Many anxious patients prefer to have their procedures done whilst they are asleep. Although the terms ‘sleep dentistry’ and ‘twilight sleep’ are often used to describe intravenous conscious sedation (aka “IV sedation”), patients are generally awake during the procedure and do not actually go to sleep at all. However, despite being able to understand and respond to requests from your dentist during the procedure, you may not remember much at all once the anaesthetics wear off.
IV sedation induces deep relaxation and a feeling of not being bothered by anything, so even though you are aware of what is going on, you just don’t care as much. The drugs used induce a memory loss (amnesia) and time will seem to pass by very quickly. In effect, from your point of view, you would feel as if you were asleep during the procedure.
Frequently Asked Questions
Yes. The drugs are usually not for pain relief, although some pain relief drugs are often given, while they relax you totally, they will not numb you, so you will still need a local anaesthetic. The local anaesthetic is not given until you are well sedated and by this stage, you are unlikely to care that needles are given. The dentist usually waits until you are numb and then starts the procedure. How do we know if you’re numb? Obviously, you can tell us! (Remember, that you’re still awake, you just won’t remember ever talking to us afterwards).
The drug is put into veins directly with an extremely thin plastic tube at the surface of the skin in either the arm or the back of your hand. If you are terrified of all needles, a numbing patch can be applied to these areas beforehand to numb the skin. It is very effective in removing any discomfort and tolerated very well, even by kids. Throughout the procedure, your pulse, blood pressure, breathing and oxygen levels are continuously measured using a special monitor to gives a useful signs to tell us if you start to go to sleep.
Good question!! As a general rule, the fewer medications used, the safer the procedure will be. The most commonly used drugs for IV sedation are benzodiazepines and opioids. Both of these drugs have a short duration of effect, so you should be able to fully awaken shortly after the procedure is complete. Benzodiazepenes are the most commonly used drug for IV sedation. It has 3 main effects: a) reduces anxiety and relaxes you b) makes you sleepy, and c) produces partial or total amnesia (i. e. makes you forget what happened). Opioids can be used as an add-on to either benzodiazepines to multiply the effect and is very useful in surgery where some post-treatment pain relief is required. There generally is no pain felt during the procedure though, because the local anaesthetic is used to numb the area in addition to any intravenous drugs used.
IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist or anaesthetist. Purely statistically speaking, it’s even safer than local anaesthetic on its own! However, contraindications include a) pregnancy b) known allergy to benzodiazepines c) alcohol intoxication or other drug dependency d) central nervous system depression, and e) some instances of glaucoma. Cautions (relative contraindications) include psychosis, impaired lung or kidney or liver function, advanced age, and sleep apnea. Many people who have sleep apnea haven’t been officially diagnosed – if you are overweight and you snore, do mention this. Heart disease is generally not a contraindication. If you have been taking benzodiazepines for many years, your tolerance may be very high – so let your dentist know that you’ve been taking them! Generally speaking though, if you are a fit and healthy patient or one with a mild systemic disease such as well controlled diabetes, epilepsy or mild asthma, then IV sedation in the dental practice is suitable. If your health requirements are extensive though, it would be better to treat you in a hospital or day surgery setting. Please contact us so that we can discuss with you your treatment needs.
If you don’t want to be remember the procedure ie – you “don’t want to know”, then IV sedation is usually the sedation method of choice for healthy patients. Although oral sedation is possible, it is not nearly as reliable or effective as IV sedation for this purpose. The sedation acts very rapidly, and the level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation is both highly effective and highly reliable. The maximum level of sedation which can be reached with IV is deeper than with oral or nitrous oxide sedation. Benzodiazepines produce amnesia for the procedure- you won’t remember the procedure even though you will be awake. The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulties with gagging. Both nitrous oxide and IV sedation are used very effectively to diminish the gag reflex. An airway tube is not required and patients are awake and able to communicate.
Yes. No food or drink for at least 6 hours prior to the procedure. Sometimes, the drugs can cause you to feel dizzy and nauseous, making you want to vomit. This can fall into your lungs especially when you are in a sedated state and thus, no food or drink for 6 hours prior to the procedure is very important to ensure your safety. If you take regular medications, then continue to take these as directed by your dentist and doctor after consulting them first.
You will need someone to escort you home after the procedure so that you can rest for the remainder of the day. An adult needs to stay with you until you’re fully alert. Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day. Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e. g. soup, jelly, custard. If you experience nausea, lie down for a while or drink a glass of apple juice or sweet drink. Don’t drink alcohol for the rest of the day. Take medications as directed by your dentist. Don’t enter into any legal contracts for the remainder of the day. If you have any unusual problems, call your dentist.
All of our staff are highly trained in all types of sedation and pain control. We understand what it takes to treat patients with dental anxiety and have extensive experience treating these patients. Dr Thien Pham, the dental surgeon and principal dentist has studied IV sedation and pain control at a post-graduate level and has been entrusted by the Australian Defence Force to treat their members. In fact, all of our dentists and specialists working in our facility have done or are currently doing post-graduate training and further study as they are committed to providing you excellence in the quality of work. We are able to treat you in most cases without an additional referral to an outside specialist saving you both time and money. Our facility is equipped with happy gas and designed specifically to accommodate IV sedation. Call us today to make an appointment to discuss your treatment needs so that we are able to tailor a solution that meets your individual requirements.