A Consumer s Guide to Sedation and Sleep Dentistry

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1 A Consumer s Guide to Sedation and Sleep Dentistry Brought to you by: The terms sedation dentistry and sleep dentistry are often used interchangeably leading patients to be confused about the treatment options available to them. Although both sedation dentistry and sleep dentistry can be characterized as forms of sedation, they are very different practices. In this guide, we will explore the techniques and characteristics associated with both. Before we begin, it is important to remember the broad objective behind using sedation in conjunction with dentistry, is to relieve the anxiety and pain experienced by the patient. The level of anxiety on the part of any individual considering sedation should first be evaluated by the treating dentist. A treatment plan should be devised based upon the needs and goals of that individual patient. Only then can the appropriate level of sedation be determined.

2 Sedation Dentistry WHAT IS SEDATION DENTISTRY? In general terms, sedation dentistry employs medications that allow the patient to experience levels of reduced anxiety during a dental procedure. Using sedation dentistry the patient will be in a deep state of relaxation and feel as though the procedure lasts only minutes when in fact it may have taken a much longer period of time. The patient will be able to respond to verbal commands and breathe on their own although they will remember very little of the actual treatment. TYPES OF SEDATION DENTISTRY: ORAL SEDATION Oral Sedation involves the use of oral medications in the form of a pill or tablet to relieve mild to moderate anxiety. The most commonly prescribed medications are Halcion, Ativan and Valium, all of which produce a high level of drowsiness but not a complete sleep. The medicine is generally administered one hour prior to treatment. You will, however, remain awake and alert thoughout your dental treatment and be able to breathe on your own without the fear and anxiety you might otherwise experience. One downfall to oral sedation is that since every patient exhibits different levels of tolerance to drugs and different digestion times, there is no way to measure how much medication has been directly absorbed into the stomach. It is not effective or safe to try to make the patient more relaxed by giving more pills if the initial dose was not effective to relieve the patient s anxiety. NITROUS OXIDE ( Laughing Gas ) Nitrous Oxide is a sweet tasting gas administered through a inhaler placed over a patient s nose. The patient simply breathes in the laughing gas and almost immediately experiences a relaxed state. Nitrous oxide is administered to patients requiring relatively short dental procedures and for those with mild anxiety. Recovery time for patients receiving nitrous oxide is very brief, as the effects subside within minutes, allowing patients to drive themselves home if necessary.

3 INTRAVENOUS (IV) SEDATION Intravenous (IV) Sedation involves the use of medications administered intravenously to produce a relaxed and anxiety-free dental experience. The most commonly used drugs are Versed and Fentanyl. During intravenous sedation, a patient is hooked up to a blood pressure monitor, heart rate monitor and pulse oximeter per standard safety procedures. Although highly effective, many dentists do not currently employ this sedation method because specialized training and certification by their state dental agencies is required. IV sedation does not put the patient completely asleep however, partial or complete amnesia of the dental experience is often produced. INTRAMUSCULAR (IM) SEDATION Intramuscular (IM) Sedation employs the use of sedative drugs that are injected into the muscle of the upper arm or thigh to produce a relaxed state. Although this technique is less common among adult patients, it is an effective sedation method for moderate levels of fear and anxiety. This is often used in special needs patients where it is not possible to have the cooperation of the patient to start an IV. As with intravenous sedation, a patient is monitored for vitals as a safety precaution, specialized training and certification by their state dental agencies are needed. Sleep Dentistry WHAT IS SLEEP DENTISTRY? With sleep dentistry the patient is completely a sleep and unaware of his/her surroundings. With this method the patient feels no pain and has no recall or awareness of the procedure. Sleep dentistry produces a deep level of complete sleep and is a similar type of anesthesia to a surgery in a hospital such as having your tonsils removed. Many times, if a dentist s office is not equipped for sleep dentistry, the procedure will take place in a hospital or outpatient facility.

