Conscious sedation is an important part of pain and anxiety control in many dental procedures. It is used to treat anxious or phobic patients who would otherwise be denied access to dentistry.
Needle phobic patients who cannot accept an injection in the mouth can often be persuaded to accept venepuncture. If not, we offer nasal sedation to provide adequate anxiolysis to enable venepuncture to be performed. Intra-Venous sedation enables an unpleasant or prolonged or complex procedure to be carried out without much distress to the patient. This technique is also highly effective to overcome pronounced gag reflex.
What is Intravenous sedation?
Intravenous (IV) sedation is a method whereby a drug or drugs is injected into the bloodstream, via a vein, to produce sedation. You become relaxed and no longer anxious about having your dental treatment done. Many patients may know this technique as ‘an injection in the arm‘. The most commonly used drug for IV sedation in the UK is Midazolarn.
Midazolam is a medication classified as a short-acting benzodiazepine (sedative) that depresses the central nervous system. The drug is a primary choice for conscious sedation because Midazolam causes patients to have no recollection of the medical procedure. In general, Midazolam has a fast-acting, short-lived sedative effect when given intravenously, achieving sedation within one to five minutes and peaking within 30 minutes. The effects of Midazolam typically last one hour but may persist for six hours (including the amnesic effect). Patients who receive Midazolam for conscious sedation should not be allowed to drive home after the procedure. We will provide patients with further information following an assessment session with the patient.
If patient is to undergo a minor surgical procedure, the potential risk factors include advanced age, history of adverse reactions to the proposed medications and a past medical history of severe cardiopulmonary (heart/lung) disease. Once it has been established that the patient would be a good candidate for conscious sedation, just prior to the surgery or procedure, the patient will receive the sedating drug intravenously. Dosing of medications that produce conscious sedation is individualized.
IV sedation can be used to allow the whole range of dental procedures to be done. It is more
predictable than many other methods of sedation as the dentist gives you the drug a little at a time and finds the right level of sedation that is right for you. It is also suitable for long procedures and in the most anxious patients, even those who have always had a general anaesthesia for their treatment before. Many patients who have had a general anaesthesia before actually prefer IV sedation, as they feel so much better afterwards.
What happens during the treatment?
You may be asked to arrive a little before your appointment time so that all the necessary checks can be made. You must bring along with you an adult, your escort, who will be responsible for you after you leave the dental practice and to look after you when you leave the practice.
You may also have been asked to starve for a period of time before your appointment or to have a very light meal. It is important that you follow these instructions; your dentist may refuse to see you if you have not followed the instructions given to you as it can be dangerous if you are sick while sedated.
The sedation is given gradually via an injection, usually in the back of your hand or crook of
your arm. Usually only one injection is needed as the cannula or small plastic tube is left in place and the drug given bit by bit through the same needle or cannula. .
If you are extremely nervous about the injection your dentist may be able to give you a little
of the same drug via the nose. This will relax you and also makes-the injection more comfortable. Your dentist can also put some anaesthetic cream on your hand; which will numb the skin a little. The sedative is given gradually as every person needs a different amount. This usually takes a few minutes. You will begin to feel much more relaxed and happy; most patients remember very little of the-treatment.
Many patients on recovery feel surprised that part of their mouth is numb. Your dentist will do this. This will be done while you are sedated and the vast majority of patients are unaware that this has happened until they recover. Before, during and after your sedation you will be closely monitored by the dental team, to ensure you are all right.
Will it work for me?
IV sedation is suitable for-the vast majority of anxious patients, even those who have previously needed a general anaesthesia for their treatment. Patients with certain medical conditions, however, may not be suitable for treatment under sedation in the dental practice. IV sedation is much less predictable in the younger patient. If you have been taking sleeping, tablets for many years you may be quite resistant to the action of the sedative drugs. Regardless of what technique of anxiety arid pain control is used there will always be some people who will not respond and this is true of IV sedation too.
We provide a range of recognized and approved sedation techniques for anxious and nervous patients. The most commonly used approaches at our clinic include:
- Intravenous sedation with Midazolam and
- Nasal transmucosal sedation with Midazolam