What is sedation?
Sedative medication helps relax patients by slowing the action of the central nervous system. People remain aware of their surroundings, but are less responsive to external stimuli. Among other things this reduces their sense of pain. Sedatives aren't new; in fact, they date back thousands of years. Pain relief is as old as medicine, and other ancient forms include alcohol, the mandrake root and opium poppies. The modern age of sedative medications began in the 1800s with the creation of bromides and chloral hydrate.
Today's doctor draws upon a continually-expanding list of new sedatives to help lessen pain and anxiety. Current medications are often more powerful and less likely to carry unpleasant side effects. However, all medications differ, and none are appropriate for every patient. Some of the drugs take action quickly but rapidly fade in potency, while others last for hours. Doctors weigh a number of factors carefully to assess which drug will represent the safest choice in a unique situation for a particular individual.
Sedatives are given to patients a variety of ways, including by mouth, under the tongue, via the rectum or intravenously (through the veins). The vast majority of those receiving sedation within a dental office will take the medication orally. In fact, millions of oral sedatives are prescribed by doctors every single day.
Most people feel calmer and more relaxed after taking sedative medication. But it's important to understand that these drugs are used to produce sedation along a continuum, ranging from mild to moderate at one end and unconscious at the other. In the dental setting mild or moderate sedation almost always applies, with patients remaining alert and responsive, and able to answer questions. General anesthesia -- where patients are actually asleep -- is only provided in the hospital.
The number of patients who feel frightened by the prospect of dentistry ranges as high as 20 percent. For these individuals and many others sedative medication can make oral care easier to tolerate. When patients are comfortable -- but still awake -- the dentist and dental team are able to proceed more efficiently. Sedation dentists can often perform a number of procedures in a single appointment, without sacrificing either patient safety or clinical quality. Many people with hectic schedules find it very beneficial to receive necessary treatments in one dental visit instead of two or three.
The type of sedative or sedatives the dentist prescribes depends on the procedure being performed, the patient's medical condition and any other drugs they take. In many cases doctors use a class of sedative medication called benzodiazepines. Examples of benzodiazepenes include diazepam, lorazepam and triazolam.
Benzodiazepenes were first developed in the 1960s, so scientists have had many decades during which to study them. In general the drugs are extremely safe and pose little risk of adverse reaction with other medications. Benzodiazepines are the most commonly prescribed sedatives used today.
No prescribed drug -- for that matter no over-the-counter medication -- is completely without risk. Some of the more powerful sedatives such as barbiturates pose the possibility of addiction along with a variety of unpleasant side effects. But the profile is very different for benzodiazepenes. These drugs are not addictive and do not carry many side effects.
In the case of any medication, however, caution is always advised. Patients may react differently. For this reason the dentist will ask a series of questions about overall health and other prescriptions in order to minimize the likelihood of any harm. It's important to answer questions as accurately as possible to ensure a safe outcome.
Besides a careful history and possible consultation with the medical doctor, the dentist and clinical staff will monitor the patient throughout the procedure and ensure that they leave the office with a companion or escort.
In addition to creating a feeling of deep relaxation, sedative medication may produces other effects. Patients may feel the hours passed very quickly or otherwise retain little memory of their time in the dental office. Analgesic properties decrease any sensation of pain or discomfort. In very rare instances sedative medication reacts adversely with another drug the patient takes. That's why it's critical to receive sedation treatment from a dentist who has extensive training in sedation as well as all applicable licensing.