Conscious Sedation in Dentistry

1. Introduction

Dental anxiety has a major impact on oral health, as people with dental anxiety tend to postpone treatment, which worsens their condition. Mostly, people tend to get dental anxiety due to their bitter experiences during their previous dental treatment. Children tend to fear dental treatments due to their parents having dental anxiety.  Dental anxiety involve fear of pain, fear of loss of control and also fear of unexpected events during dental treatment.

Dental sedation for anxiety

So conscious sedation is administered to patients with anxiety and also for dental patients with 

conditions like hypertension, epilepsy and Parkinson’s disease to provide effective treatment.

2. What is Conscious Sedation in Dentistry?

Conscious sedation provides a state of depression, but the patient can respire, respond to stimuli and also able to maintain reflex actions.

Conscious sedation vs General anaesthesia

The difference between conscious sedation and general anaesthesia is that in conscious sedation the patient is in a state of drowsiness but able to respond to stimulus. In general anaesthesia, the patient is completely unconscious and will be under mechanical ventilator for respiration.

Explain the levels of consciousness achieved with conscious sedation

There are three levels of conscious sedation 

1. Minimal sedation/anxiolysis: In this level, the patient is able to respond to verbal stimulation, cognitive function is minimally impaired, and respiratory and cardiovascular functions will remain unaffected.

2. Moderate sedation/ twilight sedation: In this level, the consciousness of the patient is reduced by drugs, and the patient is able to respond to verbal stimulus and tactile sensation easily, the cardiovascular and the respiratory function are unaffected.

3. Deep sedation: The sedation is drug induced, patient does not easily respond to any stimulus, even after repeated painful stimulus. The patient requires assistance for respiration but the cardiovascular functions are maintained. 

3. Benefits of Conscious Sedation

The patient’s anxiety will be reduced so that the treatment can be started and proceeded effectively. The patient can relax throughout the treatment, so they can follow their appointments regulary as they are less anxious about their treatment. Moreover, there are chances for patients to forget the procedure as they were under conscious sedation during their treatment.

4. Types of Conscious Sedation in Dentistry 

The following types of conscious sedation are also used for wisdom tooth removal.

Nitrous oxide (laughing gas) sedation

Nitrous oxide is an odorless gas, when inhaled, it diffuses throug alveoli of lungs to the bloodstream, and it leaves the body through expiration. It is both anxiolytic and analgesic, and has mild analgesic effect.

Oral conscious sedation (pills)

Diazepam is the drug of choice for oral sedation. It is given to patients before starting the procedure, and the drug when given orally start to work between 15 to 60 minutes, making the patient cooperate effectively during the treatment.

Intravenous (IV) sedation

Flumazenil and Midazolam are drugs of choice for intravenous sedation. Flumazenil shows its effects within 1 to 2 minutes and has a shorter duration of action than midazolam, it recovers quickly and discharges effectively.

5. Who is a Good Candidate for Conscious Sedation dentistry ?

• Patients with dental anxiety or phobia.
• Patients with sensitive gag reflexes.
• Patients requiring complex or lengthy dental procedures.
• Patients who fear needle injections, also known as aichmophobia.
• Patients with extreme teeth sensitivity.
• Patients having difficulty controlling voluntary movements
• Patients with cognitive or behavioural challenges.

6. Side Effects and risks of Conscious Sedation Dentistry

Patients might have potential side effects following conscious sedation like drowsiness, dizziness, nausea and vomiting, headaches and bruises may occur due to IV administration of sedatives. Children might have fever, and irritability as side effects.

7. Recovery from Conscious Sedation Dentistry

• Conscious sedation recovery time varies based on the type of sedation used. Nitrous oxide has a recovery time of 15 to 30 minutes, while oral sedation and IV sedation require a recovery time of 24 hours.
•  Patients who received oral or IV sedation should not drive for the next 24 hours after the procedure.
• Patients are advised to take liquid foods during the day like milkshakes and smoothies and should have a lighter diet for a week.

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