SHOULD YOU CONSIDER IV SEDATION FOR DENTAL PROCEDURES?

Many patients find it challenging to handle dental procedures. The fear and anxiety often make patients delay their visits to the dental office. The introduction of sedation in modern dentistry has substantially reduced the discomfort of patients. Sedation, also known as monitored anesthesia care or twilight sleep, is used during minor surgical procedures. 

In dentistry, sedation can be administered through inhalation, oral, or intravenous (IV) route. Unlike general anesthesia, sedation does not make patients completely unconscious. Hence the technique is also known as conscious sedation.

Intravenous sedation is one of the most recommended sedation techniques in dentistry. In this article, we discuss intravenous (IV) sedation in detail.

What is intravenous (IV) sedation? How does it work?

IV sedation is a type of conscious sedation that makes patients feel relaxed before dental procedures. With the help of a syringe, a sedative drug is administered into the vein in hand (intravenously). Through the vein, the sedative drug directly enters the bloodstream and acts within minutes. The level of sedation may vary from minimal (feeling drowsy) to deep (not remembering the procedure) depending on the dose administered. However, even in deep sedation, patients remain conscious. Patients respond to verbal commands and even gentle nudges and can breathe properly. IV sedation reduces patients’ pain and anxiety, resulting in better cooperation.

Who administers IV sedation in the dental office?

Certified dentists or oral and maxillofacial surgeons who have completed specialized training and program in deep sedation and general anesthesia can administer IV sedation.

Who requires IV sedation before dental procedures?

Most dental procedures are performed under local anesthesia. However, patients can take up IV sedation before dental procedures in the following situations:

• Patients have dental anxiety and phobia.
• Patients are undergoing invasive surgical procedures such as wisdom tooth removal, dental implants placement, cyst removal, or root canal treatment.
• Patients have compromised medical health conditions that can aggravate due to stress during dental treatments (e.g., heart patients, epileptics, asthmatics).
• Mentally challenged and physically disabled patients.
• Uncooperative children above 1 year of age.
• Patients have severe gag reflex.
• Conditions where local anesthesia turns ineffective during the procedure.
• Situations where extensive dental treatments are to be completed in a limited time period (e.g., full mouth rehabilitation).

What are the benefits of the use of IV sedation?

Key benefits of using IV sedation for dental procedures are:

• It works within minutes of administration and rapidly reduces patients’ pain and anxiety.
• It enables better cooperation from patients for time-consuming dental procedures.
• The dentist can adjust the dose of the sedative drug based on patients’ responses.
• Patients’ recovery after sedation is rapid.
• The administration of IV sedation is largely painless.
• Patients’ breathing remains undisturbed.

What are the considerations before administration of IV sedation?

Dentists consider the following before administering IV sedation:

• Complete medical history and examination to rule out any possibilities of ailments.
• Airway examination in children to check for any airway obstruction.
• An informed and written consent regarding the sedation procedure from the patient.
• Vital signs (e.g., pulse, blood pressure, oxygen saturation) before the sedation.
• Availability of drugs and equipment required in case of any medical emergencies.

Patients are instructed to avoid eating 6 hours before the procedure and drinking fluids 2 hours before it. Patients are also recommended to get friends or family to accompany them while going back home. Driving back home is strongly discouraged.

What to expect after the IV sedation?

Here are some of the things that patients can expect after IV sedation:

• The sedation may take at least 1-2 hours to wear off.
• The patient may feel drowsy for a few hours.
• For the next 24 hours, patients should avoid unapproved medications, alcohol, and strenuous activities.

How safe is the IV sedation procedure?

IV sedation is one of the most recommended and safe procedures. Patients usually recover within 30-60 minutes after IV sedation. However, patients are also at risk (although rare) of developing hypoxia (decreased oxygen levels), cardiovascular depressions, respiratory distress, or losing consciousness. So, the dentist must be trained in sedation procedures and able to manage medical emergencies. The dental office should be well equipped and supporting staff should also be adequately trained to manage medical emergencies.

Who should avoid IV sedation?

Patients with any of the following conditions should avoid IV sedation:

• Pregnancy
• Allergy to sedative drugs
• Kidney, liver, or respiratory disorders
• Central nervous system depression
• Glaucoma
• Uncontrolled blood sugar levels

When should patients consider IV sedation for dental procedures?

Patients can consider IV sedation for dental procedures if they have dental anxiety or phobia. Besides anxiety, one can consider IV sedation for dental procedures that are invasive or lengthy. IV sedation performed under trained dentists in a controlled environment is considered safe. However, a dentist will assess the patient’s condition and decide if it is fit to use IV sedation. 

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References:

• Corcuera-Flores JR, Silvestre-Rangil J, Cutando-Soriano A, López-Jiménez J. Current methods of sedation in dental patients - a systematic review of the literature. Med Oral Patol Oral Cir Bucal. 2016 Sep 1;21(5):e579-86. doi: 10.4317/medoral.20981. PMID: 27475684; PMCID: PMC5005095.
• Yoon JY, Kim EJ. Current trends in intravenous sedative drugs for dental procedures. J Dent Anesth Pain Med. 2016 Jun;16(2):89-94. doi: 10.17245/jdapm.2016.16.2.89. Epub 2016 Jun 30. PMID: 28879300; PMCID: PMC5564087.
• McKenna G, Manton S. Pre-operative fasting for intravenous conscious sedation used in dental treatment: are conclusions based on relative risk management or evidence? Br Dent J. 2008 Aug 23;205(4):173-6.
• Peden, C. J. (2008). Sedation for dental and other procedures. Anaesthesia & Intensive Care Medicine, 9(8), 334–337.
• Kapur A, Kapur V. Conscious Sedation in Dentistry. Ann Maxillofac Surg. 2018 Jul-Dec;8(2):320-323. doi: 10.4103/ams.ams_191_18. PMID: 30693254; PMCID: PMC6327823.
• Takarada T, Kawahara M, Irifune M, Endo C, Shimizu Y, Maeoka K, Tanaka C, Katayama S. Clinical recovery time from conscious sedation for dental outpatients. Anesth Prog. 2002 Winter;49(4):124-7. PMID: 12779113; PMCID: PMC2007416.
• https://www.sdcep.org.uk/wp-content/uploads/2018/07/SDCEP-Conscious-Sedation-Guidance.pdf
• https://www.asahq.org/madeforthismoment/anesthesia-101/types-of-anesthesia/ivmonitored-sedation/
• https://www.colgate.com/en-us/oral-health/anesthesia/is-iv-sedation-dentistry-right-for-you
• Working Group on Guidelines Development for Intravenous Sedation in Dentistry, the Japanese Dental Society of Anesthesiology. Practice Guidelines for Intravenous Conscious Sedation in Dentistry (Second Edition, 2017). Anesth Prog. 2018 Winter;65(4):e1-e18. doi: 10.2344/anpr-65-04-15w. PMID: 30702348; PMCID: PMC6318731.

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