If you or a family member have a fear of going to the dentist because of a past traumatic experience or simply from a fear of the unknown, the first thing you should find comfort in knowing is that you’re not alone. Beddington Dental has helped countless patients in your same situation overcome their hesitation to visit a dentist, and we can do the same for you and your family.
One of the main reasons that people avoid going to the dentist is that they have tremendous fear. Sometimes it is because they had a very traumatic experience in the dental chair in the past. But many times, there is no specific explanation for their anxiety of visiting the dentist. If you are one of these fearful dental patients, please give us a try. Our dentists are trained to offer different types of sedation to alleviate your fear in the dental chair.
In Alberta, if a dentist wants to expand his/her ability to offer sedation to patients, there are different levels of trainings offered at the University of Alberta or other institutions in North America. Sedation can be divided into two main categories: conscious and unconscious sedation. Because of the level of extensive training requirements to administer unconscious sedation safely, general dentists and dental specialists alike can offer conscious sedation. Please understand that the way of administering the sedation has nothing to do with the level of sedation. For example, if you are given a large enough dose of a commonly used sedation medication like Ativan, you can be sedated to the level of unconsciousness! Therefore, sedation dentistry requires additional specialized training for dentists so that patients will be safely cared for. Among the conscious sedation options, it can be divided into three categories,
The lightest mode of sedation available to dental patients is nitrous oxide gas also known as the laughing gas. Throughout the dental procedure, the patient wears a small mask on their noses. The mask is connected to two gas tanks with small tubes. One tank is pure oxygen and the other, nitrous oxide. The device allows the dentist to adjust the concentration of nitrous oxide gas to be delivered to the patient from 0% up to 70%. The reason the maximum level is set at 70% is for safety. We want to make sure at least 30% oxygen is in the gas that the patient breathes. The advantage of nitrous oxide sedation are safety and reversibility. The patient can quickly return to a 100% normal state of consciousness once the gas supply is discontinued. One of the main limitations of the laughing gas is that it provides only very light sedation. For many fearful adult dental patients, nitrous oxide gas is an ineffective method of sedation, but because it is very safe and readily reversible, this mode of sedation is a good option for pediatric patients. However very young and fearful children sometimes cry when they are nervous in the dental chair. When crying, they breathe through their mouths, therefore the nitrous gas, which is being delivered to the nose, is unavailable to sedate them successfully.
For patients older than 12 years of age, oral sedation is generally an option. Your dentist will give you pills either to swallow or put under your tongue to dissolve. It takes about 60-90 minutes for the medication to be effective because it takes time for it to be absorbed into your blood stream. Ativan, Valium, and Triazolam aka Halcion are a few medications commonly used by dentists. Among them, I (Dr Lawrence Lai) routinely use Triazolam for oral sedation because it has the shortest lasting effect. Patients who takes Triazolam will recover completely from sedation within 6-8 hours instead of a whole day of feeling drowsy when Ativan or Valium is used. As I mentioned earlier, even though oral sedation is very safe, if the dosage is too high for that patient, he or she can still go to the stage of deep or unconscious sedation. Because different patients react differently to a certain dose of sedation drugs, one person may feel untouched after taking 3 pills of 0.25mg of Triazolam while another patient can get into deeper state of sedation which is not desired or planned for by the dentist. One of the major risks of overly sedated patients is suppressed breathing ability. Therefore, knowing how to monitor the vitals of the patient throughout sedation administration is very important. Observation of breathing patterns and using pulse oximeter to continuously make sure the patient has enough oxygen in the blood stream is necessary while patients receives sedation. One of the biggest drawbacks of oral sedation is that it does not allow the doctor to adjust the dosage of the sedation drug once the patient is given the pills. Many times, the dosage is effective to attain mild or moderate conscious sedation. Most times this state of sedation is enough for the patient to stay calm for the dentist to carry out dental procedure with no worries of choking or suffocating due to sedation. However, it is not uncommon that the dosage chosen by the doctor is either too light to alleviate the anxiety of the patient or too much that the patient is over sedated and enters a deeper state of sedation and becomes unconscious.!, In cases when the dose is to light the doctor cannot give more pills because it will take another 60-90 minutes to be effective. The slow reaction time of oral sedation makes this mode of sedation not adjustable If the patient is overly sedated and goes into deeper state of sedation, he/she may not breathe enough on one’s own reflexes. That is very dangerous! Luckily there is antidote medication that can quickly reverse the effect of the sedation drugs the dentist commonly uses. This antidote medication makes the sedation procedure reversible and safe, if the doctor is well trained to recognize the complications during the procedure.
In order to get around the inability of adjusting the dosage in oral sedation, I would say IV or intravenous sedation is the preferred choice of conscious sedation. In order to be certified to offer IV sedation to our dental patients, Drs Rok Jeong and Lawrence Lai attended the University of Southern California for a 12 days course in 2018. The training comprised of 5 days of didactic, 7 days of hands on instruction, and passing the Advanced Cardiac Life Support (ACLS) examination, and a minimum of sedating 20 dental patients during the course. In order to continually providing safe IV sedation service, the dentists are required to attain yearly recertification of the BCLS (Basic Cardiac Life Support) and the ACLS recertification every two years. Also, there must be additional personnel designated to monitor the vitals of the sedated patient throughout the dental treatment time in addition to the normal arrangement of a registered dental assistant working with the dentist. The medication used for IV sedation at Beddington Dental is Midazolam which belongs to the same family class of drugs Ativan, Valium and Halcion which were mentioned earlier. Because the medication is administered into the vein of the patient via a catheter, the medication takes effect almost instantly. The patient will feel the sedation effect with a minute or so with the right dose instead of waiting 60-90 minutes as in the mode of oral sedation. Because of this fast response to the drug by the patient, the doctor can tell quickly if the dose administered is enough to attain the desired sedation state. This will allow the dosage to be increased slowly in a controlled manner. So, we say that the advantage of IV sedation is it allows the doctor to adjust the dosage to an effective amount safely and efficiently.
For both the oral and IV sedation options, patients are required to be refrained from operating a motor vehicle or any machines at work for 24 hours. In other words, the patients need to arrange a friend or family member to help them get home after the dental treatment. Also because of the risk of suppressed normal coughing and breathing reflexes when overly sedated, it is important that the sedated patients fast for 4 hours or more in advance to have empty stomach when they come for the appointment. In a nutshell, sedation options available at Beddington Dental are very safe and effective for fearful patients.
With all these sedation options available to our patients being anxious and fearful should not be the reason to avoid seeing the dentist!