What does the term conscious sedation really mean?
Sedation is a process to establish a relaxed, easy, and calm state through the use of sedative medications. These medications can be administered in pill form, inhaled through the nose (nitrous oxide), or injection intravenously (IV). In this very sleepy state, patients can still respond if requested, but it can feel as though treatment is completed very quickly (oral or nitrous oxide) or patient have little or no memory of the procedure (intravenous). This is called conscious sedation for that reason and is very safe in the outpatient setting when administered by a trained practitioner. You may not always be asleep, but you will be comfortable, calm, and relaxed drifting in and out of sleep—a “twilight sleep.” Many times oral anti-anxiety medications are combined with nitrous oxide or intravenous routes. In a hospital setting, general anesthesia is used which is not considered sedation.
Who is a candidate for conscious sedation in our office?
We are happy to offer sedation to nearly all our patients in one form or another. Intravenous medications may be limited to fairly healthy patients with more severe dental anxiety. Sedation is very useful for patients with fear, previous negative dental experiences, a severe gag reflex, “white coat syndrome,” certain cardiac conditions, extreme sensitivity to noises in the dental office, and moderate-to-severe sensitivity of the gums or teeth. Depending on patient preference, planned procedures, or cost, one form of sedation may be preferable to the others. Oral and IV sedation both require an escort/driver to and from the office whereas nitrous oxide does not. A consultation prior to the date of treatment will be required to decide which course of sedation is safe and appropriate for you. Occasionally, a patient will be referred to an oral and maxillofacial surgeon.
How is intravenous administered?
A thin needle will be placed in a vein and all medications will be introduced through the tubing. The main medications administered are midazolam (or Versed, a benzodiazepine) and fentanyl (an opiod). Again, some patients will “sleep” whereas others may drift in and out. In addition, the medications provide a great deal of amnesia. Due to medical conditions, some may be sedated more deeply than others. The goal is to provide a safe level of disassociation of the patient’s awareness from the procedure being performed It is desirable to use the smallest amount of medication possible to achieve comfort while maintaining safety during, and for hour after, the procedure. A monitor is used throughout the procedure and during the recovery period. In addition, you will be continuously monitored by Dr. Hingst and/or one to two trained assistants. Dr. Hingst has had training in sedation, maintains certification in Basic Life Support (BLS) as well as Advanced Cardiac Life Support (ACLS) as mandated by the Iowa Dental Board. A bi-annual sedation permit is granted from the Board, and an on-site inspection is completed to assure the safety of our facility and equipment. Dr. Hingst has been a sedation dentist since 2000 and has completed over 1,400 sedation procedures.
Nitrous oxide (laughing gas / happy gas)
Nitrous oxide is a sweet smelling, non-irritating, colorless gas which is inhaled through the nose. It was developed by a dentist long ago and has been used with extreme safety for 175 years. It is a very effective means of relieving mild-to-moderate levels of anxiety and even an exaggerated gag reflex. You likely will not fall asleep but will have drowsiness, possibly experience euphoric feelings, feel a whole-body comfort, and feel like treatment went more quickly than it actually did. The amount given can be modified throughout the procedure and tailored minute-by-minute for each patient. Afterward, the effects are removed within five minutes and you can drive yourself. It is extremely safe for adults and children and has little to no effect on the heart and lungs. In addition, nitrous oxide can be used during dental cleanings as well as operative dental treatment.
For more information on sedation dentistry in the Cedar Rapids, IA area, call our office at 319-365-0534!