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 complete your dental procedure successfully.

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.

For extensive dental procedures or individuals with special needs, your dentist may recommend general anesthesia. General anesthesia is often referred to as "being knocked out" or "put to sleep." It's administered by inhaling a gas that causes a medically induced coma and paralyzes most of your muscles. You are unconscious, feel no pain, and have no memory of the experience. You cannot breathe on your own and must breathe artificially through a tube supplied with oxygen or oxygen-enriched air (intubation).

While you are under general anesthesia, you cannot be awakened easily until the effects of the anesthesia wear off or are reversed with medication.

Few dentists other than oral and maxillofacial surgeons or dental anesthesiologists are certified to administer general anesthesia. When general anesthesia is recommended, many dentists prefer to bring in an anesthesiologist. Your dentist or trained professional will continuously measure and adjust the balance of the anesthesia delivered to reduce the risk of under-sedation or over-sedation. In some cases, your dentist may recommend that the procedure is performed at a hospital or surgical center where there are additional experts to handle emergencies.

Before the procedure

• Your dentist may require you to go without eating or drinking for a period of time before the procedure.
• It is important to arrange for someone to drive you to and from your dental appointment. Most sedatives impair your ability to drive, operate machinery, or perform other activities requiring normal motor function.
• 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 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 general anesthesia. 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 will not be able to comprehend informed consent forms or questions describing your dental procedure while sedated, and you do not legally have the ability to sign them while sedated to any degree.
• A specially-trained professional will monitor you while you are asleep and adjust your medication, breathing, temperature, fluid levels, and blood pressure as needed.
• Once you're asleep, you will not be able to breathe on your own. The dentist or anesthesiologist will insert a tube into your mouth and down your windpipe. The main purpose of the tube is to provide you with oxygen, but it also protects your lungs from inhaling blood or other fluids.
• You may be fitted with a special mask to help you breathe.

During the procedure

• Your dentist may give you a local anesthetic (injection) in the region of the procedure.
• Once you are sufficiently "under," your dentist will perform the dental procedure(s).
• When all procedures are complete, the dentist or anesthesiologist will reverse the medications to wake you up. You'll wake up slowly and may initially feel confused or groggy.

After the procedure

• Even if you feel fully alert, you must have a ride arranged to take you home.
• Your dentist may recommend or prescribe medication to help with pain management following the procedure.

General anesthesia may have specific risks not mentioned here. Your dentist will provide you with detailed information about the medication and process. Be sure you understand all of the risks and benefits of general anesthesia before beginning the procedure.

• Side effects: Some of the temporary side effects following general anesthesia include:
  • Fatigue/extended sedation
  • Nausea or vomiting
  • Hoarse voice
  • Sore throat
  • Sore muscles
  • Itching sensations
  • Cold/shivering
• Assistance: Because it may take up to 24 hours for you to fully recover from the effects of general anesthesia, you must have someone's help to get you home. You may also need additional help with tasks until you fully recover.
• Breathing risks: General anesthesia can eliminate spontaneous breathing and can present a life-threatening situation in cases of over-sedation.

• Diminished capacity: General anesthesia can impair your ability to drive, operate machinery, or perform other motor functions safely, even for a period of time after the procedure. You may not be fully aware of your impaired abilities and must be supervised until your motor functions are normal. Your dentist can help you determine how long the period of sedation should last based on the medication you are taking.
• 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.
• Additive effects: General anesthesia can have a potentially life-threatening additive effect on 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. Let your dentist know if you have sleep apnea. Your breathing will need to be carefully monitored during the sedation.
• Insurance coverage and cost: Ask your dentist about the cost of general anesthesia. It is the most expensive type of sedation, and some insurance plans may not consider this expense eligible for full coverage.

• Over-sedation: It is possible, though rare, to be over-sedated to the point where you never regain consciousness.
• Amnesic effects: If you decide to get general anesthesia for your dental procedure, keep in mind that you will not remember it. This inability to remember what happened could make you uncomfortable or anxious.
• Availability: Few dentists are certified to perform general anesthesia. Exceptions include oral and maxillofacial surgeons and dental anesthesiologists.
• Incontinence: General anesthesia only paralyzes specific muscles. It will not cause paralysis of the bladder or bowel muscles. You should not be concerned about incontinence when under the effects of general anesthesia.

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 as they are being sedated.
  • 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 may 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.

• What are the risks and benefits of general anesthesia for dental procedures?
• What are the effects of this sedation? How long will I "be out?"
• Will this type of sedation counteract my medications or medical conditions?
• What are your procedures in the event of an emergency?
• If a complication from the procedure occurs, will the sedation make it more challenging to address?
• Are all of your sedation administration and advanced cardiac life support certifications current?
• Can you describe the training and monitoring equipment you have in place?
• How soon after I wake up will it be safe to return to work, drive or use machinery?
• 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?