- Sedation dentistry provides several options for patients who are fearful of the dentist.
- Nitrous oxide is the most common and affordable option.
- Side-effects and risks vary depending on the type of sedation chosen.
- Sedation dentistry is not always covered by dental insurance, unless it’s deemed medically necessary.
For as many as one-in-five adults in North America, visiting the dentist is a source of great anxiety. Sedation dentistry helps make this experience more tolerable.
What is sedation dentistry?
Sedation dentistry is used to help patients relax when challenged by anxiety and fear during visits to their dentist.
Anxiety during a dental appointment can easily stem from the variety of tools and procedures performed in the mouth–an area that can, for some, feel very vulnerable, sensitive, and awkward.
“Perhaps no other discipline in dentistry has enjoyed as much growth over the last decade as sedation dentistry,” writes Dental Economics. “The use of oral and intravenous sedation has evolved from a procedure provided primarily by specialists to an accepted mainstream procedure practiced by more than 40% of general dentists in the United States.”
As with any sedative, the depth of sedation given to a patient varies based on the chosen pharmacological treatment and the dental procedure itself. The American Dental Association (ADA) describes the different degrees of drug-induced sedation as follows:
- Minimal sedation — a state during which patients can respond to verbal commands, but cognitive function and coordination may be impaired.
- Moderate sedation — a depression of consciousness during which patients are still able to respond to verbal commands, sometimes using small hand gestures rather than speaking their reply.
- Deep sedation — a depression of consciousness during which patients cannot be easily woken, but they are still able to respond with a physical gesture or short verbal reply after more effort to wake them up.
- General anesthesia — a loss of consciousness during which patients are not able to be woken up without medical intervention performed by a trained professional. Some patients require assistance with their breathing during the procedure due to the anesthesia. This form of sedation poses the greatest risks to a patient’s cardiovascular function, necessitating ongoing monitoring of their cardiac health throughout the procedure.
The stronger the sedation, the more time you’ll need to gradually wake up, a process generally spent relaxing in the dentist’s office, usually requiring 15 minutes to one hour before patients are able to leave.
How is it administered?
The two simplest and most common forms of sedation for dentistry are benzodiazepines and nitrous oxide.
The two types of this drug are sedative-hypnotics and anti-anxiety pills. Both are taken orally approximately one hour prior to the procedure. This means you will probably need someone to drive you to and from your appointment, because it can be unsafe to drive with this drug still active in your system.
The anti-anxiety type of benzodiazepine induces a calm, drowsy state that can cause a patient to fall asleep.
“When a patient is asleep in response to this type of drug, it’s considered a form of hypnosis,” explains Dr. Siegel of Alder Brook Dental in Essex, VT.
The second option, adds Dr. Siegel, is a sedative-hypnotic which very simply relieves anxiety and induces a state of relaxation. Both leave a patient’s system within 10 hours and provide relatively little-to-no risk or ongoing side-effects.
Similar to feeling inebriated after drinking alcohol, nitrous oxide is a mild sedative and is often referred to as “laughing gas” thanks to its side-effect of making patients feel happy and silly.
“Nitrous oxide is a colorless, odorless to sweet-smelling inorganic gas that was first used in surgical and dental anaesthesia in the mid-1800s,” explains the ADA.
Considered very safe and usually administered through a small mask that is gently held to the patient’s mouth and nose, it’s one of the most effective methods for managing a patient’s pain and anxiety during any oral procedure.
Should the idea of wearing a mask create it’s own severe anxiety for some patients, this form of sedation can also be administered intravenously.
According to the ADA, “Inhaled nitrous oxide-oxygen is the most used gaseous anaesthetic in the world. One 2007 survey commissioned by the ADA estimated that “70 percent of dental practices using any form of sedation employed nitrous oxide-oxygen sedation.”
Who is it for?
While anyone can request to be sedated during their next dentist appointment, the National Institute of Health (NIH) says the patients who are most in need of this treatment are those who suffer from dental anxiety, and as a result, regularly skip or cancel their appointments.
Patients with a variety of oral health issues also commonly show increased anxiety because their mouths have already been enduring regular pain prior to their appointment. Simply having delayed dental treatment for so long and ignoring their oral health issues can mean these patients are in a state of pain when they finally do visit a dentist, which can be a source of anxiety in itself.
The diagnosis of “dental anxiety” has been a known issue in the dentistry field going back to the 1960s, except the condition hasn’t appeared to decline since then in spite of all the advances in dental technology over the past five or six decades.
