Traditionally, images of pain has been associated with dentistry and those images has often been passed down for generations. Fortunately, dentistry has advanced tremendously over the past one or two decades such that dental treatment can be made more comfortable for patients.
Topical numbing gel before using a finer needle with a distractor when administrating local anaesthetic to achieve profound numbness on the treatment area is sufficient for most patients.
However, there is still a small group of patients whose dental anxiety still prevent them from seeking dental treatment even if profound numbness can be achieved with local anaesthetic. Sometime, this procrastination to seek dental treatment may lead to more serious dental problem. That in turn lead to a downward spiral where dental treatment required can be more extensive.
Patients with dental anxiety may prefer not to be aware of what happens during the treatment and may request for a treatment modality that is completed when they are awake.Such treatment modality normally include general anaesthetic (GA) or IV sedation. Most people would have heard of GA where patients are completely unconscious, such that the body’s normal automatic functions, like breathing, heartbeat and circulation of blood are suppressed.
IV sedation is normally used for minor surgeries or shorter, less complex procedures when local anaesthetic is not sufficient but deeper general anaesthesia is not necessary. When a patient is under IV sedation, they are still breathing on their own with oxygen supplemented. IV Sedation like the name suggest, is where sedative medication is given via IV (intra venous) by an anaesthetist.
Some of the more common procedures that IV sedation are used for in a dental clinic include procedures like extraction, wisdom tooth removal, implant placement. Some patients have also requested for IV sedation for procedures like root canal treatment, ceramic crowning and even direct composite restoration. In some procedures that are not surgical in nature like root canal treatment, ceramic crowning or direct composite restoration alternatives to IV sedation like nitrous oxide or oral sedation are also possible.
Nitrous oxide is commonly known as laughing gas. When inhaled, it gives a calm and euphoric feeling and can provide a mild sedative effect. Do note that when administrating the nitrous oxide, it needs to be administrated with oxgyen. A key element to a safe and good nitrous oxide experience is on the titration of nitrous oxide and oxygen. Nitrous oxide can be used for even simple procedure like routine scaling to allow the patients to have a clam experience.
With local anaesthetic, nitrous oxide, IV sedation and GA it gives us a scale to control the pain and consciousness for different patients for different procedures. Sedation can be used to overcome dental anxiety that some people may have. Often, a conversation with the patient will allow us as clinician to know what type of sedation and analgesia is needed for the individual based on the procedure and the dental anxiety that they may have.