“I hate dentists” is a statement that dentists hear multiple times every day. Of course, this statement is followed by “nothing personal Doc, but I hate getting dentistry done,”. The reality is that receiving dental work is unpleasant at best. Fortunately, there are various modalities that can be used in order to make the experience less unpleasant.
A. Levels of Sleep Dentistry
- Iatro Sedation
This is a term coined by late Dr. Nathan Freedman that describes a series of systemic questions that would help alleviate the patient’s fear of dentistry and provide reassurance for the upcoming dental work. Dr. Zadeh taught this technique at USC School of Dentistry from 1986-1990.
- Nitrous Oxide Inhalation Sedation (Laughing Gas)
This technique is very useful for children, and for adults, has the advantage that it wears out of the system within minutes that the mask is removed and therefore allowing the patient to drive on their own without the danger of being under the influence.
- Oral Sedation
Oral Sedation is the technique used by those who do not have intravenous sedation certification but allows them to produce some level of anxiolytics. Oral Sedation is highly limited in efficacy because of unreliable absorption of the medication and the delayed onset of action.
- Intravenous Sedation
The most effective of these methods is the use of intravenous (IV) sedation. IV Sedation is different than general anesthesia that is used for general surgery. In IV sedation, the drug of choice is Midazolam (Versed). This drug does not produce general anesthesia and pain control must be achieved by local anesthesia (shots). Reflexes remain intact during a sedation procedure and patients often fall asleep by themselves. Versed is a good amnestic medication, that slows down/prevents the short-term memory from converting to long term memory. As a result, patients often do not recall their experience while under the influence of this drug the next day.
- General Anesthesia
General Anesthesia is the ultimate “sleep” dentistry available. Due to the fact that patients’ reflexes are inhibited and breathing is affected, it needs to be administered by a separate anesthesiologist. This makes the procedure twice as expensive and difficult to schedule. In the opinion of Dr. Zadeh, unless in very special medically compromised individuals, it is not necessary to use general anesthesia for dental surgery.
B. Risks of Sleep Dentistry
The most important point with sleep dentistry is that although the patient may feel alert and sober when the procedure is completed, they are not. The effect of IV Sedation stays in the system for 4-5 hours after the last dose. In fact, it is not safe to drive or operate machinery until the next day. We have numerous examples of people buying items or going places that they did not mean to and regret it the next day because of the residual effect of Versed. The greatest danger of IV Sedation is for the patient not to be taken home directly for rest. Remember, that you will not remember what you have done or what you have said after the drug has been last administered until 10-12 hours later.
We, at Zadeh Dentistry, use a pulse oximeter and other measures mandated by law to ensure patient safety during sedation. Dr. Zadeh has not had a single near emergency situation with IV Sedation. We have a full arena of up-to-date emergency medications and equipment necessary for IV Certification and advanced cardiac life support
C. When is Sleep Dentistry Necessary?
In our office, there are two categories of patients that qualify for IV Sedation. The first are those that are so apprehensive about getting dental treatment that if it is not for being “put to sleep”, they would not get their necessary dental work. The others are those that have procedures of three hours or longer. In these cases, IV Sedation helps to avoid extreme fatigue and muscle spasm of the jaw that occurs from prolonged opening of the mouth.
D. Contradictions of Sleep Dentistry
- When the patient has not arranged for post-treatment transportation home.
- In absence of medical clearance.