Sedation dentistry

Sedation dentistry refers to the use of pharmacological agents to induce relaxation and often sleep in a patient prior to and during a dental appointment. The pharmacological agents used differ depending on patient, level of sedation desired and medical professional administering the sedation medications. The medications can belong to a class of drugs called sedatives, which exert their action by depressing the central nervous system, specifically those areas concerned with conscious awareness. Medications used to obtain sedation often include a benzodiazepine (i.e. alprazolam, triazolam, diazepam), opioids (i.e. fentanyl), dissociative (i.e ketamine) and anti-histamines (i.e. hydroxyzine, Benadryl).

There are different degrees of central nervous system depression, each corresponding to a level of relaxation which ranges from minimal, moderate, deep sedation and finally general anesthesia. In general, minimal sedation refers to a patient who has reduced anxiety but readily responds to verbal or physical stimulation (tapping on the shoulder). With moderate sedation the patient is even more relaxed, and will respond to purposeful stimulation (pin prick). In deep sedation and general anesthesia, the patient may not exhibit any signs of consciousness and therefore be unresponsive to stimulation (pin prick, incision). General anesthesia requires a breathing tube and anesthesia team and is commonly only administered in the hospital setting (i.e. heart surgery) and is not generally used for dental treatment. Young children with extensive dental needs and mentally handicapped patients are generally candidates for general anesthesia.

Sedation by pharmacologic methods may be obtained by two general routes. The enteral route involves absorption of medication across enteric membranes which line the alimentary canal from the oral cavity, through the digestive tract, ending in the rectum. This route includes medications that are either swallowed, absorbed through the mucosa of the oral cavity, or inserted rectally. The parenteral route involves the administration of sedative drugs other than absorption across enteric membranes (outside of the alimentary canal). These methods include intravenous, inhalation, intramuscular, and submucosal administration, among others.

General dentists who offer sedation must have taken a vigorous certification course and the requirements differ state by state. The certificate training allows for mild and moderate enteral/parenteral sedation to be offered by a certified general dentist. However, they are not specialists and are not board certified in anesthesia. A dental anesthesiologist however, is a specialist who has pursued an official residency program and is board certified in dental anesthesia (includes deep and general). An oral surgeon is a specialist who has taken a vigorous residency program and is a board certified oral surgeon who can offer deep and sometimes general anesthesia.

Sedation for children
Although researchers are calling for further studies to be carried out, current research indicates that oral medication is a useful sedative drug for pediatric patients. This includes benzodiazepines such as midazolam or anti-histamines such as hydrozyzine. Additionally, Nitrous oxide inhalation has also proven to be useful method to treat anxious children.