What is “sedation dentistry”?

A friend recently told me that he saw a sign at a mall for “a dentist that specializes in doing procedures where they either knock you completely out of sedate you (their specialty)”. He asked me what my thought was about theses types of dentists and what they do. This post primarily refers to general dentists who offer sedation dentistry for restorative and minor surgical procedures and not oral surgeons or dental anesthesiologists who use IV or inhalation anesthetics for deeper levels of sedation or general anesthesia.

It probably comes as no surprise that a lot of patients are somewhat fearful of going to the dentist. In some cases, the anxiety is so great that the idea of even getting a cleaning is too much for the patient to tolerate, leading to missed appointments and a negative feedback loop which ultimately can lead to catastrophic oral health outcomes. For these patients, regular local anesthetic and even nitrous oxide (“laughing gas”) aren’t enough for them to overcome their fear of the dental office.

Sedation dentistry has been a fantastic option for the aforementioned dental phobic  patient. Imagine getting work done while in a very relaxed state and not even remembering the appointment! Today, there are very safe oral “anxiolytic” (anxiety reducing) drugs that allow one to perform procedures on patients who otherwise wouldn’t have been able to walk into a dental office. Note that we are not discussing drugs that are administered through needles or gases which produce deeper levels of sedation or general anesthesia for which very few general dentists are trained. Those are altogether different subjects that I am not broaching in this post. We’re talking about a very light level of sedation using oral medications with or without the addition of nitrous oxide. So, who can dispense these drugs?

State laws vary, but almost all dentists can perform anxiolytic dentistry, once properly trained.  Please note that this is NOT “sleep” dentistry. Under these procedures, one wants the patients to be drowsy and NOT fast asleep. Additionally, while it is VERY safe, patients need to be screened for medical history issues that could interfere and should be monitored with a pulse oximeter (a device that fits over the finger and monitors blood oxygen levels completely painlessly) and blood pressure measuring device. That’s it, aside from the requisite training which is readily available.

When I was initially trained in sedation dentistry (oral medications and nitrous oxide) over a decade ago, there were companies that tried to get me to sign up with their marketing plan to advertise as a “sedation dentistry” provider using their radio and print marketing program. The whole goal was to use my training in sedation dentistry as a way of getting a stream of new patients into my office.I was qualified to treat patients with anxiolytic drugs with or without the advertising campaign.

Here’s how I see it: Patients have a choice of picking a “sedation dentist” who does dentistry or a dentist who does sedation. My suggestion would be to find a dentist who is highly recommended by peers and patients and then ask them if they do sedation dentistry. For most “smaller” procedures like crowns, fillings, root canals and cleanings, this is easily handled with oral medications. In cases where someone needs a full mouth of work done, I used to bring in an actual dental anesthesiologist who used either IV or inhalation anesthetics to take the patient to a monitored deeper level of sedation that I simply couldn’t (and wouldn’t) do on my own. Again, most of the well-trained restorative dentists that I know offer this service in their offices and one doesn’t need to go to a “sedation dentistry” provider to get that service, though I have nothing against using them if you want to.

Most dentists are comfortable providing light levels of oral sedation in the office and in my 24 years in dentistry I’ve found that this is something that works well for the overwhelming percentage of patients with dental fear. Find a great dentist and then see if they can offer the sedation procedure before simply going to someone because they have an ad in the mall or on the radio.

However, there are cases where patients need to be more deeply sedated or under general anesthesia and again, I am in favor (just one man’s opinion) of having one person handle the dental work and another do the anesthesia. That’s not to say that one person can’t do it well. They can, but again, I would first choose a dentist for the quality of their dentistry, not their sedation experience.

All the best,

Glenn