Sedation dentistry allows
you to be sedated just enough to be pain free and unaware of
the treatment, as if you were relaxing. That is why it is normally
referred to as conscious sedation dentistry. So if you have
sensitive teeth, a fear of dentists, have a bad gag reflex,
hate needles, or have limited time to spend on dental care at
the dentist, Sedation during dentistry procedures can help you.
Whatever the case may
be sedation by your dentists can help you be more anxiety free
during your dentistry treatment. Your dentist's ultimate goal
is to make your visit to the dentist a relaxing and enjoyable
one. Since you are completely comfortable, relaxed, and pain
free your sedation dentist can do years of dental treatments
in one or two dental visits.
With sedation your dentist can restore sore gums to good dental
health, fix a chipped tooth, replace crowns or dentures, whiten
yellow or stained teeth, and more. All pain free.
General
Anaesthesia
Nowadays, general anaesthesia
in adults (being put to sleep)
is a treatment of last resort. For most adults, sedation works
perfectly acceptably. If sedation fails then GA can be provided.
Also, there are exceptional circumstances under which general
anesthesia is recommended. But find out more below!
What
are General Anaesthesia and Deep Sedation?
General anesthesia (GA)
is when you are totally unconscious. In this state, you can't
feel any pain, even without local anesthesia. You can't reliably
breathe on your own, so for more complex procedures (such as
fillings - these are actually more complex than extractions
under GA!) and procedures of longer duration you need to having
a "breathing tube" inserted.
Deep sedation is a state
of depressed consciousness, where you may lose the ability to
breathe independently and you can't respond to verbal commands.
However, you can still feel noxious stimuli like pain, so local
anesthesia is necessary.
In contrast, what is
usually called "IV sedation" (or, in advertisements,
"twilight sleep") in dentistry is conscious sedation.
Conscious sedation is a minimally depressed level of consciousness
during which the patient is able to breathe independently and/or
respond purposely to verbal command
Why
is General Anaesthesia not used very much for dental work?
General anaesthesia is
a procedure which is never without risk (including the risk
of death). As a result, the General Dental Council in the UK
recommends that "the decision to refer a patient for treatment
under general anaesthesia should not be taken lightly."
"In assessing the needs of an individual patient, due regard
should be given to all aspects of behavioural management and
anxiety control before deciding to treat or refer for treatment
under general anaesthesia. General anaesthesia for dental treatment
should only be administered in a hospital setting with critical
care facilities. All dentists involved in arranging or providing
treatment under general anaesthesia should discuss with the
patient advice and treatment options to avoid or reduce future
episodes of general anaesthesia. A dentist who refers a patient
for treatment or carries out treatment on a patient under general
anaesthesia without ensuring that the relevant conditions ...
are met is liable to a charge of serious professional misconduct."
(excerpt from "Maintaining Standards", GDC, 1997)
Apart from the risk of death (which, while very small, is still
significantly higher than for conscious IV sedation), general
anesthesia has a few major disadvantages:
(1) Complications are
more likely with GA compared with conscious sedation both during
and after the procedure. GA depresses the cardiovascular and
respiratory systems. For some groups of medically compromised
patients, it is contraindicated for elective procedures.
(2) It's not recommended
for routine dental work like fillings. The potential risk involved
is too high to warrant the use of GA. For things like fillings,
a breathing tube must be inserted, because otherwise, little
bits of tooth, other debris or saliva could enter the airway
and produce airway obstruction or cause illnesses like pneumonia.
(3) Laboratory tests,
chest x-rays and ECG are often required before having GA, because
of the greater risks involved.
(4) Very advanced training
and an anesthesia team are required, and special equipment and
facilities are needed. GA introduces a number of technical problems
for the operator (i. e. dentist), especially when a "breathing
tube" is involved: the tongue is brought forward more into
the dentist's way by the airway tubing, the muscles are paralysed
so the operator is working against a dead weight all the time
and there are postural problems because the patient can't be
moved about much. The operator can get very tired very quickly
when doing a session. It's physically the most demanding kind
of dentistry (usually standing, hot lights, compromised patient
position).
(5) You can't drink or
eat for 6 hours before the procedure (otherwise, vomiting is
possible and this would be extremely dangerous during GA).
(6) It's expensive.
(7) GA does nothing to
reduce dental anxiety. The next time you need any work, or even
a routine check-up, you'll most likely be as afraid as ever.
This may not be applicable to all situations - as mentioned
below, GA can be useful or even indicated for certain situations.
As a means of anxiety
management however, GA is next to useless. Anecdotal evidence
suggests that people who have treatment done under GA as a means
of anxiety-control are less likely return for regular check-ups
and cleanings which are necessary to maintain dental health.
Obviously, there may be exceptions.
Are
there any circumstances under which general anesthesia should
be used?
Exceptional circumstances
include treatment for certain groups of special needs patients,
procedures which would be very unpleasant if you were conscious
(such as very complex extractions of bony impacted wisdom teeth),
certain other types of oral surgery, and people with an extreme
anxiety of dental procedures for whom conscious IV sedation
isn't enough (although IV sedation works fine for about 97%
of people with a high anxiety of dental procedures).
If it's extractions that
really terrify you, it may be possible to be put to sleep for
the extractions and then have fillings etc. done under conscious
sedation with local anaesthetic. However, general anaesthesia
is not widely on offer, and must be carried out in a hospital,
in the UK at least.
How
is it administered?
GA is usually started off with an injection in the hand or arm.
It can be supplemented by a face mask but if a face mask is
used you probably won't remember it.
If post-op pain is expected,
the normal practice is to inject a long acting local anaesthetic
during the GA, so that when you wake up everything is nice and
numb for a good few hours (say 6 hours?) afterwards, which should
give you time to take some painkillers and allow them to kick
in. It's much better to premptively stop pain than it is to
try to deal with it once it has started.
is a treatment of last resort. For most adults, sedation works
perfectly acceptably. If sedation fails then GA can be provided.
Also, there are exceptional circumstances under which general
anesthesia is recommended. But find out more below!
