Nitrous Oxide

Conscious Sedation is defined as a minimally depressed level of consciousness that retains the patient’s ability to independently and continuously maintain an airway and respond appropriately to physical stimulation and verbal command and that is produced by pharmacological or nonpharmacologic method or combination thereof.

Sedation Dentistry, sometimes called Relaxation Dentistry, refers to the way dentist’s  manage Pain and Anxiety during dental appointments.

Unlike General Anesthesia where a patient is completely unconscious, asleep, and unable to respond,  patients under Conscious Sedation, are able to respond to commands and breath on their own. 

There are actually 14 different ways that sedation drugs can be administered. There are 3 primary ways that Sedation is administered in the Dental Office:
 1. IV Sedation also known as Deep Conscious Sedation is usually used by Oral Surgeons and dentists with specialized training and special certification. With this type of sedation, medications are administered directly into the blood stream. The greatest advantage of IV Sedation is that if someone is not sedated enough, the doctor can administer more medication and the effects are instantaneous. IV Sedation is not used commonly in most dental offices because of the specialized advanced training required and the requirements for certification by the State Board of Dentistry. The drugs used for IV Sedation are more effective then the same drugs taken orally. There is a more profound amnesia associated with this technique.

 2. Enteral Conscious Sedation “Orally Administered Sedation”, sometimes called  “Sedation Dentistry” is administered by taking a pill. All body functions remain normal and the person is able to breathe on their own. The patient will often fall asleep. Some degree of amnesia is common. The disadvantage with this method of sedation, is that the level of sedation for each person is not predictable. 

3. Inhalation Conscious Sedation, Nitrous Oxide/Oxygen Sedation also known as “laughing gas”. This is the most frequently used sedation method used  in dentistry. All bodily functions remain normal and the person is able to breathe on their own. The patient will often fall asleep and experience some degree of amnesia about what happened during their dental appointment. Inhalation Sedation has been used my dentists for many years.

Sedation Dentistry

Oral Sedation
 This Oral Medication used for Oral Conscious Sedation in dentistry are from a group of drugs known as Benzodiazapines. Not only do these medications have a sedative effect they also have some degree of  amnesic effect for most people. Patients remember little or nothing about their dental appointment.

Advantages to Dental Oral Sedation:

  • Easy to administer: Swallow a small pill 
  • It is safe and easy to monitor
  • Works well for most people
  • Low Cost

Disadvantages of Dental Oral Sedation:

  • The level of Sedation is not easily changed
  • Someone must drive you to and from your dental appointment
  • There is no analgesic (pain relief effect)

What medications are used for Dental Oral Sedation?

  • The most common medication is Halcion (triazolam). Halcion provides a deep level of relaxation and amnesia effect. 
  • For children the most common medication is Versed (Medazolan) which is a liquid.

Sedation Dentistry
Inhalation Conscious Sedation

Nitrous Oxide and Oxygen (“laughing gas”) has been used as the most frequent and primary means of Sedation used in Dentistry for many years. 35% of all US dentists offer Nitrous Oxide Sedation to their patients. 

Advantages or Dental Inhalation Sedation:

  • Works well for mild to moderate anxiety
  • Rapid Onset
  • Flexible duration can be used for any appointment length
  • Absolute Control. It is easy to quickly control the level of sedation which may be altered moment to moment. 
  • People recover quickly
  • Very few side effects
  • There is an analgesic effect
  • You can drive yourself to and from your dental appointment
  • You can return to normal activities immediately

Disadvantages of Dental Inhalation Sedation:

  • Severe anxiety may require a deeper level of sedation
  • Not indicated for people who have respiratory problems (Asthma and Emphysema)
  • Claustrophobic patients do not like anything covering their nose

What medications are used for Dental Inhalation Sedation?

  • Nitrous Oxide (N2O)
  • Oxygen (O2)

The safety features of the machine insure a patient receives no less than 30% Oxygen mixed with Nitrous Oxide. Usually the patient receives 50 to 70% Oxygen. is sedation for you

Who Should Consider Using
Conscious Sedation?Relaxation Dentistry 

 

You may benefit from Conscious Sedation if you have a lot of stress, fear and anxiety about going to the dentist. “You are afraid of the Dentist”. If you need or require a lot of dental treatment, you should consider the use of Conscious Sedation. Conscious Sedation is sometimes called “Sedation Dentistry” or “Relaxation Dentistry”.Conscious Sedation will allow most people to overcome the stress fear and anxiety associated with Dental Treatment, because they can relax during their dental visit.