“The most important fears patients face involve seeing, hearing, and feeling the vibrations of the dental drill,” explains the NIH.
Both children and adults are susceptible to dental anxiety and as such are considered candidates for sedation dentistry.
Without sedation options, the ADA says many patient populations, including young children and some people with physical or mental disabilities, would not be able to undergo routine oral healthcare.
“It is very important to understand that anxiety, cooperation, and pain can be addressed by both psychological and pharmacological techniques and local anesthetics, which are the foundation of pain control in dentistry,” explains the ADA.
Despite patient requests for referrals, one 2010 study looking closely at sedation dentistry found that only one-third of patients with referrals actually carry through with receiving sedation and undergoing their required dental procedures. The low success rate is attributed entirely to these patients’ phobia towards dental procedures.
Who shouldn’t receive dental sedation?
The only patients who absolutely should not undergo sedation — outside of an emergency — are pregnant woman, explains the NIH.
“With pregnant women, the procedure should be postponed until after they’ve given birth. And in the case of an emergency, the dentistry needs to be performed in hospital.”
Other types of patients who will find their sedation options limited include those who suffer from the following conditions:
- Narrow-angle glaucoma
- Severe respiratory disease
- Congestive heart failure
- Impaired kidney or liver function
- Obstructive sleep apnea
- Bipolar disorder or any other psychosis diagnosis
Be sure to inform your doctor of any other drugs you are currently taking to prevent any harmful drug interactions.
What are the risks and side-effects?
“The use of sedation and anesthesia by appropriately trained dentists in the dental office continues to have a remarkable record of safety,” says the ADA.
Even so, any medication can pose some degree of risk.
Risks of benzodiazepines: “Benzodiazepine administration can result in an impairment of performance whilst driving similar to that seen with bl ood alcohol levels below the legal limit,” according to the medical journal Psychopharm’s guidelines on benzodiazepines.
In other words words, while it’s not quite like driving while over the limit, one’s motor skills can be compromised while under the influence of these drugs.
This type of sedation can also become habit-forming when taken for longer periods of time. In dentistry, benzodiazepines are only administered during the procedure itself, so long-term abuse or addition to the drug is highly unlikely. Nevertheless, patients with a history of drug addiction might want to consider alternative approaches.
Risks of nitrous oxide: “Because it’s well tolerated, has a rapid onset, is reversible, can be adjusted in various concentrations, and is non-allergenic, nitrous oxide-oxygen is considered a safe sedative in dentistry,” according to literature published by the California Dental Association (CDA).
While most patients experience zero negative side-effects, rare reactions can include nausea, headaches, and excessive sweating and shivering.
“It is advised to keep meals light prior to dental appointments in which nitrous oxide will be used to reduce the risk of nausea and vomiting. Patients may also be advised to avoid eating heavy meals for three hours after their appointment,” adds the CDA.
Risks of general anesthesia: This form of sedation poses the most risk because it is the deepest form of sedation possible and ultimately the most complicated.
“General anesthesia affects the whole body, including the brain, heart, and lungs,” according to literature made available by the University of Michigan Medicine. “It therefore increases a person’s risk of side effects, although most are minor and can be easily managed.”
Rare risks and side-effects include:
- Irregular heartbeat
- Dangerous changes in blood pressure
- Rapid fever
- Difficulty breathing
- Heart attack
“Serious side effects of anesthesia are uncommon, especially among people who are otherwise in general good health,” continues the University of Michigan Medicine literature on the subject.
Anyone who has medical problems, such as heart, lung, kidney, or endocrine conditions, including diabetes, needs to inform the anesthesiologist or nurse anesthetist who will be working on them of as much. The same thing with any medications he or she may be taking and whether they have any allergies.
How much does dental sedation cost?
The cost ranges dramatically depending on the type of sedation being applied, and can be anywhere from $50 to $600.
“The average fee for the sedation portion of the appointment is $50 for nitrous oxide, to $245 for oral sedation, and $562 for intravenous sedation,” explains Dental Economics.
Is it covered by insurance?
Unfortunately, not every dental plan through your employer or private health insurance will cover sedation dentistry. The easiest type of sedation to receive insurance coverage for is nitrous oxide, simply because it is very inexpensive.
Being covered for more intensive sedation options, like general anesthesia, is by no means guaranteed unless it is considered medically necessary for all patients due to the severity of the procedure.
The best chance of having your insurance cover this extra expense is by getting a referral from your primary care doctor or a mental health professional stating that your anxiety or fear of dental procedures warrants a severe need for sedation.