Sedation Dentistry

Who likes to go the dentist?  Honestly, not many people and I don’t blame them.  Our jokes are not funny – well except this one, what do you call a cow with no legs >>> ground beef?.  Okay, maybe that isn’t that funny, but, when you have sedation dentistry, it is hilarious! 

I love sedation because it provides a way for me to help you overcome your anxiety – it helps to put you in a place where you feel safe and good about coming to see us.  It is just like my wife, Lisa, and her claustrophobia – every time we get in an elevator I tell her it is going to be okay, and every time I can see her fists clench and her pulse go up!  It is a hardwired response – just like when I go to the zoo with my daughters and we go through the snake exhibit – seeing those poisonous snakes just inches away from your face in a darkened room, with the perpetual fear that one has escaped and is going to bite you – deep breaths, deep breaths!

The goal of sedation dentistry isn’t to put you to sleep – although we can do that – rather, it is to help you come in knowing you won’t remember anything you just went through.  There is a wide range of sedation options out there, and, I want to spend a few moments discussing each one so you can find the one that is right for you.

The most basic form of sedation dentistry is good old fashioned laughing gas, or nitrous oxide.  It is one of the most common forms of mild sedation that we offer, and, most of the Magnolia Dental team uses while having their teeth cleaned – yes, that is an option (in particular, I recommend combining it with your favorite music on your phone with headphones – best concert ever!).  Nitrous oxide is easily administered by using a small scented (yes, we have different scents from peach to mint and so on) nose piece that allows you to breathe normally.  We are able to adjust the level of nitrous oxide to help you find your happy place, but, do it in a way that is completely safe with minimal risks and/or side effects.  After your treatment is complete, we will let you breathe 100% oxygen for 5 minutes which will allow the nitrous to clear out of your system completely and you back to normal – no driving restrictions at all.  Best of all, you don’t have to worry about taking any special steps before your appointment.  Funny gas is a great option for kiddos as it helps to lower their anxiety level to where they don’t care as much … making for a much more enjoyable appointment.  The biggest limitation to nitrous oxide is how much I can sedate you with … some patients are very mellow on it, while others not so much.   In addition, it doesn’t help to create an “amnesic effect” at all – meaning you still remember everything. 

Perhaps you have tried nitrous oxide and it wasn’t to your liking, or it didn’t help reduce your anxiety as much as you would have liked.  Or maybe you just don’t want to remember anything about your appointment, in particular the horrible cow jokes I like to tell!  In that case, the next options are oral conscious sedation and IV conscious sedation.  Let’s spend a few minutes discussing both of these options. 

Both of these options are called “conscious sedation” for a reason … in both cases, you are awake to an extent.  Even though we have a treatment room dedicated to surgery, we are not a hospital setting and we will never be a hospital.  So, our sedation is to help you relax, forget and not care,  but we want you to be able to breathe on your own at all times.  We don’t place a tube down your throat, so, we have to keep you more alert so your brain remembers to breathe, because, after all, that whole breathing thing isn’t overrated!   Both of these options have some definite guidelines and rules that I ask you to follow for your safety.  First off, it is essential that you have a friend or family member to bring you to the office and to take you home – no uber drivers please!  The reason is simple, we need someone that is willing to hang out with you the rest of the day at home to make sure you don’t do something crazy afterwards!   Secondly, I need you to avoid any food or drink 6 hours prior to your appointment – this means anything – we need your tummy to be empty so you don’t get nauseous during the sedation. Commonly, we do our sedation appointments in the morning so we ask that you don’t eat or drink after midnight.  In certain cases, we may make an exception for you to take your medication or have a small cup of black coffee (with NO cream), but, always make sure to ask our Magnolia Dental team.

With that in mind, the first option is called oral conscious sedation.  This is one of the most common sedation options offered in dentistry, and for the first 10 years of my career was what I offered.  It is a wonderful option that can work very well.  Commonly we use a medication along the lines of valium, halcion or versed in a pill form.  We provide you a prescription for the medication to take prior to your appointment, or when you get to the office.  Often times, I may prescribe you a couple different pills so we can gauge your sedation level and add more medication as needed.  Commonly, I will place you on nitrous oxide during the appointment to help you find a comfortable level of sedation.  As I mentioned above, for the first 10 years, this was the most common form of sedation I offered.  It is relatively easy to implement, minimal setup and no IV’s to start.  There are some limitations to this form of sedation that I want to share with you.   The biggest limitation is the sedative medicine is given to you in a pill form, which means it has to travel through your stomach before it starts to work on you.  This creates a delay in the sedation and adds a HUGE unknown in how you will respond.  For some patients, this is a terrific form of sedation, for others, not so much.  I just don’t know how you will respond and I cannot accurately control how much medicine gets in your blood stream.  For those reasons and others, I typically prefer to offer IV conscious sedation 99% of the time. 

IV conscious sedation is a safer and more predictable way for me to help you relax and forget your appointment.  The medications are very similar to what I use when doing oral conscious sedation, but in a different form.  By starting an IV, easily placed in simple veins in your arm, we are able to place the sedation medicine directly into your bloodstream bypassing the delays and uncertainty associated with the pill form of the medication.  So, I am able to accurately control your sedation level at all times and work to make sure you are happy and relaxed at all times.

Another huge benefit to IV conscious sedation is that it gives me the ability to give you other medications through your IV as needed – medications to help prevent nausea, reduce swelling and inflammation and to help control your pain afterward.   By utilizing these benefits, I am able to have less pain after the appointment and to heal faster!

Finally, for some patients that may have medical concerns, or, would prefer to be in a deeper level of sedation, I often times will partner with an anesthesiologist to help with the sedation.  This is a wonderful approach as they will come in to our office and administer the sedation medicine in an IV form, but, they use a sedation medicine that is more common in day surgical procedures – commonly a medicine called Propophol.  This medication is the typical one you receive when you are asked to count back from 10 and get to 7!  It is a great option for those cases where you would like to be more asleep, but, still able to breathe on your own.  Since the sedation is deeper and due to state regulations, we need the anesthesiologist in the office to administer it and keep it safe for you. 

I work hard to make sure we can offer you all forms of sedation in a safe and comfortable atmosphere.  What may be right for one person isn’t always right for another … so, it is important to me that I do a great job of listening to your concerns and helping you to select the form of sedation that you will love.