Sedation dentistry techniques -
To help, we offer sedation dentistry. We offer nitrous oxide and oral sedation options, to help relieve fear or anxiety our clients may feel during a dental procedure. We may also recommend it for patients undergoing a time-consuming treatment or several dental procedures. Sedation will make you feel very relaxed and sleepy quite quickly.
You may feel a mild tingling as well. You may not remember anything from your procedure. The feeling may pass in about two to eight hours, but you should allow yourself 24 hours to recover.
Your medical history and health are reviewed to decide if sedation dentistry is right for you. Because patients are calm and still, the dentist can safely perform procedures with less movement, for better results. A friend or family member should drive you home and stay with you afterwards, though.
Be sure to let the sedation wear off completely before returning to a regular routine. At Waterloo West Dentistry, we will provide you full information about your sedation options. At your dental appointment, we will guide you on how it is administered, any side effects, and what you can expect from it.
The entire procedure is under the complete observation of our qualified dental team. Where there is the potential of pain or discomfort, we use local anaesthetic to numb the area, in addition to sedating you. You can be sedated so you are still awake but completely relaxed, or you can sleep through a procedure with general anesthesia.
For general sedation, we offer oral medication or nitrous oxide, also known as laughing gas. With these moderate sedation options, you are conscious but completely relaxed. You may not remember your procedure afterwards. Oral sedation is popular, as no needles are required and works within minutes.
Oral sedatives can be swallowed whole or dissolved under the tongue. Each oral sedative type used is very safe and has been used for many years. Nitrous oxide is inhaled through a small mask over your nose. It is a very safe and effective anti-anxiety treatment, and is quick to wear off for minimal after-effects.
IV sleep dentistry is a heavier sedation option that makes you so relaxed you are nearly unconscious; some patients fall asleep. Patients who remain awake usually report not remembering their procedure. You will be relaxed for some time after waking up.
Meperidine, an opioid agonist, has been used mainly for intravenous sedation for many years. Opioids are preferred because of their very strong analgesic properties. Although it affects many systems in the body, its therapeutic properties are due to its effects on the central nervous system.
Opioids cause analgesia, drowsiness, changes in mood and blur the mind, but do not cause loss of consciousness [33]. Meperidine is the only opioid that causes tachycardia and reduces secretions.
May cause orthostatic hypotension. It is not recommended to be administered in individuals with severe asthma due to respiratory depression. Other side reactions include dysphoria, nausea and vomiting.
At therapeutic doses, it has almost no adverse effects on the cardiovascular system [32]. It is used together with other central nervous system depressants because it requires high doses for sedation alone.
In paediatric dentistry, the use of meperidine in combination with promethazine, which is often antihistamine, is preferred. Tolerance and dependence may develop after repeated applications. Although its potential to cause dependence in the use of sedation in dentistry is quite low, this feature is a limiting factor in the choice of meperidine [15].
Fentanyl is a short-acting opioid agonist with a fast onset time. Its clinical effect is similar to meperidine and morphine. However, 1 mg fentanyl provides analgesia equivalent to mg morphine and mg meperidine. Fentanyl has replaced meperidine for moderate intravenous sedation in dentistry.
In intravenous administration, the analgesia and sedation effect start in less than 1 minute and the clinical effect lasts for an average of minutes. In intramuscular administration, the effect starts in minutes, the maximum effect develops in 30 minutes and the duration of action is about hours.
Fentanyl is a useful drug for the relief of pain and anxiety by intravenous or intramuscular route for short-term dental and surgical procedures [34]. Fentanyl, like other opioid agonists, may cause myosis, bradycardia bronchoconstriction and euphoria, rarely nausea and vomiting Fentanyl-induced respiratory depression lasts longer than its analgesic effect [15].
Chloral hydrate is one of the hypnotic group drugs synthesized in With the introduction of effective drugs such as midazolam in pediatric dentistry, the use of chloral hydrate has decreased.
Oral capsule, elixir form and rectal suppository is available. It is an effective drug in patients with low and moderate anxiety [10].
