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Sedation Procedures in Cosmetic Dentistry

When a patient has chosen to undergo a life-changing cosmetic dental makeover, the appointments can be long and difficult. Great care and skill on the part of the dental team is needed to meticulously prepare the teeth and to give the porcelain ceramist excellent impressions and lab work so they can create beautiful results.

A wonderful way to keep makeover patients relaxed and comfortable is with the help of sedation dental treatment. Once sedated, these patients can complete long, difficult cosmetic makeover appointments easily and comfortably with little memory of the appointment.

A patient can be kept relaxed and sedated for many hours, while the dentist and dental team skillfully complete their cosmetic dental care.

Some commonly asked questions and answers:

1. What kinds of sedation dentistry are available?
Answer: The most popular are oral, I.V., I.M., and Nitrous Oxide or a combination of these options. Nitrous Oxide (relaxing air) helps you achieve a relaxed state where you are less apprehensive, stress - free, and are able to complete your needed care. Many patients who are apprehensive or fearful can complete their dental care comfortably with the help of nitrous oxide.

For phobic or fearful patients who want to be totally relaxed and have little memory of their appointment, I.V. (intravenous) or I.M. (intramuscular) sedation is recommended. By the time your I.V. is started you are already extremely comfortable and relaxed because you have already taken an oral sedative pill dissolved under your tongue one hour prior to your appointment. In addition, you have been on Nitrous Oxide air, so starting the I.V. will not bother you at all. The I.V. provides your fluids during your sedation appointment. Through the I.V., we use .9% Sodium Chloride (normal saline) to keep you hydrated and provide the necessary medications to keep you very relaxed during your appointment.

Certain sedation medications can be given I.M. (intra-muscular) in an arm or leg muscle or even by drops in the nose (intra-nasal sedation). With any sedation method, doctors typically use only enough sedation medication to keep you safely comfortable throughout your appointment.

2. I hate needles and getting shots in my mouth, can anything be done?
Answer: For regular, non-sedation appointments, a topical anesthetic gel is used on the gum prior to the injection. Some doctors use a topical, Tricaine, which is a combination of three different strong numbing gels. The Tricaine gel is applied and usually left on for a few minutes. It totally numbs the area so you do not feel anything, even a small pinch when the injection is given. As your tooth starts to get very numb, the anesthetic is placed in other areas around your tooth, as needed, as treatment progresses.

3. Am I unconscious or will I feel pain?
Answer: No, you are not totally unconscious but you are extremely relaxed. You will be able to communicate with us and follow our directions but you will have little memory of the appointment, if any at all. This light type of sedation is termed "Conscious Sedation" and all of your protective breathing reflexes are intact. You are continually monitored with a sophisticated medical device during your entire sedation appointment. In our practice we use a Poet 8100 monitor from Criticare Systems. It monitors a 3-level EKG reading, blood pressure, respiration, and heart rate. A pulse oximeter reading of your blood oxygen content which is monitored through the nailbed of one of your fingers with a comfortable external finger monitor and an end tital volume CO2 (Carbon Dioxide) reading as you exhale through your nose. A permanent record is printed out every 5 minutes of all of these vital signs. We monitor your vital signs closely through out the entire sedation appointment. If during the appointment you become too sleepy, we can use a reversal medication to lighten your sedation level. You will not feel any pain during your sedation appointment as you will not perceive any pain or discomfort.

4. What Kind of Sedation Medicines Are Used?
Answer: A popular oral medication - sedation that is used is called Halcion. It is a Benzodiazepine that relaxes you, causes drowsiness, and has effects to help you get a great nights sleep the night before your dental appointment. This sedative is placed under your tongue and dissolves, taken up immediately by your bloodstream. Its action starts much sooner and more effectively versus taking the pill by swallowing it. If swallowed, it must pass through your stomach where it is diluted and taken up much more slowly. This is also the reason that I.V. sedation appointments can have a great advantage over oral sedation alone. Sedation medications that can be introduced by intravenous route (I.V.) go directly into the blood stream and the effects take place within minutes. We can titrate, or deliver, the sedation medications slowly and judiciously over lengthy sedation appointments lasting 4, 6, or 8 hours long safely and comfortably. The I.V. medication most commonly used in our office that has the best results and safety record is a Benzodiazepine called Versed (Midazalam). It is a Valium like medication that has a shorter half-life than Valium so it wears off by the end of your sedation appointment. It gives you a wonderful feeling of peace and well being, takes anxiety and apprehension away, and produces amnesia. It is kind on the veins, has a stellar safety record and is widely used in the medical profession during out patient procedures for a number of invasive medical exams such as colon, heart, G.I. procedures to name a few.

If you become too sleepy and relaxed, some doctors may use a reversal agent in the I.V. such as Romazicon (Flumazinil). This medicine takes up the sites of action of the Versed, thus waking you up enough so treatment can continue. You will be unaware you are more alert, but if needed as your appointment proceeds, more Versed can be used to ensure you are comfortable.

A second I.V. medication we commonly use is a synthetic morphine called Fentanyl. It is 10 times stronger than morphine and is classified as a central nervous system (CNS) pain blocker. It is used in conjunction with the Versed to block out the pain receptors in your mouth and body in general to keep you relaxed, pain free, and sedated even during difficult dental procedures.

Ron Briglia, DMD

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