4 TYPES OF SLEEP & SEDATION DENTISTRY: GENERAL ANESTHESIA (Sleep Dentistry) General Anesthesia produces a state of complete sleep through the use of anesthetic drugs and is ideal for patients with a high level of fear or phobia. It is fast acting and usually takes effect within minutes of being administered. It can be controlled throughout the dental procedure to increase or decrease your level of sedation based upon need. With general anesthesia, you will not hear, smell, taste or feel pain during your procedure. It creates a sleep much different than one would normally experience by blocking all memories and inhibiting normal body reflexes to pain making the dental procedure easier to perform. The effects last for several hours after the treatment is complete, however, the patient will not leave the office until they are awake. For patients who have special needs, anxiety or require extensive treatment, general anesthesia ensures that the treatment can be completed without any anxiety or memories of the procedure. INTRAVENOUS (IV) SEDATION Intravenous (IV) Sedation induces sleep though the use of medications administered intravenously. Like general anesthesia, IV sedation is fast acting and can be controlled to increase or decrease the level of sedation based upon a patient s needs. Once the medication is introduced, the patient will have little memory of the treatment and will feel no pain. They will not be able to hear, smell or taste anything. Most fear and anxiety will be alleviated. Who Benefits from Sedation & Sleep Dentistry In general terms, sedation dentistry employs medications that allow the patient to experience levels of reduced anxiety during a dental procedure. Using sedation dentistry the patient will be in a deep state of relaxation and feel as though the procedure last only minutes when in fact it may take a much longer period of time. The patient will be able to respond to verbal commands and breathe on their own although they will remember very little of the actually treatment.

5 FEAR AND ANXIETY: When it comes to seeing a dentist, one out of seven people experience some form of anxiety. For people unaffected by such anxiety, the fear of those who are uncomfortable with routine dental visits often seems silly. But those anxieties are real for many of us and often result in problematic consequences when that anxiety is allowed to impact the decisions we make towards our dental care. Many of us end up putting off dental visits until we find ourselves in an emergency situation. When an individual experiences anxiety over routine dental visits they tend to put them off or even neglect them completely. Unfortunately, neglecting routine dental care often results in more serious dental and overall health problems. Such problems require treatments that are more extensive and more expensive than when routine treatment is maintained. Our anxiety can lead us into a vicious cycle of neglect, not because we want to ignore the care of our teeth but because we fear it. You may be asking yourself what causes this anxiety and for every person it will be different. Delving into those causes is beyond the scope of this guide. The real issue is to recognize that apprehension over dental care ranges from relatively mild anxiety and fear to, in extreme cases, phobia. DENTAL PHOBIA: The word phobia is defined as an irrational fear that causes the sufferer to avoid the feared experience. In this case the feared experience is the dental visit. Depending on the severity of the phobia, physical symptoms can be present. Such symptoms might include nausea or butterflies, increased heart rate, sweating and the inability to concentrate. Some people may even experience a full-blown panic attack at the thought of visiting a dentist. While it s true that phobias can be overcome, treating a phobia can be a long process. It often makes more sense to take care of much-needed dental work and deal with issues of fear as time allows. Extreme fear or phobia associated with dental care could make you the perfect candidate for sleep dentistry.

6 SPECIAL NEEDS & OTHER MEDICAL CONDITIONS: In addition to helping people with anxiety and fear, sedation dentistry offers solutions for people with special needs and other medical conditions. Treating the needs of those suffering from physical and developmental disabilities such as Alzheimer s, Parkinson s, Down syndrome, Cerebral Palsy and Multiple Sclerosis require the expertise of a properly trained and certified sleep dentist. Where it was once hard to treat patients with these disabilities, having them sit still in a dental chair, sleep dentistry now offers a welcomed answer. Sedation dentistry can also offer relief for those suffering from neck and spinal disorders who find it difficult to recline in the traditional dental chair. It has been a proven solution to those with difficulties getting or staying numb or who suffer from a sensitive gag reflex. Choosing the Right Dentist for Your Needs When choosing a dentist it s important to remember not all dentists are created equal. A dentist who holds a dental degree without any additional training beyond that which they receive in dental school is certified in the state of Florida to administer only one dose of an oral sedative drug per dental treatment. For those patients who exhibit more than a mild level of fear or anxiety, or suffer from a phobia or have special needs, one dose of a sedative drug may not offer the level of comfort they are seeking. To practice a higher level of sedation dentistry in the state of Florida including the use of multiple oral sedatives, IM sedation and intravenous sedation that will relax a patient without fully putting them to sleep, a dentist is required to complete additional training through a university or hospital accredited program. For a dentist to be able to offer sleep dentistry (general anesthesia) where the patient is completely a sleep and unaware of the dental procedure, a dentist is required to complete a minimum of a one year medical residency in general anesthesia at a hospital. In order to assess which level or levels of sedation is being offered by a particular dentist, it is helpful to inquire into that dentist s education and additional training. Since sedation dentistry and sleep dentistry have commonly been used interchangeably, and often are confusing in dental advertising, this will help clarify any confusion you may have in choosing the right dentist for your individual needs.

