Conscious Sedation Service, Billericay, Essex
“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 withy the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry margin of safety wide enough to render loss of consciousness unlikely.”
At 15 The Pantiles, we have found that dental sedation can help nervous patients to overcome their fear and allows them to have dental treatment in relaxation and comfort.
Conscious Sedation (also known as ‘IV sedation) is an extremely safe technique that encourages a deep state of relaxation. At 15 The Pantiles, we use a sedative called Midazolam. This is not designed to ‘put you to sleep’, but is a relaxant (although we find that many patients fall asleep during treatment).
Patients are usually responsive during treatment (you may hear voices and respond to the gentle squeeze of your hand) but the amnesic effect of the drug means that patients remember very little of the procedure afterwards. In addition, patients treated under conscious sedation will often lose track of time, and a very long appointment will appear to be over in minutes.
Intravenous sedation is a modern, safe, predictable and effective way to reduce anxiety in dental patients, making potentially stressful dental procedures more pleasant for you. The sedative used is called midazolam. It is a member of the benzodiazepine group of drugs and is the main agent recommended for use in intravenous sedation in the UK. Midazolam is well suited for intravenous sedation as it brings about a general state of relaxation. The recovery period is smooth and quite short, with no feelings of nausea.
You will feel very relaxed and possibly sleepy, with a general sense of detachment from what is going on. During your procedure, you stay conscious, so you do not lose vital protective reflexes (such as the ability to cough). After your procedure, you are likely to have little or no recollection of having the treatment carried out.
The sedative is given through a small plastic tube (a ‘cannula’) put into a vein on the back of your hand or inside your elbow. The insertion of the cannula is very quick and simple. The sedative is given in small amounts over a period of time until you are sufficiently sedated for the procedure to begin. You will be monitored from the start of the procedure by our nurses who have specific and recognised training in the care of patients receiving treatment under sedation. Medical monitoring equipment is used to record your pulse, blood pressure, blood oxygen levels throughout your treatment as well as during the recovery period.
A local anesthetic is still needed to numb the area of surgery, and is given slowly and carefully before your procedure begins. After your treatment, a recovery period is necessary during which the immediate effects of the sedation start to wear off. Your monitoring will be continued during this time. All relevant postoperative instructions (including any prescribed medicines) will be discussed with you and your escort. When we are satisfied that you have recovered enough, you will be discharged home in your escort’s care.
The length of dental sedation depends on the treatment you need; we aim to keep the sedation at a satisfactory level for the duration of your procedure, and you will only be discharged home when you have recovered enough from the sedation. The effects of the sedative will be present for the next 24 hours, so it is essential that you follow our postoperative instructions.
The administration of any drug carries some risk: the risks associated with intravenous sedation as described are very small and can be further minimized by following our pre- and postoperative instructions. A very small number of patients are not suitable for treatment under intravenous sedation for medical reasons. Please discuss any concerns you have by contacting Skene Street Dental practice.
Intravenous sedation is a form of ‘conscious sedation’ as, unlike general anesthesia, the aim is not to bring about a complete loss of consciousness (including loss of protective reflexes). General anesthesia can now only be administered in a hospital setting; intravenous sedation is an inherently more pleasant way of having potentially stressful dental treatment carried out. It is especially effective if you are apprehensive as the sedative’s action actually removes anxiety and so makes dental treatment much more comfortable.
What does it feel like? Will I be asleep?
During sedation you remain conscious during conscious IV sedation. You will also be able to understand and respond to requests from your dentist.
However you might have little or no recollection about the procedure for two reasons:
1. IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.
2. the drugs used for IV sedation produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. The effect of this is that time seems go by quickly and you have very little recollection of what has just occurred. A lot of patients remember none of the proceedings which suggests that during the procedure there was a period of sleeping.
Is it still necessary to be numbed with local anaesthetic? Will my dentist numb my gums before or after I’m sedated?
The drugs which are usually used for IV sedation are not painkillers, but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.
If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (i.e. until you’re numb) before starting on any procedure.
How is IV sedation given?
“Intravenous” means that the drug is put into a vein. An ultra thin needle is put into a vein near to the surface of the skin either in the arm or the back of your hand. The anti-anxiety drug used is Midazolam, chosen because it is a short acting benzodiazepine.
Throughout the procedure , your pulse and oxygen levels are measured using a “pulse oximeter”. This gadget clips onto a finger and measures pulse and oxygen saturation. It gives an audible early warning sign if you’re getting too low on oxygen, although if your dentist and the nurses are paying attention they should see it way before the machine does. Blood pressure before and after the procedure should be checked with a blood pressure measuring machine.
Is it safe? Are there any contraindications?
IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it’s even safer than local anaesthetic on its own!
Is there anything to help me overcome my fear of the dentist?
Yes. If you have a phobia of the dentist it can often deter you from visiting us for regular examinations and dental treatments. At the Grange Dental Centre we are sympathetic to your fears and can offer intravenous (IV) sedation.
What is sedation?
Intravenous (IV) sedation is given by injection into the back of your hand in most cases. The dose will depend on the treatment and the length of time required to complete the procedure at the appointment.
How will IV sedation in the surgery affect me?
Sedation will make you drowsy and unaware of the treatment never the less you will still be able to co-operate with your dentist. The effects of sedative medicine take time to wear off and your dentist will advise you how long the drugs will take to clear from your system.
Pre – operative instructions.
- You will be required to attend a pre appointment to assess your suitability to IV sedation and have your blood pressure recorded.
- Complete and sign a consent form.
- Have your regular meals before the appointment
- Bring a responsible adult with you to take you home by car or taxi.
- Inform the dentist of any medication you have taken.
- Post operative instructions.
- Most people feel drowsy after the treatment and you will be required to stay at the practice until the dentist discharges you.
- You must rest and not perform any physically demanding work.
- Do not drive or operate any machinery.
- Do not consume any alcohol after sedation.
- You must contact the surgery if any problems arise.