A Complete Guide to Sedation Dentistry

May 4, 2020 | Uncategorized

Going to the dentist can trigger a moderate level of anxiety in any patient – but for some, there may be physical, mental, and emotional obstacles that make even a simple dental check-up impossible.

For some of these circumstances, sedation dentistry may be a viable solution. However, there are many questions and apprehensions associated with the practice that may prevent those in need of dental care from properly seeking it out.

This guide to sedation dentistry serves to inform all patients of the sedation dentistry process, the types of sedation involved, and who it may be best for.

What is Sedation Dentistry?

Sedation dentistry is a form of dentistry in which patients are given medication in order to promote relaxation during any dental procedures. In previous years, sedation dentistry had commonly been known as “sleep dentistry.” However, most patients who undergo sedation dentistry are awake for their procedures – patients are only given general anesthesia and rendered unconscious for very specific, serious circumstances.

There are three different levels of sedation used in dental procedures:

  • Minimal sedation. You are awake, but medications make you feel more relaxed. The ADA describes this as a minimally depressed level of consciousness.  Patients retain their ability to respond normally to stimuli and verbal commands.
  • Moderate sedation. You are awake, but you may feel groggy and in a dreamlike state. Some patients under moderate sedation may not remember their procedure. In general, patients retain the ability to respond to verbal commands but may require tactile stimulation from the dentist.
  • Deep sedation. You are nearing unconsciousness, but you can be awakened if necessary.
  • General anesthesia. You are completely unconscious, and you only wake up at the conclusion of your procedure.

Some dental offices group deep sedation and general anesthesia in the same category, so it may be recommended to get clarification on the level of sedation that is required for your procedure.

Types of Sedation used in Sedation Dentistry

What Types of Sedation Are Available?

In order to achieve these levels of sedation, there are three common types of sedation that may be used.

Inhaled Sedation

Inhaled sedation is a form of minimal sedation in which patients breathe in a combination of nitrous oxide and oxygen to make them feel more relaxed. Also known as “laughing gas,” nitrous oxide is breathed in throughout the procedure via a mask that is placed over a patient’s nose. Dentists can easily control the dosage, increasing and decreasing as needed.

Compared to other types of sedation, inhaled sedation wears off fairly quickly – and in most cases, adults may be able to drive home immediately after their procedure.

Oral Sedation

Oral sedation is the most common type of sedation in dentistry. It involves the ingestion of medication that relaxes you. In sedation dentistry, the medication most often used is Halcion, a drug that is in the same family as Valium. Although patients usually take oral sedation in a pill format, those who may have trouble swallowing pills – such as younger children and those with special needs – may take oral sedation through a liquid form.

Oral sedation may take some time to take effect in patients, which is why it is usually administered an hour before a procedure. It can induce minimal to moderate sedation in patients, depending on the dosage given. Even minimal sedation levels can make many patients groggy – and in some, may even cause them to fall asleep during the procedure. However, it’s important to make a distinction between this and losing consciousness.

IV Sedation

IV sedation allows dental professionals to administer drugs through the veins for continuous medication. Because the drugs are administered directly to a vein, they take effect much more quickly than oral sedation.

IV sedation can induce anywhere from moderate sedation to general anesthesia, depending on the dosage. It is most commonly used to induce a form of deep sedation also known as “twilight sedation,” in which a patient is completely conscious and responsive, but may give off the notion that they are sleepy, groggy, or unconscious.

Who Needs Sedation Dentistry?

Sedation is usually recommended for patients who may have issues or problems with getting dental work done. Sedation dentistry is appropriate for people who have:

  • A low pain threshold or sensitive teeth and gums
  • An overly sensitive gag reflex
  • Problems with sitting still in a dentist’s chair
  • A phobia of dentists and dental work
  • General anxiety about extensive dental procedures
  • Special needs, such as behavioral, physical, or cognitive impairments that prevent them from completing dental work

Additionally, sedation dentistry may also be reserved for those who need extensive dental procedures completed. This can include orthopedic surgery, advanced dental work, or other procedures that require the patient to sit for long periods of time.

What Special Needs Patients Could Benefit from Sedation Dentistry?

Special needs patients may arguably benefit the most from sedation dentistry. This unique group of prospective patients can include anybody with any behavioral, physical, or cognitive impairments or disabilities that can otherwise prevent them from seeking dental work.

Common special needs patients who could benefit from sedation dentistry include those with:

  • Down syndrome
  • Autism
  • Epilepsy
  • Cerebral palsy

What Benefits Does Sedation Dentistry Provide for Special Needs Patients

Sedation dentistry is especially beneficial for special needs patients because it enables those with special needs to receive the dental care they need. Some patients who have cognitive impairments or physical disabilities may not be able to sit still for long periods of time in a dentist’s chair. Some dental offices use restraints, belts, and boards to keep their younger special needs patients restrained and still during a procedure – but some argue that this may further exacerbate the fears and trust put into a dentist’s hands. Sedation is a more viable alternative that allows patients to be compliant for the duration of the procedure, without increasing tensions and stress between the patient and the dental professionals on hand.

Additionally, it can allow those with special needs to receive preventive care before any dental issues degrade into more serious problems. Many with special needs may not be able to effectively communicate any dental issues they may experiencing until they have worsened into more severe issues. Sedation dentistry allows these patients to receive routine check-ups without having to worry about further, more serious pain down the line.

Is Sedation Dentistry Safe for Special Needs Patients?

