Conscious Sedation

Fear of the dentist is a widespread phenomenon and therefore should not be underestimated. It is estimated that only 50% of people know how to control their anxiety and fear of the dentist, while the remaining half of the population experiences the dental visit as a source of great anxiety; among these, many people even avoid undergoing dental operations due to excessive fear and go to the dentist only in an emergency and when any problems affecting the oral cavity have now reached worrying levels.

Odontophobia (scientific term for the fear of the dentist) is not only linked to the fear of pain, but also to the fear of losing control and refusal to rely totally on someone else’s hands. In the past, the fear of the dentist represented a real problem that prevented many individuals from undergoing the necessary dental treatment, with the result that the problems related to the oral cavity could not be solved but, on the contrary, worsened further, with the negative consequences that we can imagine both functionally and aesthetically.

Fortunately, modern dentistry nowadays boasts the possibility of using an important aid to meet all patients suffering from dental phobia: conscious sedation, also known as sedative analgesia.

It is defined as “conscious” (despite this term, together with sedation could appear as a contradiction, almost an oxymoron), because during the state of sedation the patient remains awake and cooperating for the entire time, in order to interact with the dentist without creating problems of any kind for this. Indeed, thanks to conscious sedation, the dental specialist also can operate in complete tranquility and more freely, feeling himself more serene with a patient not in the grip of anxiety and nervousness attacks.

There are two different types of administration about conscious sedation: the first is of the inhalation type, using a mask and a dispenser of a mixture of nitrogen and oxygen, the other is of the injective – intravenous type. In the latter case, the doctor can use a mixture of different drugs, including benzodiazepines such as midazolam and diazepam; sedative medications such as pentobarbital and narcotic pain relievers such as meperidine and morphine. The method must be used by modern professionals in the field, again regarding the intravenous route, is a mixture of benzodiazepine I combination with one of the many narcotic analgesics.

inhalation sedation

The gas used (nitrous oxide) was already known in the nineteenth century, a period from which it was used several times as a narcotic. Sedation involves administering a mixture of this gas and oxygen through a small nasal mask. The effect begins already after the first breaths: there is a feeling of relaxation and lightness, and a condition of total abandonment is reached. During conscious sedation, fears and tensions are transformed into a state of safety.

This type of very light anesthesia without side effects also decreases the sensitivity to pain, making even the injection of anesthesia in the mouth less traumatic. The intensity of sedation is chosen by the dentist who can decide how much to vary the oxygen-nitrous oxide ratio in the mixture according to the patient’s needs, age and build.

After the session, the patient undergoing dental treatment breaths pure oxygen for a few more minutes and, as soon the effect of the gas used for sedation has completely disappeared, he can leave the dental office alone (unless it is an underage patient or a person with handicaps), since his physical and mental conditions will be perfectly normal.

Intravenous sedation

In this type of sedation, the doctor may use a mixture of several drugs, including benzodiazepines such as midazolam and diazepam; sedative medications such as pentobarbital and narcotic pain relievers such as meperidine and morphine. The method most used by modern professionals in the field, again regarding intravenous route, is a mixture of benzodiazepine in combination with one of the many narcotic analgesics.

Benzodiazepine has an immediate amnesic effect capable of eliminating the fear of pain, while the analgesic produces a state of mild euphoria. The anesthetic effect of this combination is estimated to be around 80 – 90% and remains active in the patient for about 20 – 40 minutes after administration. For this reason, doctors and anesthetists must always be able to monitor the patient’s sedation and condition as time passes: pulse, breathing rate, heartbeats, the patient must always be under the strict control of the doctor, just to fully understand the patient’s condition. This monitoring phase is very important during an operation that requires sedation, as is the dose administered, which varies according to the age, weight and response of the various patients.

Having said that, it should be noted that intravenous sedation guarantees much greater results than any other type of administration of anesthetic drugs. This is done by a specialized anesthetist.

Thanks to intravenous conscious sedation, many interventions have become safer and faster to perform, since the collaboration of the patient is the added value of this type of anesthetic practices: being able to intervene in complete tranquility, knowing that the patient does not fell any kind of pain, and at the same time being able to dialogue with him, perhaps advising him on how to open his mouth, where to place his tongue, etc., it only makes the doctor’s performance better, facilitated in these cases in the task he is called upon to perform.

A significant step forward therefore from the past in which it was necessary to administer total or local anesthesia, which however had the effect of completely putting the patient to sleep. In addition, as we mentioned at the beginning, the greatest action of this type of sedation is on the psychological level of the patients, who do not feel pain and remains in a peaceful state of muscular and mental relaxation. Avoiding the fear dictated above all by prejudices towards past forms of intervention, which surrounded the dentist with a very negative aura, is probably one of the greatest results from the medical point of view that conscious sedation has risen to achieve.