Understanding Sedation Dentistry

Sedation is a placation by means of a sedative. Experts define sedation as the use of medications, intended to ensure the physical and psychological comfort of a patient. Sedation is used in various situations by allowing the patient to not suffer during a procedure, even though they are aware of what is happening.

Conscious sedation assumes that the patient keeps a “certain consciousness” throughout the intervention, despite the sedatives administered, as opposed to neurolept-analgesia or general anesthesia. In practice, the patient is more or less cut off from reality and disinhibited according to the type of sedation. Below are the kinds of sedation used in dentistry.

“Conscious” Dental Sedation

Conscious sedation relaxes the patient, but he or she is still aware of what is going on. These protocols can be performed by a dental surgeon at the dental office. Sedatives of this type come in the form of tablets or gas.

Oral Sedation involves the patient taking oral sedative tablets belonging to the benzodiazepine family (Diazepam). One advantage of taking oral sedatives is that the patient can take medicine before the surgery. This sedation protocol is very suitable for patients who do not have dentophobia (being afraid of the dentist), but who have a slight apprehension and wish to relax just before the intervention.

“Laughing gas” is the second level of sedation and is designed to put the patient into a state of relaxation before and during the procedure. When it comes to gas sedation, the patient breathes in nitrous oxide (an oxygen-nitrous oxide mix, 50% – 50%). There is a hallucinogenic effect as well as a mild analgesic.

“Unconscious” or “Semi-conscious” Dental Sedation

The patient has no awareness of reality although they remain in a level of sedation that does not exceed a “sleeping” state as opposed to a “comatose” state. This type of sedation is very suitable for all acts of dental surgery, from the simplest to the most complex. Even though unconscious sedation can be performed in a dental clinic, there needs to be an anesthesiologist present.

Semi-conscious sedation is not anesthetic, meaning anesthesia is only obtained with local anesthetics. Oral surgery or dental care is impossible with conscious sedation alone, without local anesthesia. The drugs are administered intravenously directly into the bloodstream.

In this protocol, the patient is immersed in a deep sleep. This deep sleep is a kind of “chemical hypnosis” that completely disconnects the patient from the reality that he or she is having dental work done. The patient’s level of unconsciousness is equivalent to general anesthesia.

The most significant advantage of intravenous (IV) semi-unconscious dental sedation is that, if the patient is not sufficiently sleepy, the anesthesiologist can give them an extra dose of sleeping aid and the effects are instantaneous. Medications used in IV conscious sedation are much more useful than if these same medications were taken orally. This means that the Dentist can control the amount of sedation, making the person’s deep sleep a pleasant one.

This protocol can be repeated as many times as necessary without taking a significant risk because the clinic is inducing sleep and not a coma. This means that you can do a session every day, for several hours, if necessary. Unlike general anesthesia that cannot be repeated safely, it can be practiced in a dental office whose technical platform is structured for this purpose.

Total unconscious sedation

Entirely unconscious sedation is named as such because the dental professional puts the patient in a level 1 or 2 coma (based on a four-level scale). This option can only be performed in surgical clinics, in the operating room.  This is the next level of Sedation Dentistry and uses intravenous injection drugs, just before and during the intervention.

The entire process is controlled by an anesthetist resuscitator doctor in the operating room. This is the best option for those who have an extreme fear of the dentist, or for those who have nauseated reflexes during dental care. According to experts, this protocol is very suitable for long and arduous sessions.

On a side note, this type of protocol cannot frequently be repeated and is reserved for specific interventions. Only a resuscitating anesthesiologist doctor can practice this type of sedation and only in the hospital environment.

Intravenous “non-conscious” sedation or Level 2 coma

Dentists at Gulfside Periodontics in Ocean Springs, Mississippi, use this option to induce a stage 2 coma by intravenous injection drugs, just before and during the procedure. General anesthesia is a massive protocol and has particular indications:

• This protocol is reserved for patients who require extensive dental work, most often surgical.
• It is reserved for patients who require, due to a poor general condition, special monitoring of their vital functions in the operating room and which must be intubated.
• Used for patients who are afraid of going to the dental clinic or have nausea reflexes during dental care.
• It is excellent for pain-free dental treatments for either phobic patients or geographically remote patients who wish to limit their visits.

There are downsides, however, to this type of protocol. For instance, it must be justified either by the operative indication or because the patient presents general pathologies. To learn more, contact Gulfside Periodontics of Ocean Springs.

Meet our providers:

Blake Benefield & Matt Chiniche

Matt Chiniche, CRNA

Matt completed his education and anesthesia training at The University of Mississippi and Arkansas State University. There, he rotated through many Memphis, TN area hospitals providing anesthesia for a variety of patient populations, including the world renowned St. Jude Children’s Hospital and Baptist Health Systems. After his training, he moved back home to the Mississippi Gulf Coast and accepted a position at Memorial Hospital in Gulfport, MS. He has since become affiliated with multiple area hospitals and provides anesthesia for additional outpatient clinics, surgery centers, and offices as an independent anesthesia provider. He is also a United States Naval Reservist providing independent anesthesia at The Naval Hospital of Pensacola.

Blake Benefield, CRNA

Blake was born and raised here on the Mississippi Gulf Coast. Blake graduated from Harrison Central High School, and then obtained a Bachelor’s Degree in Biological Sciences from The University of Southern Mississippi and a Bachelor’s of Science in Nursing from the University of South Alabama. After working in Intensive care, Blake completed anesthesia training at Louisiana State University Health Sciences Center in New Orleans. While in training, he did clinical training at LSU University Hospital, V.A. hospital, Oschner Medical Center, and many other clinical sites. Following graduation, Blake returned to the Mississippi Gulf Coast where is credentialed and works at Gulfport’s Memorial Hospital and Garden Park Medical Center.