In general, sedation dentistry has been proven to be safe for most patients, as long as the dental professionals on hand take all the necessary precautions. All experienced dental professionals understand that there may be special considerations to make when special needs patients are sedated. There may be many risk factors in administering sedation to special needs patients that must be taken into consideration, including:

  • Congenital health issues, such as heart defects. Those with Down syndrome often have congenital heart defects that can cause cardiac arrest if sedation levels are not properly managed.
  • Regular medications. Many special needs patients regularly take medications to help moderate their condition. These combined with sedation may result in an adverse reaction that can negatively affect their health.
  • Seizure triggers. Sedation must be carefully managed in those with epilepsy or autism so that it is not a trigger for a seizure at any point during the procedure.

Many dental offices specializing in sedation dentistry strive to ensure the safety and health of their patients. Before any procedures are even considered, most exceptionally qualified individuals will conduct a thorough consultation with their prospective patients. During these consultations, they work with special needs patients and their parents to ensure that all of these considerations are addressed and that any potential for complications is minimized.

How Do I Prepare for Sedation Dentistry? 

Sedation dentistry, in general, requires specific preparations before the procedure and sedation process.

  • Patients must not eat any type of food or dairy product at least 6 hours before the procedure, and they must not drink any clear liquid at least 2 hours before the procedure. This is primarily done to prevent patients from vomiting, which they can then aspirate into their lungs when they are under anesthesia.
  • Patients are highly advised to dress comfortably in loose clothing that is appropriate for the temperature.
  • Unless otherwise directed, patients should continue taking any regular medications. The sedation dentistry professionals will have taken these medications into consideration when calculating the proper dosage and type of sedation; diverting from this circumstance can result in dangerous complications.
  • Regardless of sedation, it is highly recommended to have someone to drive you to and from the dentist’s office. Even minimal sedation can cause impairment in an individual.

Following these provisions can be difficult, especially in those who are more temperamental such as younger children and those with special needs. However, these provisions are paramount in providing a comfortable experience for patients and minimizing complications throughout a procedure.

Does Insurance Cover Sedation Dentistry?

Is Sedation Dentistry Covered by Insurance?

Generally, sedation dentistry is partially covered by a patient’s dental insurance plan. The actual dental work and procedures may be covered, but the costs involved with sedation typically are not. Most, if not all, plans consider sedation as a luxury or an optional practice, and therefore is excluded from coverage.

However, sedation may be covered if it is deemed a medical necessity due to a pre-existing medical condition or disability that prevents a patient from getting dental care without it, such as those with special needs. This may depend on your dental plan, so it is highly recommended to consult your provider for any concrete details.

It is also important to note that sedation, even when covered by dental insurance, can be expensive. Most insurance plans only cover anywhere from $1,000 to $1,500 in annual dental costs. Depending on the extent of the dental work, the costs of the procedure plus the sedation may end up exceeding your annual limit.

However, don’t let the assumed cost deter you from making an appointment.  Fortunately, dental offices that specialize in sedation dentistry often provide special services or programs to help remedy these high costs. These solutions can involve payment plans, subsidies, or other financial considerations – these are often reserved for patients with special needs who are not fortunate enough to receive the care they need.

How Do I Choose a Sedation Dentist?

More and more dental offices beginning to offer sedation dentistry procedures under minimal to moderate sedation. However, not all dental offices may have the proper training, experience, or overall conduct with patients who require sedation dentistry. In fact, only a tiny percentage of dentists have completed the Commission on Dental Accreditation (CODA) program for deep sedation.

According to the American Dental Association, in order to administer deep sedation or general anesthesia, the dentist must have successfully completed:

  • A CODA accredited advanced education program that offers comprehensive and appropriate training on clinical guidelines in safely administering and managing deep sedation and general anesthesia.
  • A current Basic Life Support for Healthcare Providers certification
  • Current certification in Advanced Cardiac Life Support or an appropriate dental sedation/anesthesia emergency management course.

When seeking out an office with sedation dentistry abilities, it is important to take the following factors into consideration.

  • Experience. A qualified dentist should have considerable experience providing sedation dentistry services to a wide variety of patients. This includes those with special needs, children, and others who benefit from sedation dentistry.
  • Credentials. The American Dental Association has strict educational requirements for all levels of sedation dentistry. Dentists must meet these requirements and certifications in order to be allowed to administer specific levels of sedation. Additionally, membership to notable dental organizations such as the American Dental Society of Anesthesiology and the Special Care Dentistry Organization can be material proof of a dental professional’s abilities in sedation dentistry.
  • Ongoing Training. The most qualified dental professionals often pursue continuing education to keep up in any advances in dentistry or sedation techniques.
  • Specialization. Any general practices may be certified to administer certain levels of sedation, but those who specialize in sedation dentistry may be able to provide more comfort and care. This is especially important for patients with unique considerations, such as those with special needs.
  • Communication. Sedation dentistry requires comprehensive communication between dental professionals and patients in order to ensure the safety of the patient. A dental professional who is thorough in communicating the status, health history, and considerations taken during sedation is likely more knowledgeable than a dentist who is less communicative and understanding.
  • Care about total health. Dentists who understand how dental procedures can impact the total overall health of an individual are often the best equipped for sedation dentistry. This is especially important in patients with special needs, where extenuating circumstances have the potential to cause adverse effects as a result of sedation.

Extensive research, communication, and consultation are necessary to find the ideal dental office that practices sedation dentistry.

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