Conscious Sedation in Dentistry: Applications and Benefits
Conscious sedation can help people who, out of fear, don’t go for regular dental check-ups. This is good because dentists must be able to detect problems in their early stages.
When they come to the office, because pain or the inability to use their mouth normally forces them to seek help, the pathologies are usually bad. In these stages of the lesions, the treatments to restore health are much more complex, long, uncomfortable, and expensive.
To avoid reaching these extremes, patients can resort to conscious sedation in dentistry. We’ll tell you everything you need to know about this procedure that allows for more pleasant and less uncomfortable experiences when visiting the dentist.
What is conscious sedation in dentistry?
Conscious sedation used in dentistry is a technique that consists of applying certain drugs to the patient to make them relax. Dentists use it in people who feel a high level of fear, stress, and anxiety when they have to go to the dentist.
As the name suggests, this type of sedation allows the person to remain conscious while undergoing dental treatment. However, he/she will be able to relax and feel well and calm, avoiding worries about the procedure.
Being awake, the patient can respond to the different stimuli and requests of the dentist, collaborating when necessary. In any case, the reflexes will diminish and there’ll be a state of numbness and relaxation.
In addition, conscious sedation in dentistry has the particularity of producing certain amnesia. This causes the person to have minimal memory of the intervention.
On the other hand, it also reduces involuntary movements during treatment. In this way, it facilitates and speeds up the professional’s work in the mouth.
Thus, the benefit is not only for the patient, but also for the dentist, who can work more comfortably. Its use doesn’t cause significant changes in cardiac or respiratory functions.
What is the difference between conscious sedation and anesthesia?
In the field of dentistry, there are multiple procedures that help patients feel no pain and be more comfortable during treatments. However, it’s important not to confuse conscious sedation with other ways of achieving comfort and relaxation in dental offices.
Local anesthesia is one of the procedures that is commonly used in dental procedures and that we must differentiate from conscious sedation. This technique achieves the temporary loss of pain and sensitivity in any area of the body a dentist might apply it to.
This is the classic injection that the dentist gives to desensitize the area of the mouth on which he is going to work. In this way, dentists can perform fillings, endodontics, extractions, and other surgeries without the patient feeling pain.
In turn, conscious sedation, consists of calming and providing comfort to the person while the treatment is underway. Since the objectives pursued by these two techniques are different, they are used in a complementary manner: the dentist applies sedation to calm the patient and anesthesia to avoid pain.
You may also like to read: What Are the Types of General Anesthesia?
The application of conscious sedation in dentistry
Different medications can achieve patient relaxation and comfort during dental care. The patient’s characteristics, level of anxiety, and duration of the treatment will dictate the best option for each case.
One of the most commonly used drugs is triazolam. This is a benzodiazepine that begins to take effect 15 minutes after its application and reaches its peak of effectiveness after 60 minutes. This drug produces anterograde amnesia, which makes the patient not remember what happens before and during the intervention.
Other drugs used to achieve conscious sedation in dentistry are diazepam, lorazepam, midazolam, and propofol. Depending on the case, a single drug or several in combination will be used.
The medication can be administered orally or intravenously. Both are safe and achieve the same effects.
Oral conscious sedation
The medication enters the body by swallowing the sedative drug in the form of a tablet. In some cases, it’s best to place the tablet under the tongue without swallowing it, so that it’s absorbed sublingually.
This type of administration has the advantage of achieving the expected effects more quickly than the digestive route.
Administering conscious sedation by mouth has the advantage of avoiding punctures and not requiring the presence of an anesthesiologist. This makes the process simpler, more comfortable, and cheaper for the patient.
In opposition, the oral route is characterized by not having an immediate effect, so there must be a waiting time prior to the intervention. In addition, the dose cannot be modified during the process.
Intravenous conscious sedation
This technique uses sedative drugs, inoculating them into the body intravenously, i.e. injecting them directly into the circulation. This makes it a procedure with immediate effects.
It requires the presence of an anesthesiologist to administer and control the depth of sedation. This allows the dose to be adjusted and other types of medication to be administered, according to the patient’s needs and the requirements of the treatment.
This technique is more expensive compared to the oral route.
What are the advantages of conscious sedation in dentistry?
Fear of the dentist can lead people to postpone their dental check-ups and only go to the professional when pain or discomfort forces them to do so. Lack of attention deteriorates oral health and predisposes these patients to require complicated, long, and costly treatments.
Going to the dentist with fear makes the patient present a state of constant tension and alertness. With this, not only do they experience an unpleasant moment, but they also increase the risk of moving during treatment because of their nervousness and causing unwanted complications.