Drowsiness and drowsiness usually pass in minutes and the total effect time is hours [35]. Chloral hydrate can cause irritation to the skin and mucosa.
It also irritates the gastrointestinal tract in the vast majority of patients. Gastric discomfort can be reduced by diluting the drug or by drinking a glass of water or milk after the drug. It does not have analgesic properties. The effect of chloral hydrate on blood pressure and respiration at therapeutic doses is similar to that in normal sleep.
Disturbing side reactions of chloral hydrate include bad taste, stomach upset, nausea and vomiting. Other central nervous system effects are dizziness, ataxia, and nightmares [15].
Since titration of inhalation sedation is possible, the level of sedation sought can be achieved in this way.
If the oral dose is not sufficient, the dose should not be increased, or a different agent should be given orally. In another session, the procedure should be performed by re-calculating the dose according to the patient's response.
In order to obtain maximum benefit from chloral hydrate, the appointment period should not be longer than 1 hour [35]. Although chloral hydrate is a safe drug with minimal effect on respiration, it can have serious effects that may cause permanent neurological damage and death when given in high doses, not given in hospital environment, administered by untrained people and when the patient is not observed enough and discharged quickly [36].
Ketamine is an aesthetic agent which has been preferred for many years in anaesthesia practice and has analgesic, hypnotic and amnesic effects. This prevents the patient from perceiving visual, auditory and painful stimuli, and presents a clinical picture in which the patient stands awake, his eyes are open and can move involuntarily, but appear to be unaware of the environment.
Since ketamine is water and oil soluble, it can be administered by intravenous, intramuscular, oral, rectal, intranasal routes.
The highest plasma concentration is reached approximately 1 minute after intravenous administration, 5 minutes intramuscular administration and 30 minutes after oral administration.
Ketamine has a sympathomimetic effect on the cardiovascular system, causing an increase in blood pressure, heart rate and heart rate. After the application of ketamine, spontaneous respiration continues, and muscle tone of the upper respiratory tract increases. Pharyngeal and laryngeal airway reflexes are usually preserved.
Ketamine acts as a bronchodilator. Ketamine stimulates saliva and tracheobronchial secretions that may cause laryngospasm. The use of oropharyngeal tampon is recommended when ketamine is used during dental treatments [37].
Wathen et al. Vomiting was higher in the ketamine-treated group than in the ketamine and midazolam-treated group. At the same time, vomiting was observed more frequently in children who received ketamine under 10 years of age compared to children who received ketamine over 10 years of age.
Ketamine can cause skeletal muscle hypertonicity and rigidity. This effect can be reduced by administration of benzodiazepine.
Random movements that are not associated with painful stimuli may be seen in the patient. These movements should not be confused with insufficiency of sedation level [37]. Ketamine should be administered only by an experienced anesthesiologist in a hospital setting [35].
Propofol is the most commonly used intravenous anaesthetic agent for induction of anaesthesia, which is not chemically related to other intravenous anaesthetics. It has no analgesic effect and can be used for sedation in doses lower than the dose required for general anaesthesia.
It has a narrow security range when used for sedation [39]. It is preferred in sedation applications due to its short duration of action and rapid recovery, as well as its low side reaction [33].
It is a strong respiratory depressant. Since it does not cause histamine release, it can be used safely in patients with asthma. Propofol is also known for its amnestic and antiemetic properties. During injection, it may cause pain. To prevent injection pain, it is recommended that the drug be injected slowly into a large vein and administered prior to intravenous lidocaine [40].
Propofol should not be used in children with egg allergy due to its formulation containing egg lecithin [34]. Since the safety and efficacy of propofol use in children has not been established, its use is not recommended [33].
In case of application, it is recommended to be applied in a hospital environment by an experienced anaesthesiologist [39]. Nitrous oxide is used to provide general anaesthesia in the s, analgesia in the s and conscious sedation today [41].
