Dental Sedation

If you feel that the right dentist and psychological techniques alone won’t do the trick for you, have a look at the available sedation options for coping with dental treatment.

These are not recommended for use instead of, but in addition to a caring dentist1. Trust your gut instinct while figuring out which methods might work for you. Sedation is sometimes touted as “the solution for overcoming dental anxiety or phobia”, but in reality, many people don’t like the idea of sedation. Scores on dental anxiety tests may bear little relation to the need for (or desirability of) sedation.

❓ “What’s the story with ‘sleep dentistry’? Are there certain procedures which would be too painful otherwise?”

❗ “I don’t recommend sedation for procedures, but for patients. Some patients require sedation for almost any treatment, others prefer it for long duration of treatment or something that they find unpleasant.

As a rule of thumb, IV is for people who want to know nothing about the treatment and be as “out of it” as possible. The disadvantage is that they need escorted home and watched for at least the next 6 hrs. Nitrous Oxide is for people who are a bit nervous, it calms them down nicely and is a fairly effective painkiller. It’s fantastic for older children and properly done almost guarantees painless dentistry.

I sometimes combine nitrous with IV for proper needle phobics, for whom desensitisation doesn’t work.

GA is a last resort. There are many procedures that can’t be really be done under GA and there is always the risk of death. I always get a bit nervous before a GA clinic and I’ve been doing them for a long time now.” (Gordon Laurie, BDS)

Sedation can be helpful if:
  • you’re having to undergo an invasive or potentially unpleasant surgical procedure such as the removal of impacted wisdom teeth
  • you don’t want to be aware of what’s happening during a procedure and you want to be “out of it”. In this case, IV sedation is the method of choice
  • you want a little help to relax – “laughing gas” can give you a pleasant relaxed feeling
  • you have a gut feeling that sedation would help you and allow you to get work done which otherwise you wouldn’t be able to tolerate
  • your fear is procedure-specific (e. g. needles, extractions), especially if you know that the fear would persist in the presence of an empathetic dentist and adequate pain-control
  • you have a severe gag reflex which can’t be helped with other tricks and technologies
  • you perceive your fears to be irrational and not helped by either an empathetic dentist or psychological techniques
  • you have other mental health issues and you feel that sedation would help you
  • you have difficulty controlling movements
  • your aim is to get a lot of dental work done as quickly as possible, for example because you’re very busy or you’ve got an important social event coming up (or because you’d just like to have it over and done with!)
Sedation may not be a good option if:
  • control and trust are key issues for you
  • the relationship with your dentist plays a major role in your fears
  • you feel you would benefit from a gentle approach which would involve being talked through procedures, going at your pace, and using stop signals
  • you’re worried that sedation will interfere with your judgment and your ability to communicate your concerns to your dentist
  • you’re considering sedation to “make life easier” for your dentist, for example because you fear that they will get frustrated or angry with you
  • you feel you’re being “bullied” into accepting sedation
  • you have a history of sexual, emotional or physical abuse
  • you have a fear of unnecessary or wrong treatment
  • you have an intense dislike of or fear of the drugs used for sedation (or drugs in general)

Types of Dental Sedation

The 3 most common forms of sedation on offer are:

  1. Inhalation sedation (also known as “laughing gas”, “happy gas”, nitrous oxide, “gas and air”, relative analgesia)
  2. Oral sedation (anti-anxiety pills or a liquid)
  3. Intravenous (IV) sedation (drugs administered into the blood-stream through a vein – that’s what “intravenous” stands for)

Click on the links to find out more about each of them.

None of these involve “being put to sleep”, even though advertisements for “sleep dentistry” sometimes refer to oral or IV sedation. Being put to sleep is called general anaesthesia, or GA for short.

