Sedation Dentistry

No one likes the saying "no pain, no gain." This is why sedation dentistry exists; it deals with the type and amount of sedation patients need to ensure their dental visits are as painless as possible. Some sedatives relax the patient; others numb all feeling altogether. Dental sedation is recommended for:

  • longer procedures
  • young patients with behavioural difficulties
  • medical conditions that cause involuntary movements, such as Parkinson's or cerebral palsy
  • patients with "dental phobia"—patients who become panic-stricken and, in some cases, ill at the thought of entering a dental office
Dentists choose from different types of sedation to put the patient at ease:
  • Oral sedatives. For patients with severe dental anxiety, dentists can recommend a pill that will make them severely drowsy for the duration of the treatment. The patient should take the pill about an hour before the appointment. Driving is not possible, so the patient must arrange to have a friend, relative or caregiver accompany them to the dental appointment.

  • Intraveneous sedatives. The dentist injects an anesthetic drug solution into the patient's gum or inner cheek. The patient can receive a block injection, which numbs an entire region of the mouth, or an infiltration injection, which numbs a specific area. Both types of injections will numb the area for several hours. The most common such drug is lidocaine; others include prilocaine, mepivacaine, bupivacaine and other drugs ending in "caine." (The earliest anesthetic drug, procaine, is no longer used because newer drugs yield a much lower rate of allergic reactions.) In addition to the anesthetic drug, the solution the dentist injects also contains agents to help narrow blood vessels, chemically adjust the pH of the anesthetic, and insert it into the bloodstream. Your dentist dries the portion of your mouth to be numbed before injecting it. It is normal to experience some side effects, such as numbness in other areas or swelling, for several hours after the anesthetic has worn off.

  • Topical anesthesia. These are the same drugs used in local anesthetic drugs, but they are applied to the skin or mucous membranes to ease the pain of injected drugs. These drugs come in the form of ointments, gels, sprays, or an adhesive patches.

  • Nitrous oxide. Also called "laughing gas." Nitrous oxide, often used in conjunction with a local anesthetic, is inhaled through a mask clamped over the nose. It relaxes the patient, leading him or her to a state of giddiness. The patient remains awake for the procedure, but is extremely calm. Nitrous oxide raises the patient's pain threshold, so the anesthesia injection is easier to bear.

  • General Anesthesia. Longer, more complex procedures, such as tooth implants, root canals and tooth extraction or surgeries all require general anesthesia, which knocks the patient unconscious. General anesthetics block the patient's airway and thus must be used along with tubes in to help the patient breathe during the procedure. It can only be administered by dentists or nurses with specialized training. General anesthetic drugs can be inhaled, injected, or both. Drugs commonly used for this procedure include benzodiazepines, barbiturates, opioid analgesics and neuromuscular blocking agents.

Pain control is an ongoing area of interest and research for dental specialists, as fear of pain keeps many people from scheduling dental appointments at all. Recent developments, such as topical gels and computer-guided injection methods, can ease the pain of the numbing needle. Some dentists even offer anesthesia consisting of electrical impulses delivered through electrodes, eliminating the need for needles altogether. In addition to sedatives, dentists will often give patients the option of watching a movie or listening to music as a distraction from the dental procedure.

The dentist cannot tell if the anesthetic is working, so be sure to speak up or give a prearranged signal if you feel its effects wearing off. Note that before sedatives can be administered, your dentist must be informed of all medication you are currently taking, and any previous allergic reactions to sedatives.