Hulland et al. In the study of Işık et al. Nitrous oxide is a non-irritating, pleasantly smelling, colourless gas obtained by heating the ammonium nitrate crystals to °C. It is the only inorganic gas used to create anaesthesia in humans.
When the nitrous oxide gas is inhaled, it is rapidly absorbed from the alveoli and transported by physical dissolution without binding to any element in the blood when it enters the circulation [43]. Because of its low solubility in blood, the onset of action and recovery time are very fast.
Although nitrous oxide is classified among inhalation anaesthetics, it is the weakest and provides limited analgesia and is unlikely to provide surgical anaesthesia unless concentrations leading to anoxia are reached [4]. Some patients may experience amnesia, but with little change in learning or memory.
When used at the recommended concentrations, there is a superior safety margin in which no significant morbidity and mortality is recorded [45].
As it does not irritate the respiratory tract mucosa, it does not increase the risk of bronchospasm and can be used in patients with asthma. Changes in respiratory rate and depth are not due to the direct effect of nitrous oxide, but because of the patient's anxiety [46].
This is particularly advantageous in the treatment of patients with cardiovascular system disorder [4]. As a result, the dentist should know which method to use and choose the appropriate sedative agent. While making this choice, the degree of difficulty of the application, cooperation of paediatric patients, anatomical and physiological characteristics of the children, age, and average processing time should be taken into consideration.
In addition, the dosage, safety, duration of action, ease of administration and titration of the sedative agent to be used should be considered.
Considering all these, a sedation route that provides optimum results should be preferred. It should be remembered that success in sedation can be achieved when maximum treatment is provided with the lowest dose-correct sedative agent-appropriate method.
Received: January 03, Accepted: January 13, Published: January 20, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Oznurhan F, Derdiyok C Sedation methods and drugs used in dental sedation. J Dent Res Pract 4. DOI: Home Contact Us. About us About Us Providing cutting-edge scholarly communications to worldwide, enabling them to utilize available resources effectively Read More.
About Us Our Mission Our Vision Strategic Goals and Objectives. Open Access News and events Contact Us. For Authors We aim to bring about a change in modern scholarly communications through the effective use of editorial and publishing polices. Read More. Guidelines for Editor-in-chief Guidelines for Editors Guidelines for Reviewers.
Special Issues Frequently Asked Questions. Links Advanced knowledge sharing through global community… Read More. Take a look at the Recent articles. The drugs and application methods in dental sedation Fatih Oznurhan.
Sivas Cumhuriyet University, Faculty of Dentistry, Department of Pediatric Dentistry, Turkey E-mail : bhuvaneswari.
Sedation application ways Agents selected for sedation; inhalation, oral, intramuscular IM , intravenous IV , intranasal IN , sublingual SL and rectal.
Inhalation Inhalation is the route of sedation where the gas or volatile sedative agent reaches the alveoli in the lungs and shows its primary effect by absorption via blood-gas [7]. Oral The oral route is an easy and economical way to administer and is the oldest used drug administration route.
Intramuscular Intramuscular administration is a parenteral technique in which the drug enters the cardiovascular system directly without passing through the gastrointestinal tract. Intravenous Intravenous administration is the fastest mode of action of the drug, and hand-heart-brain circulation is completed in approximately seconds.
Intranasal Intranasal administration, which has recently begun to be used with increasing interest in non-invasive applications, is used as an alternative to sedation by oral or injection, especially in paediatric patients [21].
Sublingual The advantages of this method are that the permeability of the mucosa in the sublingual region is very high and that the drug passes directly into the systemic circulation with virtually no enterohepatic circulation.
Rectal The availability of more reliable drug administration routes reduces the frequency of rectal administration. Drugs used in sedation Hydroxyzine The Hydroxyzine is an antihistamine that has features of reducing sedative, antiemetic and salivary secretion [4]. Promethazine Promethazine is a phenothiazine with sedative and antihistaminic properties.
