Sedation in Dentistry
General anesthesia is an artificially induced, temporary dissociation from motor and sensory nerve transmission to perform procedures that have the potential to cause significant discomfort. Under general anesthesia, a patient cannot manage their own airway, and must be kept breathing by artificial means. Most people refer to general anesthesia as “going completely out”, or “going to sleep.” General anesthesia is typically produced through the inhalation of certain gases. Sometimes an “inducing agent” is given intravenously before the general anesthesia is given.
Sedation likewise produces a degree of dissociation from normal motor and sensory nerve transmission, and is also used when procedures have the potential to produce significant discomfort. However, people who are merely sedated retain control over their own airway, and do not normally require artificial support of their respiratory function. Sedation can be accomplished via intravenous medications, through oral medications, or through inhaled medication, like nitrous oxide. Each has its own associated benefits and risks, and each provides different levels of control over the depth of sedation. Consequently, the safety factors for each type of sedation are different.
Dental procedures for which general anesthesia is normally prescribed include maxillofacial surgery—surgical manipulation of the jaws and/or bones of the face. Use of general anesthesia is uncommon for general dental procedures, unless the patient has special needs.
Sedation is more commonly used in general dentistry for invasive procedures that involve the possibility of significant discomfort. The risks of sedation need to be carefully weighed against the potential discomfort of the dental procedure. Generally speaking, the deeper the level of sedation, the more risk involved to the patient. Among the procedures for which deep sedation may be appropriate are removal of multiple teeth, including wisdom teeth; placement of multiple dental implants; advanced bone grafting procedures; and procedures on special needs patients, such as young children with extensive dental needs, and developmentally disabled patients. There are many specific indications for sedation dentistry, and the field is growing in popularity.
General anesthesia and sedation are typically performed in dentistry only if the procedure is extensive, or has the potential to cause above average discomfort that cannot be controlled with local anesthetic; or if the patient has special needs (e.g. developmentally disabled, very young patients with substantial treatment needs).
Furthermore, general anesthesia and sedation are relatively costly services to deliver (with the exception of oral sedation and nitrous oxide sedation). Since dental plans have limited annual maximum benefits, plan dollars that are disproportionately allocated to non-dental services like general anesthesia or sedation would leave fewer dollars for dental care.
Offices that provide oral sedatives frequently schedule sedation procedures on multiple patients in sequential order, so that waste in the amount of medication used may be minimized. Opening a container of sedative medication that contains enough medication for several patients is inefficient if just one patient requires treatment. Sedative medications can be costly. Consequently, some offices require a monetary deposit prior to scheduling patients who will be sedated, so that the overhead expenses are covered if a patient fails to keep an appointment.
Pediatric Sedation (Sedation of children)
Pediatric sedation involves unique risk factors and precautions because of the unique anatomy and physiology of children.