Patient Comfort

Analgesia
Analgesia refers to the relief of pain that is often included in most dental procedures and sedation techniques.

For most types of dental care a patient will receive a drug called an anesthetic.

Anesthetics reduce or prevent pain. There are three main types used in dental care.

  • Local: numbs one small area of the body. You stay awake and alert.
  • Conscious or intravenous (IV) sedation: uses a mild sedative to relax you and pain medicine to relieve pain. You stay awake but may not remember the procedure afterwards.
  • General anesthesia: affects your whole body. You go to sleep and feel nothing. You have no memory of the procedure afterwards.

The type of anesthesia your dentist chooses depends on many factors. These include the procedure you are having, your ability to cope and your current health.

Nitrous Oxide
Nitrous Oxide is a sweet smelling, non irritating, colorless gas which you can breathe.

Nitrous Oxide has been the primary means of minimal to moderate sedation in dentistry for many years and it helps reduce pain. A local anesthetic is still required for most dental procedures while using nitrous Oxide.

Patients are able to breathe on their own and remain in control of all bodily functions. A patient may experience mild amnesia and may choose to fall asleep.

Avoid using nitrous oxide if you have emphysema, take bleomycin, are pregnant, suffer from an acute ear infection or have a severe breathing problem.

Sedation Dentistry
Sedation is a management technique some dentists use to assist anxious, fearful and/or special needs patients. Sedation allows patients to safely and effectively receive dental treatment because it reduces or eliminates uncooperative behavior which results from anxiety and fear.

Many different medications can be used for sedation and these medications can be delivered in a number of different ways, such as swallowing, injection, inhaled gas or mist, or intravenously. Your dentist will discuss with you the medication(s) and the delivery option he or she recommends and give you further information and instructions.

Sedation is best described in terms of "stages" – as part of a scale – sedation usually is divided into three categories:

  • Minimal sedation, or anxiolysis (relieves anxiety)
  • Moderate sedation
  • Deep sedation

During minimal sedation, you will feel relaxed and you may be awake. You can understand and answer questions and will be able to follow instructions.

When receiving moderate sedation, you will feel drowsy and may even sleep through much of the procedure, but will be easily awakened when spoken to or touched. You may or may not remember being in the procedure room.

During deep sedation, you will sleep through the procedure with little or no memory of the procedure room. Your breathing can slow, and you might be sleeping until the medications wear off. With deep sedation, supplemental oxygen is often given.

With any of the three levels of sedation, you may receive an injection of local anesthetic to numb the surgical site. You may or may not feel some discomfort as this medication is injected, depending on how sedated you are.

Sedation can provide pain relief as well as relief of anxiety that may accompany some treatments or diagnostic tests. It involves using medications for many types of procedures without using general anesthesia, which causes complete unconsciousness.

When given appropriately, sedation is safe and effective for many procedures done in hospitals, ambulatory surgical centers and doctors' or dentists' offices. Ask the dentist performing your diagnostic or therapeutic procedure about which level of sedation is appropriate for you.

Administering the Analgesia
A dentist may administer the sedation or he or she may work with an anesthesiologist, dental anesthesiologist, or a nurse anesthetist. You should know who will be providing your sedation analgesia, what their level of training is, and who will be there to handle any medical situation that arises during the procedure.

Monitoring and Safety
As with any type of anesthesia, you will be monitored when receiving sedation analgesia. These monitors are very important to ensure your safety. They are used to monitor your heart rate and rhythm, blood pressure and the oxygen levels of your blood. During moderate and deep sedation, someone will be solely responsible for monitoring your vital signs and controlling your level of consciousness.

After the Procedure
If you have received minimal sedation only, you may be able to go home once the procedure is finished. If you have received moderate or deep sedation, you will probably require more time to recover. Often this may be within an hour. In the recovery room, you will be monitored until the effects of the medication wear off.

Any after-effects of the medication must be minimal or gone before you will be discharged from the facility. You will not be allowed to drive yourself, so arrangements should be made for a responsible adult to provide you with transportation. If you think you may need some assistance, you might consider having someone stay with you on the day of surgery.

Checklist: Questions to Ask Before Sedation Analgesia
Here are a few questions that you may want to ask prior to receiving sedation analgesia:

  1. Who will be responsible for the administration of sedative medications?
  2. What are his or her qualifications?
  3. How will I be monitored during my procedure?
  4. Will I have an IV (intravenous catheter)?
  5. Will I be receiving local anesthesia in addition to sedation?
  6. Will the level of sedation I receive be sufficient to make me comfortable during the procedure as well as the recovery period immediately afterward?
  7. Who will be monitoring my recovery after the procedure?
  8. In case of an emergency, what equipment and personnel will be available?
  9. Who will decide when I am ready to go home?
  10. Whom can I call if I have any problems or questions once I get home?