Diazepam Diazepam is an oil-soluble and water-insoluble long-acting benzodiazepine. Midazolam Imidazobenzodiazepine is a benzodiazepine group with strong sedative, amnesic and anxiolytic properties.
Effect of midazolam on systems: Cardiovascular System: Cardiovascular depression is minimal in induction doses. Arterial pressure, cardiac output and peripheral vascular resistance show little decrease.
Sometimes it can increase the number of heart beats. Midazolam is considered to lower blood pressure and peripheral resistance more than diazepam.
Respiratory system: It inhibits the respiratory reaction to carbon dioxide. This depression is important in intravenous administration or when combined with other drugs that cause respiratory depression. Although apnoea is less than induction of barbiturate, it can also be observed in intravenous administration.
Cerebral: Cerebral reduces oxygen consumption and blood flow. It is very effective in epileptic seizures. Oral sedative doses constitute anterograde amnesia. Their muscle relaxation is at the spinal level.
Induction doses may cause loss of consciousness. No direct analgesic effects. Drug interactions: Erythromycin inhibits midazolam metabolism, prolongs its effect and intensifies. This antibiotic inhibits the destruction of oral midazolam in the liver, leading to an increase in plasma levels, thus increasing the severity and duration of the sedative effect.
Ethanol, barbiturate and other agents that causes central depression strengthen the effect of midazolam [32]. Meperidine Meperidine, an opioid agonist, has been used mainly for intravenous sedation for many years. Fentanyl Fentanyl is a short-acting opioid agonist with a fast onset time. Chloral hydrate Chloral hydrate is one of the hypnotic group drugs synthesized in Ketamine Ketamine is an aesthetic agent which has been preferred for many years in anaesthesia practice and has analgesic, hypnotic and amnesic effects.
Propofol Propofol is the most commonly used intravenous anaesthetic agent for induction of anaesthesia, which is not chemically related to other intravenous anaesthetics.
Result and Conclusion As a result, the dentist should know which method to use and choose the appropriate sedative agent. Financial disclosure None. Conflicts of interest The authors declare that they have no conflicts of interest.
References Leelataweedwud P, Vann WF Jr Adverse events and outcomes of conscious sedation for pediatric patients: Study of an oral sedation regimen. J Am Dent Assoc J Clin Pediatr Dent Pediatr Dent Elsevier Health Sciences Kanwal F, Jamil Y, Khan H Effect of parental anxiety on child behaviour in the dental surgery.
Cell Ozturk M, Ay S Conscious sedation. Cumhuriyet Dent J 3: Int J Paediatr Dent J Fac Dent Ataturk Univ Malamed S Sedation: A guide to patient management. Louis, Missouri, Mosby, USA. Dogan C Approach to Sedation Practices in Disabled People. Turkey Clinics. J Dent Clin 4: Özen B, Malamed SF, Cetiner S, Özalp N, Özer L, et al.
At Waterloo Sedation dentistry techniques Dentistrywe understand many techmiques are anxious about Mood-enhancing energy booster treatments; also, more complex procedures techniquea be too long Dehydration and muscle cramps sit through dentistrt. To help, we offer sedation dentistry. We offer nitrous oxide and oral sedation options, to help relieve fear or anxiety our clients may feel during a dental procedure. We may also recommend it for patients undergoing a time-consuming treatment or several dental procedures. Sedation will make you feel very relaxed and sleepy quite quickly. Schedule Appointment Or Sedatoon The use of Concentration and cognitive skills development in dentistry is quite common, techniquess Sedation dentistry techniques available in a variety of different dentisrty depending on dentisyry nature of dentistru procedure Energy conservation methods the needs of the individual patient. Understanding when sedation would be recommended, when it may not be necessary, and what types of sedation are most suitable for a patient are important aspects of your dental care. Modern dental care is far more gentle and comfortable than it has ever been. Advanced new technology and equipment allow dentists and hygienists to perform their tasks with greater effectiveness. Techniques and methods used in dental care also undergo continual improvement to provide patients with a better experience.
0 thoughts on “Sedation dentistry techniques”