Sedation and Comfort

Your First Visit Involves No Treatment

The consult is an exam, imaging when needed, and a conversation. Nothing is done to your mouth that day unless something is urgent and you ask us to handle it, so there is nothing to be sedated for. What a first visit is like.

The Three Options

Nitrous oxide. Breathed through a small nose mask. Takes effect in minutes, and after a few minutes of oxygen at the end most people are clear-headed and drive themselves home. Good for shorter procedures and for mild anxiety.

Oral sedation. A prescription tablet taken before the appointment. Deeper relaxation than nitrous, with drowsiness that lasts several hours. You need a driver.

IV sedation. Medication through a small IV in the arm, adjusted throughout so you stay comfortable. This is moderate sedation: relaxed and drowsy, breathing on your own, able to respond when spoken to. The American Dental Association’s Guidelines for the Use of Sedation and General Anesthesia by Dentists define moderate sedation in those same terms: a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, need no help keeping the airway open, and breathe adequately on their own. Many patients remember little of it. Used for implants, grafting, longer surgeries, and anyone who would rather not be aware. Your driver waits in reception, takes you home, and stays with you for at least two hours.

Who Is a Candidate

Most healthy adults. We screen for heart and lung conditions, sleep apnea, medications, and previous anesthesia experiences. Some patients are better served in a hospital setting, and we will tell you if that’s the case.

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 received deeper sedation or general anesthesia rather than the moderate sedation used here, complications occurred in 1.3 per 100 cases, were minor and self-limiting, and two patients needed hospital admission.

The Texas State Board of Dental Examiners issues a separate permit for nitrous oxide and for each level of sedation, from minimal through deep sedation and general anesthesia, and a Texas dentist may administer only the level the permit covers.

What the Day Looks Like with IV Sedation

You arrive with your driver, having fasted as instructed. We take vital signs and place the IV. Sedation starts before any local anesthetic, so you are comfortable before anything else happens. The monitoring that runs throughout is what the ADA sedation guidelines require for moderate sedation: oxygen saturation measured continuously by pulse oximetry, ventilation observed and monitored, and blood pressure and heart rate evaluated continually. Breathing gets the closest watch for a reason: a multi-organization workshop report on oral sedation in dental outpatients, published by Dionne and colleagues in the Journal of the American Dental Association, found that most serious adverse events are related to potentially avoidable respiratory complications. Afterward you rest in the chair until you are steady, then go home with your driver and written instructions. We call you that evening.

Comfort Without Sedation

Every patient gets a long-acting local anesthetic, a blanket if they’d like one (the office runs cold), and headphones if they want them. Many procedures, including grafts and single implants, are done comfortably with local anesthetic alone. Sedation is a choice, not a requirement.