Sedation Options Explained: Nitrous, Oral, and IV
Three levels of sedation, three very different experiences. What each feels like from the chair, who it suits, and how the choice is made.
The question behind “do you offer sedation” is usually “will I be aware of this.” The honest answer depends on which option is used, so here is what each one is actually like.
Nitrous Oxide
A small mask over the nose, and within a few minutes you feel warm, a little detached, and less bothered by what is going on. You are fully awake. You can talk, and you will remember the appointment. It wears off quickly once you switch to oxygen at the end, and most patients drive themselves home. Nitrous suits shorter procedures and mild nerves. It does not suit someone who wants to be unaware, and it cannot be used with a blocked nose.
Oral Sedation
A prescription tablet taken about an hour before the appointment, sometimes with a second dose in the chair. You are drowsy, relaxed, and likely to doze; many people remember the appointment only in fragments. It lasts several hours, so you need a driver, and the afternoon is written off. The limitation is that the dose is fixed once swallowed: if it is not quite enough, more cannot easily be added, and if it is more than you needed, it takes time to wear off. A multi-organization workshop report by Dionne and colleagues in the Journal of the American Dental Association concluded that oral medication to relieve anxiety in adults appears to have a wide margin of safety, that most serious adverse events with sedation are related to potentially avoidable breathing complications, and that oral sedation still calls for careful patient evaluation and monitoring.
IV Sedation
Medication through a small line in the arm, adjusted minute by minute. This is moderate sedation: you breathe on your own, you can respond when spoken to, and you are not under general anesthesia. That is also how the American Dental Association’s Guidelines for the Use of Sedation and General Anesthesia by Dentists define it, and the same document defines the minute-by-minute adjustment as titration: incremental doses of an intravenous or inhalation drug given until the desired effect is reached. Most patients describe it as falling asleep and waking up with the procedure done, and remember little in between, though that varies. It is the choice for implants, grafting, longer surgeries, and anyone who simply wants to be elsewhere. A driver brings you, waits, takes you home, and stays with you for the rest of the day. Dr. Verrett holds the Texas permit for this level of sedation and monitors you throughout. The Texas State Board of Dental Examiners issues a separate permit for nitrous oxide and for each level of sedation, up to deep sedation and general anesthesia, and a Texas dentist may administer only the level the permit covers.
How the Choice Is Made
Three things decide it: how long and how involved the procedure is, how anxious you are, and your medical history. A single implant with local anesthetic alone is routine for many patients. A full arch or a graft with a palate donor site is more comfortable under IV. Heart and lung conditions, sleep apnea, and certain medications can change the recommendation, and occasionally the safest place for a patient is a hospital setting, in which case Dr. Verrett says so. The ADA sedation guidelines require an evaluation before any sedative is given, covering medical history and medication use, and they single out obstructive sleep apnea as a reason to look harder at the airway.
Office sedation in screened, monitored patients has a good safety record, though not a perfect one. In a prospective study by Perrott and colleagues of 34,191 patients treated in oral and maxillofacial surgeons’ offices, most of whom were sedated more deeply than the moderate sedation used here, complications occurred in 1.3 per 100 cases and were minor and self-limiting, two patients needed hospital admission, and 94.3 percent of patients were satisfied with their anesthetic.
What Patients Get Wrong About It
Most people who ask for sedation are picturing the procedure being painful. It is not; the local anesthetic handles that regardless of sedation. What sedation changes is awareness and the memory of the time in the chair. Nerves beforehand are normal rather than a sign of weakness: in the same study by Perrott and colleagues, 80.3 percent of patients reported some degree of anxiety before their procedure. Some patients who choose IV sedation for their first surgery choose local anesthetic alone for the second, once they know what the first was like. Either choice is fine. Sedation and comfort has the practical instructions, and what happens at a consult explains that the first visit involves no treatment at all.
Which option suits a given procedure and a given patient is decided at the consult, and it appears separately on the written estimate. Request a consult or call (512) 346-6097.
Frequently Asked Questions
What sedation is available for periodontal surgery?
Three levels: nitrous oxide, which leaves you fully awake and less bothered; oral sedation, which leaves most people drowsy and remembering the appointment in fragments; and IV sedation, which is moderate sedation: you breathe on your own and can respond when spoken to, and most patients remember little of the procedure afterward. It is not general anesthesia. Dr. Verrett holds a Texas State Board of Dental Examiners permit for moderate IV sedation.
Does sedation stop it hurting?
No, the local anesthetic does that, with or without sedation. What sedation changes is awareness and memory of the time in the chair. For an anxious patient the hardest part is often the time in the chair itself, and sedation lets that pass with little awareness of it.
Is IV sedation the same as being put under?
No. What is used here is what the American Dental Association calls moderate sedation, in which patients still respond purposefully to verbal commands and breathe on their own. General anesthesia is a different level requiring a different permit.
Is a driver needed?
For oral and IV sedation, yes, and the rest of the day is written off. Nitrous oxide wears off within minutes of the mask coming off, so most patients drive themselves home after it.
Is sedation needed for every procedure?
No, and plenty of patients have surgery with local anesthetic alone. A fair number choose IV sedation for a first surgery and local alone for the second, once they know what the first was like. Both are reasonable, and sedation is listed separately on the written estimate.