Conscious sedation in dentistry helps fearful patients to relax and calm down during dental consultations. It also provides other benefits, such as the following:
- It decreases anxiety and fear.
- It provides a sense of security during treatments.
- It allows a better recovery and postoperative phase.
- Conscious sedation reduces stressful and negative memories of the intervention.
- It improves dental experiences, reducing the rejection of future practices.
- It allows for the grouping the performance of several interventions in the same work session.
- It helps prevent fatigue in long treatments, allowing to solve complicated situations in a single appointment.
- Conscious sedation facilitates collaboration during treatments, speeding up the procedures to be carried out by the professional.
- In cases in which an anesthesiologist is present increase the patient’s safety during the treatment, thanks to its monitoring.
Which dental treatments require conscious sedation?
Conscious sedation in dentistry is common for those with a high degree of anxiety and fear before dental procedures. No matter how simple the procedure, for some patients it can be a very stressful and nervous situation.
In addition, some treatments themselves can cause feelings of fear. For these cases, conscious sedation is an aid that allows you to face the problem and receive the necessary dental care.
In general, the use of conscious sedation is good for the following situations:
- Complex treatments, such as surgeries to place implants or extractions of wisdom teeth.
- Patients with a disability that prevents them from relaxing or collaborating with the dentist.
- Long interventions, which will go on for a while.
- People with odontophobia or fear of the dentist.
- Anyone who wishes to have a better experience.
Prepared clinics
When performing conscious sedation in dentistry, dental offices must have certain characteristics that provide safety to the patient. Although the oral technique is simpler, it is convenient to have an office and specialized professionals to preserve the health of the person.
The offices that offer this type of service must have the equipment to monitor vital signs, a pulse oximeter to measure oxygen saturation, and a sphygmomanometer to measure blood pressure. In addition, the provision of a constant flow of oxygen with nasal goggles requires resuscitation equipment with a semiautomatic defibrillator and intravenous medication for resuscitation.
In addition to the facilities, the appropriate professionals must be available to carry out this type of intervention. As we’ve told you, intravenous conscious sedation requires the presence of an anesthesiologist is essential throughout the dental treatment.
Prerequisites
Conscious sedation is suitable for both adults and children. First of all, it’s important to do a patient assessment to determine if the patient is a candidate for this type of procedure.
Assessing the patient’s general health, medication used on a regular basis, and considering a consultation with the primary care physician are steps that help to decide if sedation is possible. Some complementary tests will also be required, such as an electrocardiogram or a laboratory to analyze coagulation.
The dentist or anesthesiologist, depending on the case, will analyze this information. If sedation is possible, the dentist plans the treatment. At the time of the procedure, the patient requires monitoring at all times.
What is the postoperative period like?
Once the dental procedure under sedation is over, the patient will remain conscious and able to stand and walk in confined spaces. His or her blood pressure and respiratory function will remain unchanged.
However, recovery will take time and there are some aspects to consider. Dentists recommend that the patient be accompanied by someone in the hours following the procedure and that he/she does not drive for 24 hours.
Conscious sedation in pediatric dentistry
Conscious sedation in dentistry is suitable for both adult patients and children. In the latter case, the procedure helps children to have more pleasant dental experiences and avoids fears in the future.
With pharmacological sedation, the intensity of pain perception reduces. Anxiety and fear decrease, making children cooperate during the interventions and develop a pleasant memory of dental visits.
The child usually remains relaxed for a period of 2 or 3 hours, which is enough to perform all the necessary interventions in his mouth in a single session. As with adults, the child requires monitoring by an anesthesiologist throughout the procedure.
In 2019, the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD) published new guidelines for safely administering sedation or anesthesia to children. Dentists performing dental treatment on infants under deep sedation should abide by these guidelines to ensure the safety of their patients.
Sedation in pediatric dentistry is appropriate for children who are very restless, fearful, and uncooperative. It’s also suitable for those with special needs, and for those who require many complicated or lengthy procedures.
Conscious sedation in dentistry is an alternative to consider
Conscious sedation in dentistry involves just one more moment of dental treatment. In exchange, it provides a sense of well-being and peace of mind throughout the entire procedure.
It’s true that it requires assessment and preliminary studies. Also, there’s the need to be accompanied to the consultation. However, the other aspects of dental treatment will be the same as in a regular practice.
Now you know the benefits of conscious sedation in dentistry. If you usually go to dental appointments with fear or anxiety, you can think about this procedure for your next appointments.
It might interest you...
