- About Sedation
30 Percent of the population avoids the dentist due to fear. This all-too-common “dental phobia” (dental anxiety) prevents people from receiving necessary routine dental care, potentially compromising the health and functionality of their mouth and smile.
It is quite natural for a person to be uncomfortable when placed in a position in which they feel that they are vulnerable, as occurs in the dental chair. It is important that a patient tell the doctor if they have any dental anxiety related to their planned dental treatment. Keeping their fears hidden can only lead to a much more unpleasant experience and, in more extreme circumstances, may even increase the likelihood of certain emergencies occurring, such as fainting.
If the dentist is aware of the patient’s dental anxiety and fears initially, he will be able to address the situation in a way that is less fearful. In some cases, simply discussing the planned treatment is all that is needed to alleviate the patient’s dental anxiety. If discussing the treatment is not enough, a number of sedation techniques can be used to alleviate the patient’s dental anxiety.
Dr. Pennington offers inhalation sedation, oral conscience sedation, and intravenous conscious sedation to his patients to reduce their dental anxiety. These three types of sedation cover only the spectrum of Minimal Sedation (Anxiolysis) and Moderate Sedation/Analgesia (“Conscious Sedation”). Though these three sedation methods are safe, he still uses caution when sedating patients for treatment. Not all patients qualify as candidates for sedation. Dr. Pennington will evaluate each patient on an individual bases taking into consideration factors such as treatment needed, anxiety levels, health history, medications, etc.
American Society of Anesthesiologists defines sedation by a continuum range of consciousness:
Minimal Sedation (Anxiolysis) is a drug-induced state during which patients respond normally to verbal commands. Although cognitive function and physical coordination may be impaired, airway reflexes, and ventilatory and cardiovascular functions are unaffected.
Moderate Sedation/Analgesia (“Conscious Sedation”) is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Deep Sedation/Analgesia is a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
General Anesthesia is a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation. The ability to independently maintain ventilatory function is often impaired. Patients often require assistance in maintaining a patent airway, and positive pressure ventilation may be required because of depressed spontaneous ventilation or drug-induced depression of neuromuscular function. Cardiovascular function may be impaired.
- Inhalation Sedation
Inhalation Sedation, which uses Nitrous Oxide gas, is the most commonly used method for patient relaxation in dental offices. Dentists have used nitrous oxide, also known as “laughing gas”, for over 160 years to provide more comfortable dental treatments to their patients. Nitrous Oxide has been a mainstay of sedation techniques in dentistry for generations. It is used by more than 35% of all U.S. dentists, and still represents the most frequently employed technique for relieving dental anxiety.
Nitrous oxide sedation is the lightest form of dental sedation, but it can provide adequate level of relaxation for most people and for the majority of dental procedures. It involves breathing nitrous oxide gas and oxygen which can help anxious patients to become more relaxed and co-operative during treatment.
Nitrous oxide provides minimal sedation allowing patients to retain the ability to breath without external help, maintain their protective reflexes and the ability to respond normally to physical stimulation and to verbal commands. This method of sedation is good for light procedures or routine visits to the dentist. It is best for people with low levels of anxiety.
- Oral Sedation
Oral Sedation involves the administration of sedative drugs taken by mouth in the form of a pill to achieve a state of relaxation and make dental procedures a comfortable experience. Oral sedation dentistry is also referred as oral conscious sedation because the patient remains conscious throughout the dental treatment but in a relaxed and less anxious state of mind.
Depending on the dosage amount, oral sedation can be used for achieving different levels of dental sedation, usually light or moderate sedation. Light sedation, also known as anxiolysis, is achieved by using a small dose of a mild oral sedative drug to achieve an elevated state of comfort and relaxation.
Moderate sedation is achieved with higher doses inducing a slightly depressed level of consciousness, but you remain awake being able to breathe on your own, retain your reflexes and respond to verbal instructions. It is preferred over light sedation for patients with moderate to high dental anxiety, or for very lengthy and invasive procedures.
After an oral sedation procedure the patient may indeed feel like he was sleeping because he has little or no memory of what happened during the appointment, but that happens due to the amnesic effect of the oral sedation medicines, and not because the patient was actually sleeping.
- Intravenous Sedation
Intravenous sedation dentistry (IV sedation) is an advanced and effective method of dental conscious sedation used by highly trained dentists in order to perform dental treatments with their patients in calm and relaxed condition. IV sedation dentistry is the method of choice for the management of moderate to more severe levels of dental anxiety. With Intravenous sedation, sedative medication is administered directly into the bloodstream. This allows the fast onset of sedation and gives the dentist better control of the sedation level. Fast onset and easily controlled are both considered as main advantages of IV sedation over the other sedation methods.
IV sedation dentistry is a method of conscious sedation, and should not be confused with sleep dentistry which is closer related to general anesthesia (unconscious sedation). With IV sedation dentistry a patient remains conscious during treatment, able to respond to questions or requests from the dentist, but in a totally relaxed state and relieved from anxieties. The amnesic effects of the anti-anxiety medications can give patients the impression that they slept through the procedure.
In order to provide IV sedation to his patients, Dr. Pennington received specialized advanced training and is licensed by the Georgia Board of Dentistry. As is required by the state of Georgia for IV sedation, Dr. Pennington and members of his staff have formal training in ACLS (Advanced Cardiac Life Support) and his dental office is equipped with the necessary monitoring devices and emergency equipment.
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