7 QUESTIONS TO ASK WHEN CHOOSING A DENTIST: When choosing a dentist it is important to feel a certain rapport with that person. As important as the dental care you receive, it is just as important to know that that he/she understands your feelings and concerns regarding the treatment itself. When consulting with a sedation dentist for the first time, be sure to ask: How long has he/she been treating sensitive patients? What special care plan design has been put into place for the patients with anxiety? If you are a special needs patient, is the dental facility equipped to handle your particular needs? In addition to understanding your needs, it is also important that you have every treatment option available to you so your experience is as carefree and comfortable as possible. In order to facilitate all available treatment options, when speaking to your dentist, ask: What form of sedation would they recommend based on your level of anxiety or need and are they equipped to treat you? If you feel that your level or anxiety or need goes beyond the form of sedation they have recommended, are they equipped to handle those needs (i.e. a higher level of sedation)? If you do opt for sleep dentistry, it is important to make sure your dentist and his associates are qualified. Ask your dentist about their qualifications: Where have you received your training and how long was the program? If you choose IV sedation, who will administer the IV medication, an anesthesiologist or a dentist? If you need general anesthesia, will you need to check in to a hospital and receive care in the operating room or does your dentist make the visit easy by offering a full-service facility within his/her own office or an outpatient facility? These are just a few of the questions that arise during the evaluation of a sedation dentist. As with all medical treatments, it is important to do your homework before committing to a dentist. Since not all dentists are licensed to practice both sedation and sleep dentistry, it is important to find out the facts first.

8 Rate Your Anxiety When it comes to seeing a dentist, one out of seven people experience some form of fear or anxiety. If you fall into this category and are considering sedation or sleep dentistry, complete the below self-assessment to rate your level of anxiety. ANXIETY LEVEL SELF-ASSESSMENT: 1. Do you feel slight uneasiness and tension the evening prior to your dental visit, which makes you consider canceling your dental appointment? 2. While waiting in the reception area of the dental office, do you feel nervous about the visit? 3. Have you had a prior dental experience that was unpleasant? 4. While in the dental chair, do you feel uneasy and anxious? 5. Does the thought of having a dental injection make you feel physically ill and tense? 6. Does seeing the dentist or dental hygienist's instruments make you anxious? 7. Do you feel embarrassed thinking the dentist will say you have the worst mouth they have ever seen? 8. Do objects placed in your mouth during the dental visit make you panic and feel like you cannot breathe correctly? 9. Do you feel that your dentist is unsympathetic to you? 10. Have you ever tolerated your dental pain just to avoid a visit to the dentist?

9 11. Do you feel dentists are efficient, but often seem they're in a hurry? 12. Do you feel that dentists will do what he/she wants to do no matter what you say? 13. Do you feel that dental professionals say things to make you feel guilty about the way you care for your teeth? 14. Do you think you can believe what the dentist says about the work that is needed? 15. Do you feel that dentists do not take your worries (fears) seriously? 16. Do you worry about the dentist's infection control methods? 17. Do you feel that if you were to indicate that a treatment hurts, that the dentist would stop and try to correct the problem? 18. Do you feel that when you're in the chair the treatment can't be interrupted, if you need a moment to rest? 19. Do you feel that dentists do not like it when you make a request? 20. Do you feel that dentists do not really listen to what you say? AFTER COMPLETING ALL QUESTIONS, TOTAL THE RESULTS: For each question you answered yes, add one (1) point for a possible twenty (20) points. 0 5 Points: Minimal Fear/Anxiety 6 10 Points: Mild Fear/Anxiety Points: Moderate Fear/Anxiety Points: Severe Fear/Anxiety or Phobia (PLEASE NOTE: Results are only an indication of the level of sedation that may be needed when choosing a doctor. The level of anxiety on the part of any individual considering sedation must first be evaluated by the treating dentist and a treatment plan should be devised based upon the needs and goals of that individual patient. Only then can the appropriate level of sedation be determined. )

10 This guide has been designed to explain the basics of sedation and sleep dentistry and answer the more common concerns and questions associated with the practices. We hope that you ve gained some insight into the benefits of sedation and sleep dentistry. These revolutionary methods of treatment have been a wonderful answer for individuals who have avoided routine dental care for reasons associated with fear, anxiety, dental phobia as well as physical or mental disabilities. This guide has been brought to you by Leff, Weiss, & Waldee, DDS, a full-service SLEEP Sedation Dentistry Practice. We specialize in all aspects of sedation dentistry including IV sedation and general anesthesia. We d be happy to answer any questions you might have about your particular needs or concerns. If you are aware of someone who might benefit from the information contained in this guide feel free to pass it along or have them visit: If you d prefer speaking with a live person please give us a call at: