According to statistics published by Dental Organization for Conscious Sedation, 30% of people do not like to visit their dentist to receive required dental treatment because of anxiety of suffering excruciating pain, needle prick, post treatment discomfort or fear of unknown or phobia of unseen complications during or after treatment. This failure to receive the necessary dental care on time because of patient’s fears and phobias can comprise the well being and functionality of their teeth and oral tissues.
Sedation dentistry is technique by which patients receive necessary dental treatment in a relaxed and anxiety-free state by administering anesthesia & sedative drugs during treatment. There are various types of sedation dentistry techniques which are used in dental practice today. The type and degree of dental sedation used by your dentist will depend on the complexity of dental treatment that has to be performed and your level of anxiety and panic. The two most commonly used techniques of sedation dentistry are Intravenous sedation and General Anesthesia. Let us discuss about each of these two techniques in more detail below.
Intravenous sedation is a technique where sedative and anti anxiety drugs are injected into blood stream of the patient via injection with a very needle into the vein of the hand or arm. This method of sedation is also called “Conscious Sedation” because when patient is put on intravenous sedation, patients retains consciousness and is able to understand and comply with the instructions of dentist during treatment, while remaining in deeply relaxed and anxiety free state. Intravenous sedation induces such a deep relaxation that patient does not feel concerned about what treatment was going on. The patient can often not remember how long the treatment lasted and what events happened during treatment because drugs used in intravenous sedation technique produce either partial or full memory loss, during the treatment period while the drugs maintains it effect in the blood circulation. Benzodiazepines are the most commonly used anti-anxiety sedative drugs used for intravenous sedation, most common being Midazolam. Midazolam is the first drug of choice among all other benzodiazepines because it has a relatively shorter duration of action (which means that patient can return to the normal state much faster) and it does not produce any burning sensation on your arm or hand when the drug is entering the body, unlike other benzodiazepines like Diazepam which produces a burning sensation. Once the intravenous sedation is administered patient looses all fear of needle pricks or surgical incisions or stitches in the mouth and any kind of local anesthesia is safely administered via local injection in oral tissues without evoking any anxiety or restless movements from patients. Intravenous sedation technique is also very beneficial for treating patients who have an instinctive gag reflex, which can not be controlled by psychological behavior training methods. Intravenous sedation diminishes gag reflex to significant degree. Specially in those patients who have a low tolerance level for procedures like removal of impacted tooth fragment in the distal part of the jaw which would involve bone cutting by machine, intravenous sedation helps the dentist to get the work done. While administering intravenous sedative drugs, the dentist can very easily administer additional pain killing drugs into bloodstream without any additional needle prick in arm or hand if it may be needed.
Intravenous sedation is very effective and safe when administered by a trained anesthesiologist. This is because the onset of action of intravenous sedative drug is very rapid and the recovery of patient back to normal state is also fast. The dose of drug required to produce a required level of sedation in a patient can be tailored according to individual’s need. This requires constant monitoring of rate of the sedative drug being administered intravenously by trained anesthesiologist. This intravenous sedation should not be administered by regular practicing dentist who has not been specially trained. This is because, not only the trained anesthesiologist has to monitor the effect the drug was producing on patient with each passing minute but also pulse, blood pressure and oxygen levels of patient have to be constantly monitored.
General anesthesia is the technique used for sedation when complex dental surgical procedures have to performed, for example, implant surgery, or surgery involved in removal of impacted tooth in jaw bone, or surgical operation involving fracture of jaw bones or surgery involving treatment of oral cancer etc.
General anesthesia is technique used in sedation dentistry which produces a state of controlled and reversible unconsciousness by a combination of intravenous drugs and inhaled gaseous anesthetics which induces deep sedation, muscle paralysis, loss of memory and lack of response to painful stimuli in the patient. General anesthesia brings the patient into such a physical and mental state where patient is able to undergo complex dental and surgical procedures which a conscious patient would find unable to tolerate due to excruciating pain or horrific memories. General anesthesia is ideally used in those cases where patient has to undergo surgical procedures for unpredictable duration or extent where proper muscle relaxation is required for prolonged periods of time. Propofol is the most commonly used induction drug given by intravenous injection while administering general anesthesia because it causes less postoperative nausea and more faster clear-headed recovery. Inhaled gaseous anesthetics which are used most commonly are chlorofluorocarbons. These are delivered to the patient’s inhaled gas stream with precise accuracy using vaporizers. In addition, opioid analgesic like fentanyl is given intravenously along with induction drug to produce synergistic effect while inducing anesthesia. The airway is secured and endotracheal tube is placed.
Unlike intravenous sedation, patient undergoing dental treatment under general anesthesia does not feel anything, is not able to respond to verbal instructions of the dentist during treatment, is not able to breathe independently without external aids, is not able to maintain adequate airway protection due to muscle paralysis and does not remember anything once the treatment is over. General anesthesia is a much more expensive technique of producing sedation as compared to intravenous sedation and it requires special preparation. Before patient can be given general anesthesia, patient has to undergo various laboratory tests like chest x-rays and ECG because the medical risks involved in general anesthetic sedation are much higher than intravenous sedation. Patient who has to be given general anesthesia can not eat or drink anything for 6 hours before starting the procedure as this could result in vomiting during general anesthesia procedure which could enter the respiratory tract in unconscious state.
Since general anesthesia causes the cardiovascular and respiratory systems of patient to be depressed, hence chances of complications are higher with general anesthesia as compared to intravenous sedation. General anesthesia for dental treatment should be administered only in a hospital setting well equipped with all necessary critical care facilities and should be administered only by trained anesthesiologist. The hospital providing general anesthesia should be equipped with all necessary machines and devices such as Anesthesiologists monitors to monitor oxygen levels, heart rate, blood pressure, ECG, pulse, temperature and level of anesthetic drugs being administered. A trained anesthesiologist should be present at all times during general anesthetic procedure to manage airway equipment, to manage cardiac defibrillator and to meet any emergency situation which may arise during this procedure.
To perform dental treatment under general anesthesia, a dentist requires having advance level of training because general anesthesia brings about some special challenges during treatment. For example, placement of endotracheal tube under general anesthesia causes the tongue of patient to be brought forward, thus obstructing the working area of dentist. Other big challenge is that when dentist is operating on patient sedated by general anesthesia, the dentist is forced to work against a dead weight of paralyzed muscles all the time and patient remains immobile in a single posture and position. Only very skillful and well trained dentists could meet such challenges. Hence patient should choose their dentist and anesthesiologist very wisely.