Sedation Dentistry – Mixed Feelings

There can be a conflict between your dental fears, on the one hand, and your need for control on the other. If you choose sedation, this can pretty much eliminate your anxiety about discomfort from the dental procedures, if that’s what you’re afraid of. Or, if you’re afraid of a panic attack while sitting in the dentist’s chair, sedation might eliminate that fear, too. But if you worried about not being in control of proceedings, “sleep dentistry” may be a hindrance rather than a help. It may be worth discussing inhalation sedation (laughing gas) with your dentist if you don’t like the idea of loss of memory for the procedure, and if some sense of control is important to you.

Most people have some degree of ambivalence about being in control of, or aware during, a delicate or potentially painful situation, medical or dental. You and your dentist should discuss whether a treatment would be uncomfortable or distressing to you. Even if you hate the idea of sedation, you may want to use it for procedures which would otherwise be unpleasant. It may be useful to talk to others who have experienced the treatment. For a few reasons you may want to have a friend or family member present during the procedure. This can ensure that your basic dignity and privacy are not compromised, if you are in any way worried about this. Also the dentist may relate useful information to them.

Some people feel empowered by using sedation, despite liking to be in control:

“I am an absolute control freak, I have to be in control, I’m just a domineering old bossy boots. However, by having IV sedation, I don’t feel I was not in control. Rather the opposite because it was my decision to have it because it was the only way for me to deal with extreme fear of extractions. I like to be in control when I know what I am doing. When it comes to dental work, I am no expert, therefore I leave it up to the experts and hand over complete control to them while I take a back seat so to speak, under sedation. Therefore, by making that decision, I feel I was completely in control of my own destiny so to speak.”

The case for sedation

The case for sedation can be summed up in one sentence: “If it helps, why not?”. If you’re going to have a treatment that will not be painful, but might be uncomfortable, why not have sedation as part of the course and forget that it ever happened (in the case of IV sedation)?

The case against sedation

Some would argue that relying on sedation does not allow you to overcome your fears, for a number of reasons. In the case of IV sedation, because you will not remember the treatment, you cannot learn that dental treatment is nothing to fear. Oral sedation can have the same effect because benzodiazepines can impair memory and interfere with the acquisition of new information and laying down new memories.

Sedation may also make you believe that the only reason why you’re able to cope with treatment is the sedation, and you may not attribute your success to yourself, but to the drugs used.

So what’s the verdict?

The argument against sedation does appear to have some validity, judging from anecdotal evidence from both dentists and patients (although there is no real consensus).  This is not so much of a problem with laughing gas, because it doesn’t appear to affect memory in the same way as benzodiazepines (for example, people often recall warm fuzzy feelings or feeling amused, and these positive associations can help with overcoming fears).

Also, some dentists and some people with dental fears find that IV sedation does ease their fears long-term and that they are able to progress to having treatment without sedation. This may be more likely if sedation is “tapered off” during treatment, so that anything which could potentially be unpleasant is done under heavier sedation first, and lighter sedation is used towards the end of the appointment.

Some people will continue to visit their dentist regularly and use sedation for any treatment they may need, including cleanings. But it’s also quite common that people who prefer deeper sedation may visit their dentist less often or only when in pain. It’s still unclear whether this is because they have a higher level of anxiety in the first place, or whether it’s a result of lack of exposure and the opportunity to learn that dental treatment can be relatively stress-free2.

There is no right or wrong when it comes to dental sedation. Many dentists quite happily offer both TLC and/or psychological approaches and sedation side by side, and together with you figure out what suits you as an individual. Other dentists have a strong preference for one or the other. If that is the case, make sure that the dentist you choose shares your own preference!

Footnotes
  1. e. g. Woolley, S., Chadwick, B. and Pugsley, L. 2017. The inter-personal work of dental conscious sedation: a qualitative analysis. Community Dentistry and Oral Epidemiology 45 (4) , pp. 330-336
  2. Woolley, S. (2008). Conscious sedation – the only tool in the box? Journal of Disability and Oral Health, 9/2, 97-94