Indication and Considerations for Conscious Sedation
In addition to the relaxation techniques offered at the office, patients who are anxious, have dental phobia, have a strong gag reflex, or have special needs may be ideal candidates to receive mild or moderate conscious sedation. During conscious sedation, the patient will be able to relax enough to receive necessary treatment while being able to respond to stimulation and maintain his/her own airway as well as protective reflexes. Patients receiving oral or IV conscious sedation will require someone to accompany them to their appointment and to help care for them for a few hours after treatment.
Services for Relaxation:
Massage Therapy: Our massage therapist can offer relaxation therapy intraoperatively using creams with calming essential oils.
NuCalm: Designed to help your mind and body relax through topical creams, micro-current stimulation patches, headphones, and eye masks. The combination of these four components gives a fully immersive experience, minimizing stress or anxiety and helping achieve a deeper level of calm with no side effects.
Types of Sedation:
Minimal (anxiolysis): Reduces anxiety via a minimally depressed level of consciousness produced by a pharmacologic method that allows a patient to continue breathing independently and respond to tactile stimulation and verbal commands. Cognitive function may be temporarily impaired during administration, but the airway, breathing, and cardiovascular function remains unaffected.
- Types: N2O, oral sedation, IM sedation, and/or nitrous in combination.
Moderate: Reduces anxiety as well as promote amnesia via a moderately depressed level of consciousness. Patients may be asleep at times but are able to respond purposefully to verbal commands alone or with light tactile stimulation. Airways are typically unaffected, independent breathing is maintained, and cardiovascular function is usually maintained.
- Types: oral sedation, IM, and IV sedation with or without nitrous oxide.
Deep (by specialist or MD only): Patients are in a deeper state of sedation where they cannot be easily aroused but are able to respond to repeated painful stimuli. Independent breathing may be impaired, and one may have difficulty maintaining a patent airway. Cardiovascular function is usually maintained, and intervention to maintain airway may be required. Most general dentists are unable to provide this deep level of sedation, and patients may require treatment by a specialist or anesthesiologist to offer this level of sedation for dental treatment.
General Anesthesia (by specialist or MD only): Deepest state of sedation where one’s reflexes and airway are both impaired. Intervention to one’s airway is often required, and spontaneous ventilation and cardiovascular function are not adequate. This is not to be considered a part of conscious sedation and is generally confined to hospitals or surgical centers.
- Types: IV sedation, inhalational anesthesia with required intubation.
There are four primary ways that mild or moderate conscious sedation is administered at Inspira Advanced Dentistry:
- Inhalational gas (nitrous oxide)
- Oral sedation (in the form of a pill)
- Intramuscular injection (shot in the arm)
- Intravenous sedation (constant IV drip through a vein in the arm)
Nitrous Oxide (N2O): Colorless, slightly sweet gas used to calm mild or moderate anxiety for patients able to breathe through their nose. The anesthetic gas is delivered through a nasal mask and is mixed with oxygen in a specific ratio tailored for each patient’s comfort. When inhaled, N2O can induce feelings of euphoria and relaxation. The patient can expect to feel the effects of the “laughing gas” within a few minutes and may feel sensations of drowsiness, tingling in extremities, or mild lightheadedness while able to swallow, talk, and cough as needed. The effects of the gas are mild and towards the end of the appointment, patients will be given pure oxygen prior to dismissal to ensure the effects are no longer present in the body. Patients may drive or return to work after receiving N2O.
Oral Conscious Sedation: Can be administered in either pill or liquid form and is used to reduce moderate or severe fear and anxiety related to dental procedures. Depending on the medication type, it may be obtained either by prescription or dispensed at the office and can be used in combination with nitrous, IM, or IV sedation as needed to achieve desired effects. During oral sedation, one may be sleepy but remains easily arousable and will have little or no recollection of the appointment. The patient can continue to respond to simple commands but will have reduced awareness of unpleasant sights, sounds, and sensations associated with the procedure. Patients will need to be accompanied to the office and cannot return to work or drive after receiving oral conscious sedation. The biggest disadvantage of oral sedation is the inability to titrate to the desired effect due to travel through the gastrointestinal tract and portal hepatic circulation.
Intramuscular (IM) Sedation: Administered via an injection into a muscular region such as an arm or thigh to reduce moderate or severe fear and anxiety related to dental procedures. Often takes longer to achieve sedation than IV sedation, but is quicker acting than oral sedation and can be used in conjunction with other sedation types. Patients will need to be accompanied to the office and cannot return to work or drive after receiving IM conscious sedation.
Intravenous (IV) Sedation: Administered via a slow IV drip in a vein (typically in the hand or arm) to aid with moderate conscious sedation. The use of IV sedation requires advanced training but is one of the safest and most predictable means to titrate medication dosages and achieve the immediate effect for an individual. Typically, a benzodiazepine is used alone or in combination with an opioid (see below for medication types). This is the best mode of treatment for lengthy appointments where amnesia and reduction of anxiety are the desired effects. Patients will need to be accompanied to the office and cannot return to work or drive after receiving IV conscious sedation.