Previous bad dental experiences cause fear and anxiety about Dentists and Dentistry. If these feelings are preventing you from getting the dentistry that need Conscious Sedation can help you.

Conscious Sedation is safe cheap and effective.

Many people have a fear of needles, had difficulty getting numb, or have a bad gag reflex, all these people can be helped through conscious sedation. These are a few of the problems that people encounter which will prevent them from seeking the Dentistry that they need.

When someone is sedated and relaxed it is possible to complete a large amount of complex dental treatment during a single visit to the dentist. People often have little or no memory of their dental visit.

If you exhibit any of the following characteristics, “Sedation Dentistry” may help you:

  • Fear Stress and Anxiety about going to the Dentist
  • People who desire a beautiful and natural smile and have fear and anxiety associated with dentistry
  • Fear of needles
  • You are hard to get numb
  • Dental Phobia
  • A history of bad dental experiences
  • Painful or sensitive teeth
  • Afraid to go to the Dentist
  • You are troubled with a bad gag reflex
  • Difficulty controlling movement from conditions such as Cerebral Palsy or Parkinson’s disease
  • You need complex treatment requiring long dental appointments
  • People who have limited time to complete their required treatment and want to accomplish a lot in a single appointment. Treatment requiring multiple visits can often be accomplished in a single visit.

Patients who are on other medications should consult with their medical doctor before taking sedatives. Previous allergic reactions to other drugs should also be reported to the sedation dentist.

Sedation Dentistry
How Does Oral Conscious Sedation Work?
Relaxation Dentistry 

You will be prescribed a pill (Halcion) to take one hour prior to your scheduled dental visit.  It is imperative that you have someone drive you to, and from your dental appointment.  When you arrive at the dental office, you will be awake and feeling very drowsy and relaxed.Upon your arrival for your dental appointment, you will be immediately escorted to the dental treatment area and seated in the dental chair. You will be placed on a monitor to carefully watch your vital signs during the entire appointment.If you would like to hear some soothing, relaxing music, a CD player with headset,  is available. Tinted glasses will be used to keep the bright light out of your eyes, and for protection. If you feel cold, you will be covered with a blanket. A small pillow is available for the small of your back.  It is our desire that you are fully relaxed and comfortable before, during and after your dental appointment.

There is no analgesic or pain relieving qualities provided by oral sedatives. Local anesthetics will be used to prevent pain. Because you are so relaxed, and because of the use of painless injection techniques,  you will probably not remember when you teeth were actually being “numbed”.

When your treatment is completed, your friend or relative will drive you home, where you can climb into bed for a soothing,  relaxing nap.

When you are fully awake, you will feel comfortable, relaxed and free from stress. You will probably remember very little about your wonderful, relaxing, dental experience.

You should not operate a motor vehicle for 24 hours after receiving Oral Conscious Sedation.

Sedation Dentistry
The Top 10 Reasons People Need Oral Sedation
Relaxation Dentistry 

10. Oral Sedation is a safe and effective way of relieving the fear and anxiety associated with going to the dentist9. Dentists have used oral medications for many years to relieve fear and apprehension associated with dental appointments

8. It works well for most patients allowing them to relax and have little or no memory of their dental appointments (partial or total amnesia)

7. Its easy, you take a pill one hour prior to your dental appointment

6. Some patients are so relaxed that they sleep right through their dental appointment. When someone is relaxed they will feel less tired after a long dental appointments.

5. Patients are so relaxed and comfortable, that a large amount of complex treatment can be accomplished in a single appointment

4. People who have trouble getting numb are often helped by Oral Sedation Dentistry

3. If you are scared of needles, sedation dentistry can help you

2. People who have difficulty controlling movements,  such as Parkinson’s Disease or Cerebral Palsy are often helped by oral sedation

1. The dentist can complete more dental treatment of higher quality,  in a shorter period of time, on a patient who is relaxed

Sedation Dentistry
How Does Inhalation Conscious Sedation Work?
Relaxation Dentistry 

You will drive yourself to your Dental Appointment as you would with any other dental visit. When you arrive at the dental office, you will be awake and normal. Most patients arrived relaxed, knowing that they will be sedated by Nitrous Oxide/Oxygen sedation during their dental visit.At your appointment time, you will be escorted to the dental treatment area and seated in the dental chair. When you are comfortable a Mask will be placed over your nose and you will be given pure oxygen.If you feel cold, you will be covered with a blanket. A small pillow is available for the small of your back. If you desire hearing  some relaxing music, a CD player is available. It is our desire that you are fully relaxed and comfortable before, during and after your dental appointment.

