Sedation

Dental sedation further information

Levels of sedation

The sedation level is best described by a continuous scale ranging from fully alert to general anaesthesia. In order to have control over which types of sedation procedures are provided, it is necessary to arrange the sedation levels in a few categories. These are:

Light sedation or sometimes called premedication or anxiolysis. Can be given in general dental practices.

The patient is given drugs either by mouth, intravenously or as a gas in order to make them less worried about treatment. The sedation level is lighter but adequate for the procedure. This technique may be suitable for patients who are a little bit worried about dental treatment or for patients who are generally ok with normal treatment but who may have to undergo a more unpleasant procedure. The patient is more awake and communicable but able to accept dental treatment unhindered. The patients may forget some or all of the treatment. This depends on the sedation level and on what type of drug is used to achieve the desired level of sedation.

Moderate sedation also called conscious sedation. Can be given in general dental practices

The patient is more deeply sedated, drowsier and sleepier but still responsive to verbal commands and still conscious. Usually, this level of sedation is achieved by intravenous delivery of the drug but can also be achieved by taking oral drugs or sniffing the drug via the nose. Patients having either light sedation or moderate/conscious sedation need to have a responsible adult to escort them to and from the practice and look after them for the period during which they feel drowsy. The 2 levels of sedation are part of a continuous scale and if the drug is potent or the patient is sensitive it is possible to aim for minimal sedation and end up with moderate sedation. This is more common with oral sedation or pre-medication. When we use intravenous drugs or gas and air (inhalation sedation-nitrous oxide sedation) we have better possibilities of controlling the dose and the level of sedation.

Deep sedation

In the UK it can only be delivered within a hospital setting or practices which fulfil the criteria for a hospital theatre setting.

General anaesthesia

In the UK it can only be given within a hospital setting.

Does sedation work for all patients?

The vast majority of patients have a very good effect of the sedation but in some patients the effect can be slower, faster and deeper or not potent enough. In case like these it is useful to do intravenous sedation or nitrous oxide (gas and air) inhalation (if appropriate) since with these two methods we can adjust the dose to the patients’ needs most of the time. You have to remember that the human body is a far more complex than any man made machine. We can control to a high degree the effect of medications on the human body but we cannot claim to have 100% control of these effects. The success rate with dental sedation is very high but is not 100 %. Research shows that a very high proportion of patients who have received sedation would choose to have it again if they needed dental treatment. This says a lot about how received and appreciated dental sedation is.

If dental sedation does not work or cannot be administered due to existent medical conditions or drug interactions, what alternatives are there?

Remember that dental conscious sedation is a very useful tool in managing dental anxiety but that ii is not the only tool. There may be other options open for you depending on your individual needs. Please discuss any alternative options with your dental seditionist.

Some alternatives to conscious sedation may be:

general anaesthesia- not available here , referral to hospital or private clinic
cognitive behavioural therapy- very effective and very good long term results in some cases
desensitisation
tell-show-do

Useful Documents

Midazolam Sedation (post op) IV Sedation RA Sedation Midazolam Sedation (pre op)