According to a study published in the Journal of Dental Hygiene, feelings of fear and/or anxiety before a dental procedure are normal in the general population. The study The Prevalence of Dental Anxiety in Dental Practice Settings states that between 50% and 80% of the American population experiences some form of fear and/or anxiety before undergoing a dental procedure, with symptoms ranging from mild to moderate.
It is important that the patient knows that they are not alone and that there are techniques available to help them overcome their fears and anxieties, including sedation and anesthesia. (in White, L. Giblin, L. Bloyd, The Prevalence of Dental Anxiety in Dental Practice Settings, Journal of dental hygiene (2017, vol. 91, 30-34).
Any of these techniques can alleviate anxiety levels, help prevent pain and ensure the safety of treatment. Although close, sedation and anesthesia are not the same thing. The side effects experienced are identical in both techniques, such as drowsiness, decreased balance and motor coordination, amnesia for the procedure, among others.
The administered drugs remain in the body for several hours, which is why you should always have someone with you and are prohibited from driving in the hours following the procedure.
Once sedation has started, the patient will feel relaxed and may fall into a light sleep, as mentioned in Conscious sedation for surgical procedures. (in: Debra, M., Wechter, G., Conscious sedation for surgical procedures, A.D.A.M., Inc. (2015))
In general, the dental community refers to this phenomenon as conscious sedation due to the fact that the patient is in a fluctuating state between being awake and deeply drowsy. With this degree of sedation, the patient is able to maintain respiratory stimulation and respond to some verbal and physical stimuli.
With conscious sedation, patients are put to sleep during the procedure and in most cases they will have no memory of the procedure. The American Dental Association guidelines argue that these techniques should only be performed in the presence of a professional team specialized in this type of procedure, with strict monitoring of vital signs, as well as advanced airway approach material and emergency drugs. (in: Debra, M., Wechter, G., Conscious sedation for surgical procedures, A.D.A.M., Inc. (2015))
In general, anyone can use conscious sedation. In adult dentistry, the cases that most frequently use conscious sedation are for the extraction of wisdom teeth and the placement of dental implants. According to the famous journal Annals of Maxillofacial Surgery, which addresses the topic of Conscious Sedation in Dentistry, sedation is considered appropriate for patients with dentist phobia or pathologies aggravated by stress (arrhythmia or epilepsy), or any other patient undergoing to a prolonged procedure. Patients with mental disabilities, children or people with a sharp gag reflex or difficulty opening their mouth may also be subject to conscious sedation. (in: Kapur, A., Kapur, V., Conscious sedation in Dentistry, A.D.A.M., Inc. (2015); Agarwal, R., Tom, J., Anesthesia or Sedation for Your Child’s Dental Work?, American Academy of Pediatrics (2016)
Sedation levels can range from light to deep during the same procedure. The drugs used during sedation have a hypnotic effect as well as, although mild, an analgesic effect.
In light sedation, the drugs used allow the patient to be in a state of relaxation, mainly controlling anxiety. In the vast majority of situations, the level of consciousness is maintained or there is a slight drowsiness, being easily aroused. In this case, the patient is able to respond to external stimuli, both tactile and verbal.
In moderate sedation the level of consciousness becomes more depressed. The response to verbal and tactile stimuli is almost nil, and the patient is arousable with mild painful stimuli.
In relation to deep sedation, consciousness is depressed and the patient only awakens under painful or repeated stimuli.
At all these levels, patients maintain spontaneous ventilation, without the need for any airway assistance. Most of the time, only a nasal cannula is placed to administer supplemental oxygen.
Monitoring vital signs is crucial. These sedation levels can fluctuate between each other. In order to always maintain safety, the presence of an anesthesiologist as well as a nurse with competence in Anesthesiology is essential.
In general anesthesia the patient is placed in a state of induced coma. In this situation, spontaneous ventilation is not possible and it is necessary to use an airway aid with subsequent mechanical ventilation. Here patients do not respond to any stimulus. General anesthesia is necessary for more invasive and very painful procedures, which also involve complete immobilization of the patient.
For most dental procedures, performed in an office environment, the desired level of sedation is light to moderate in which consciousness is maintained or quickly regained.
The analgesic effect of the drugs used is residual, and it is extremely important that an analgesic supplement is provided. In other words, the fact that the patient is under sedation does not exclude the need for local anesthesia.
Both sedation and general anesthesia have associated risks. These are more frequent in general anesthesia than in sedation and are, in short, respiratory complications, regurgitation with subsequent aspiration pneumonia, temporary nerve injuries associated with longer procedures and an allergic reaction to the drugs administered.
In order to reduce associated complications to a minimum, a pre-anesthetic assessment questionnaire is prepared, with subsequent validation by the anesthesiologist. In addition to this assessment, the following recommendations are made so that the procedure can be carried out safely.
Anesthetic drugs are currently highly safe. With compliance with all recommendations as well as adequate and constant surveillance by the anesthetic team, the risk of complications is almost zero. We can therefore conclude that it is safe to perform these dental procedures under sedation, allowing the patient greater comfort.