Today, we are going to discuss pills versus IV sedation dentistry.
Many dentists these days are advertising for a form of sedation dentistry called sleep dentistry. And many patients get confused or are under the impression that they would be put under general anesthesia. This is incorrect, as most of the time the patients are conscious and able to receive and respond to simple commands and perform most basic functions. The reason we call it sleep dentistry on occasion is that the patients fall asleep during their procedure because they are so relaxed. This is also beneficial for us because anxious patients do not remember the surgery, don’t feel any pain, and is overall safer for both doctor and patient. This is why so many dentists and patients swear by it for both major and minor procedures.
Now, this begs the question: What is real sedation dentistry? For the vast majority of sedation dentists, anti-anxiety medication is offered because of its simplicity and efficacy. Most doctors that offer sedation have the bare minimum training for oral sedation. For dental procedures this is among the most primitive techniques of achieving mild sedation. It is comparable to taking a Xanax® or Valium®. You will be far more relaxed and can even fall asleep, but you may have to take another pill during the procedure as most benzodiazapines have a very short half-life. This is the reason doctors use medications like Halcion® (Triazolam) which is from the Valium® family Benzodiazepines. Triazolam has a half-life of 1.5 to 5.5 hours at higher doses, which makes it popular for dental procedures. It is also often used for long-distance travelers to help reduce the effects of jet lag and travel exhaustion.
However, Triazolam also has a dark history. Triazolam is the allegedly the same medication that was popular many years ago until a postal worker on this medication created a new verb in the English language; “Going Postal.” However, accounts show that the postal worker may have been erratic and unstable, offsetting the medication theory. President George H.W. Bush was also a user of Triazolam for a short period with no ill effects. Other reasons that Triazolam has fallen in popularity is long term usage can lead to dependency and even addiction, and newer benzodiazapines have a lower dependency indication over the long term. Fortunately, this medication has few contraindications and is compatible with most people’s biochemistry and medications. However, if you have certain psychiatric disorders such as bipolar disorder, severe clinical depression, or schizophrenia, taking certain HIV medications, or consume large amounts of alcohol, it is important to let your doctor know ahead of time so that alternatives can be discussed.
The greatest disadvantage in taking pills for dental procedures is the fact that they cannot be titrated to the individual needs of patients. A 220 pound (100 kg) patient will likely need a larger dosage than a petite 95 pound (43kg) woman. As we know each patient has different tolerances to medications, especially sedatives or hypnotics. For safety reasons, in this protocol, minimum set amounts are given to patients. Even if you are observed to be responding well to the dosage, if you need more medication or are not relaxed enough, it is neither practical to take another dose nor is it convenient to reschedule the appointment. You generally do not want to start with a higher dosage. You many be sensitive to the medication and higher amounts can put you into a state of deep sedation or even a coma. These risks are low, but it is important to take them into account. I always account for the patient’s needs and will work with a pharmacologist to estimate the recommended dosage for a patient, but it is not always perfect.
I prefer intravenous sedation and am one of the few dentists with my qualifications in California to be licensed by the California Dental Board for IV sedation. In contrast to oral sedation training that takes only a couple of days, intravenous sedation training takes close to a year to complete and involves live patient procedures and in office examinations. The standards of treatment with IV sedation dentistry are much higher.
For the reasons mentioned earlier, it is not safe to repeatedly administer pills to a patient. Therefore it is not suitable for longer procedures and/or patients who are sensitive or resistant to the medication. Intravenous sedation on the other hand can be continuously and/or repeatedly administered as needed. More control over other supportive medications like antibiotics and anti-inflammatory agents can be effectively and safely given to patients through the I.V. line as well. Most importantly, in case of an emergency in I.V. sedation, the I.V. line is already established and life saving medications can be given immediately. There are many advantages to this approach over pills.
Using oral sedation for dental procedures is a crap shoot at best and simply ineffective at worst. If a patient is really afraid of the dentist and/or requires a procedure longer than 2 hours, I.V. sedation is the only dependable and safe way for sedation.