Conscious Sedation for Dental Treatment

What is sedation?

Conscious sedation is a commonly used, safe procedure which is defined as a technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.

Conscious sedation can be provided by tablets or intravenous injection, the main difference being the level of sedation achieved. The intention in providing sedation is to allow a patient to undergo more difficult procedures in comfort, without the worry normally associated with those treatments. It is a safe and effective procedure in common use for dentistry and dental surgery in particular.

Sedation is not sleep, but a drug induced state that reduces awareness and your ability to respond. The procedure still requires local anaesthetic and this will be given once your chosen method of sedation has been achieved. IV sedation has a strong amnesic effect, and it is unlikely that you will remember much at all about the surgery.

Sedation by tablets, usually Temazepam, is described as anxiolytic. It reduces anxiety, but is less profound than intravenous sedation, with the normal drug for the IV route being midazolam. The usual protocol for sedation by tablets is to take some the evening before the procedure to assist with sleeping, and a repeat dose an hour before the surgery. Recovery after oral sedation is slower than for IV sedation, and the normal precautions, such as avoiding driving or operating heavy machinery for 24 hours will need to be observed.

Conscious or intravenous (IV) sedation involves the administration of a sedative drug through a fine plastic tube (cannula) into a vein, usually in the back of your hand or arm. You will become drowsy and may not remember any of your dental treatment. It is vital that you can still cooperate with your dentist so you will remain conscious though relaxed. You will be monitored continuously throughout your treatment and the sedation can be topped up at any time.

As with any procedure there can be complications from sedation, which may include a reaction to the drug itself, which may require emergency medical attention and/or hospitalization, such as altered mental states, physical reactions, allergic reactions, and other sicknesses. These complications are very
rare and sedation is now considered a routine procedure to support the delivery of dental implant treatments.

Sedation also reduces your ability to discuss treatment options with the dentist should circumstances discovered during the operation require a change in the treatment plan. If, during the procedure a change in treatment is required, the dentist and the operative team will need to make whatever change they deem in their professional judgment to be necessary and in your best interest. As part of your consent to have sedation you will nominate the dentist who you wish to take responsibility for decisions if the need arises.

You will need to notify the dentist if you are pregnant or breastfeeding, or if you have sensitivity to any medication. You should also advise the dentist if you have recently consumed alcohol, or are
presently taking psychiatric mood altering drugs or other prescription medications. Please do not eat any food for 6hrs prior to your appointment time. You can have water (or any clear fluid such as black tea/coffee) up to 2 hours before your appointment.

You must have someone with you to take you home after the procedure, and should not be alone during the evening and overnight of the day of surgery. You are also advised against taking sole responsibility for children for 24 hours after having sedation.

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What to expect on the day

You will remain conscious during this kind of sedation.

You may experience a temporary loss of memory during the time that you are sedated. Many patients
have no memory of the procedure at all. You may feel unsteady on your feet for some hours after the
procedure. Your ability to think clearly and make judgements may be affected for the next 24 hours.
You may experience some forgetfulness.

Once you are sedated, the dentist can use local analgesia (pain relief that numbs the site of the dental
treatment). Local anaesthetic as a paste is sometimes used to numb the site of the treatment.

Any injections that you may need can be given through this numbed area to reduce the chance of any
discomfort.

You will spend some time in the recovery area following your treatment. You will be checked by the
dentist or the person giving you the sedation before you can go home.

You must be accompanied by an able-bodied adult who can take responsibility for you following your
treatment. This person must be able to stay with you overnight. If arrangements have not been made
for someone to accompany you after treatment, you will not be able to have the sedation.

If you have any questions or are unclear about having your sedation, then do not hesitate to ask the
dentist.

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After the treatment

Your judgement may be affected by the drugs. This is similar to the effects of consuming alcohol. You should not drive a car, ride a bicycle or operate machinery until the following day. In some cases, this may be for as long as 24 hours.

You should also not take responsibility for the care of others, use sharp implements or cook. It would be unwise to make any irreversible decisions for 24 hours following your treatment. Owing to the effects of the drugs used, care should be taken when using the internet for personal communication.

Before you are discharged, the dentist or dental nurse will give you and the adult accompanying you (escort) important information about your care. You will be given information relating to any local analgesia and the treatment you have received. The dentist will also provide details of pain relief as well as how and when to take other prescription medicines.

You will be given a telephone number of who to contact if you have any problems as a result of your treatment.

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“Never previously used but was put in contact via my dentist due to a problematic implant that was unable to be fixed. Despite being the week before Christmas, they fitted me in at very short notice, everyone was extremely pleasant and professional, from Megan who called to arrange the appointment and welcomed me on site to Richard, the implantologist who explained everything clearly and succinctly. The icing on the cake was that he solved my problem despite the implant system being one he had never encountered previously. Delighted to recommend to any prospective clients. The surgery is very clean, professional and welcoming.”

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I’m writing to thank you for the fantastic job you did with my implant. I already knew I would be in excellent hands because you were so highly recommended to me by my regular dentist whom I greatly trust. I saw from the final scan that it was not the simplest case, because of the need to avoid the sinuses, but you would never know from the result. You have such solid experience Richard and invest in the very best equipment to deliver the best possible outcomes. The tooth that Sophie fitted is absolutely perfect. Louise explained the process so clearly and helpfully throughout and was always available to clarify anything I needed to check.

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