Webster defines phobia as “an exaggerated and often disabling fear usually inexplicable to the subject.” Dental phobia certainly fits Webster’s description. Dental phobia is real and prevalent.. A Journal of Dental Hygiene study concludes that moderate to high dental anxiety prevalence of 19%. That’s about 63 million people in the US that suffer from dental anxiety. If you avoid the dental chair at all costs, don’t think you are the only one. Fortunately, today’s dentist can offer effective options to deal with dental phobia. Oral sedation and IV sedation are popular treatment modalities for treating the anxious patient.
When Should Sedation Be Used?
- If a patient feels nervous, and is afraid of the dentist, needles, or medical environments.
- If the patient is unable to keep their mouth open for an extended period during the procedure.
- If the patient has extensive dental needs that require long appointments or dental surgeries
- A significant gag reflex
What is Oral Sedation?
Oral sedation is medicine in a pill form, typically in the benzodiazepine family, that produces a sedative effect. It can be combined with other medications that provide an analgesic effect along with a drowsy and amnesia effect of sedative.
What Is IV Sedation?
Dental IV sedation is the deeper form of sedation administered directly into the vein by a qualified dentist or anesthetist through an IV catheter at the start of the procedure, enabling it to take effect very quickly.
The sedative is “titrated to effect” allowing the patient to enter a semi-conscious state where they are “asleep” but still conscious enough to respond if needed. It is often combined with other medications including opioids to achieve the desired effect quickly. IV sedation helps in relieving anxiety, relaxing the muscles and inducing drowsiness and relieving the gag reflex.
When to use Oral Sedation?
Oral sedation is typically used for patients who rate themselves as low or average anxiety on the dental phobia continuum. In our office we evaluate patients and use Oral sedation for low to moderate anxiety for non surgical procedures lasting less than 2 hours. Patients are asked to come in 45 minutes early and medication is administered in a quiet dark operatory for maximum effect.
When Should IV Sedation Be Used?
IV sedation is used for moderate to high anxiety patients. It is also used for long dental procedures so that patients relax. In our office patients who rank themselves as highly anxious will receive IV sedation as well as long reconstructive or cosmetic cases and surgical cases. This can include bone or soft tissue grafting, wisdom teeth removal or implant placement. The most common use of IV sedation in our office is for the patient who has neglected their dental health for years because of fear of the dental office. We can literally reverse years or decades of dental neglect in a day with no memory of the procedure. These patients find that very comforting.
The most common use of IV sedation in our office is for the patient who has neglected their dental health for years because of fear of the dental office. We can literally reverse years or decades of dental neglect in a day with no memory of the procedure. These patients find that very comforting.
Comparison of Oral vs IV Sedation
Pros of Oral Sedation:
Relatively inexpensive compared to IV sedation
More effective and less cumbersome than Nitrous Oxide (laughing gas)
Cons of Oral Sedation:
Typically not a deep sedation like IV sedation
Delayed desired effect
Not as safe as IV sedation because it is not immediately reversible
Sedation effect can linger longer after the procedure is complete
Amnesia effect is not a potent
Pros of IV Sedation:
Compared to oral or inhalation sedation, IV sedation delivers a stronger sedative effect.
Patient will not remember the procedure due to the strong amnesia effect
Immediate clinical effect
IV sedation is safer because it is immediately reversible
Patients who opt for IV sedation have a shorter recovery time.
Since it delivers a strong level of sedation, it is effective in easing severe anxiety.
IV sedation reduces the gag reflex, by suppressing that reflex, ensuring that the dental procedure is easier and more comfortable.
It still allows patients to have maintained a low level of consciousness during the procedure.
Cons of IV Sedation:
It is more expensive than other lesser forms of sedation
It does require an IV which can be difficult for some patients
Oral sedation is a lesser form of sedation used for low anxiety patients to ease simpler dental treatment. IV sedation is superior for higher anxiety patients and patients with more complex and invasive treatment. In our office we typically combine the two forms using oral sedation prior to treatment to ease the placement of the IV then complete the appointment under IV sedation. We have found this to be an effective and predictable treatment modality for even the extreme anxiety patient.
At DeVaney Dentistry, we use advanced sedation dentistry techniques to ensure that your dental procedure is a pleasurable, stress, and pain-free experience. If you have any other questions or concerns, calls us any time and we’ll be more than happy to answer them.
Dr. Matt DeVaney is a certified and experienced IV sedation dentist located in Greensboro, NC.