The Nitrous Oxygen mixture will be adjusted to a level that is comfortable for you. The mixture will be adjusted throughout your appointment to meet your needs.

When your treatment is completed the Nitrous Oxide will be turned off and you will be given pure Oxygen until you feel completely normal. When the effects of the Nitrous Oxide have worn off completely, you will feel fully awake and alert. You will feel comfortable and relaxed and will probably remember very little about your wonderful dental experience. You will be able to drive yourself home or do anything else you would do during a normal day .

Sedation Dentistry
The Top 10 Reasons People Need Inhalation Sedation

Relaxation Dentistry

 

10. Inhalation Sedation is a safe and effective way of relieving the stress, fear and anxiety associated with going to the dentist9. Dentists have used Nitrous Oxide/Oxygen Inhalation Sedation for many years to relieve fear and apprehension associated with dental appointments

8. It works well for most patients allowing them to relax and have little or no memory of their dental appointments (partial or total amnesia)

7. Its easy, you arrive at the dental office. A mask is placed over your nose and the Nitrous Oxide/Oxygen mixture is regulated very precisely by a special machine. The mixture can be constantly adjusted to meet your needs.

6. Some patients are so relaxed that they sleep right through their dental appointment. When someone is relaxed they will feel less tired after a long dental appointments.

5. Patients are so relaxed and comfortable, that a large amount of complex treatment can be accomplished in a single appointment

4. People who have difficulty getting numb are often helped by Inhalation Sedation Dentistry. The Nitrous Oxide has an Analgesic effect.

3. If you are scared of needles, sedation dentistry can help you.

2. People who have difficulty controlling movements,  such as Parkinson’s Disease or Cerebral Palsy are often helped by oral sedation

1. The dentist can complete more dental treatment of higher quality,  in a shorter period of time, on a patient who is relaxed

IV (Intravenous) Sedation

When a drug, usually of the anti -anxiety variety, is administered into the blood system during dental treatment, this is referred to as Intravenous Conscious Sedation (aka “IV sedation”). Conscious sedation is sometimes (incorrectly) referred to as “twilight sleep” or “sleep dentistry”. These terms are more descriptive of deep sedation. Deep sedation isn’t commonly used, and is more closely related to general anaesthesia (even though sedation occurs on a continuum). This page answers the most common questions regarding conscious IV sedation.

What does it feel like? Will I be asleep?

A lot of dental offices use terms such as “sleep dentistry” or “twilight sleep” when talking about IV sedation. This is confusing, because it suggests that IV sedation involves being put to sleep. In reality, you remain conscious during IV sedation. You will also be able to understand and respond to requests from your dentist.

However, you may not remember much about what went on because of two factors: firstly, in most people, IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on. Secondly, the drugs used for IV sedation can produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much, or perhaps even nothing at all, of what happened. So it may, indeed, appear as if you were “asleep” during the procedure.

Is it still necessary to be numbed with local anaesthetic? Will my dentist numb my gums before or after I’m sedated?

The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added, see below for a more detailed discussion), but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.

If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (i. e. until you’re numb) before starting on any procedure.

How is IV sedation administered?

“Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand. This needle is wrapped up with a soft plastic tube. The needle makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube (which is correctly referred to as an “indwelling catheter”, but more commonly known by the tradename of Venflon). The tube stays in place throughout the procedure.

Throughout the procedure, your pulse and oxygen levels are measured using a “pulse oximeter”. This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you’re getting dangerously low on oxygen, although if your dentist and the nurses are paying attention they should see it before the machine does =). The warning signs are unresponsiveness and slow breathing. Blood pressure before and after the procedure should be checked with a blood pressure measuring machine (a tongue-twister called “sphygmomanometer”, which for obvious reasons is referred to as “sphyg”).

Is it safe?

IV sedation is EXTREMELY safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it’s even safer than local anaesthetic on its own!

What are the main advantages of IV sedation?

* IV sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”. The alternative in the US is oral sedation using Halcion, but oral sedation is not as reliably effective as IV sedation.

* The onset of action is very rapid, and drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and higly reliable.

* The maximum level of sedation which can be reached with IV is deeper than with oral or inhalation sedation.

* Benzos produce amnesia for the procedure.

* The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulty with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.

* Can be ideal for those with a phobia of dental injections.

* Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.