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.

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 oral sedation medicine do you recommend for me and why? What are the risks and benefits?
• What dose of the sedative is appropriate for my age, weight, and health.
• What are the effects of this sedation? How long will I "be out"? Does the medication break down into compounds that also have a sedative effect? If so, how long will those last?
• Will this type of sedation interact with my medications or complicate any of my medical conditions?
• Do you have current credentials to administer this type of sedation?
• Can you describe the training and monitoring equipment you have in place for sedation?
• What happens if I show up for my appointment under-sedated?
• Will you be recommending other sedatives in conjunction with the pills? If so, how will you ensure that I am not over-sedated?
• What are your procedures in the event of an emergency? Does your dental office have the required reversal drugs in case complications arise? Does someone monitor those to be sure they have not expired?
• If a complication from the procedure occurs, will the sedation make it more challenging 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?