Posts for tag: Sedation Dentist Nashville TN



Frequently, I have patients inquire about oral vs IV sedation with regard to what is safer, what is more pain free and what works best. Patients have even asked if its possible for a patient to receive both for a procedure. In my practice, oral sedation is almost ALWAYS used in addition to IV sedation for the following reasons:


1. Oral sedation the night before provides a better night of sleep for the patient so that they are well rested and not as irritable from lack of

     sleep(due to "thinking about it all night").


2. Oral sedation provides adequate anxiolysis(i.e. nerve control) for the fearful person who has difficulty with needles or IVs being started

    for the actual sedation procedure.


3. The sedation process has already had an opportunity to relax the patient so that I can gauge how they will respond to the IV sedation

     so less time is needed to get the patient into a comfortable state.


4.  The oral sedation further heights the possibility of amnesia postoperatively meaning they are even less likely to recall any of the

     procedure which is greatly beneficial to someone who desires no recollection of being at the dentist.


I personally feel IV sedation is a much safer, more predictable option but I do feel oral sedation is a good option but greatly depends on multiple variables. I typically use both for patient comfort reasons as well making sure all work will be completed without hesitation. Talk to me about how IV and/oral sedation can benefit your dental treatment!!!        Dr.G


Question: Why do dentists prescribe different sedatives for oral sedation procedures? My dentist prescribed Valium the night before and Triazolam the day of the procedure. Why two different sedatives?


Answer: Valium and Triazolam have different lengths of activity as well as time of onset. Likely the dentist prescribed the Valium the night before to help the patient sleep as well as promote some initial sedation that will linger due to its "half life" being much longer than Triazolam. Triazolam is short acting but works very quickly, therefore this is given the day of or 1 hour prior to procedure to help improve/deepen the level of sedation. The prescription of these sedatives is determined by: medical history, type of procedures involved as well as length, level of anxiety and others (e.g. gag reflex). Talk to Dr.Glasmeier about what sedatives are needed for oral sedation dentistry!

Question: Who is not a candidate for oral and IV sedation?


Answer: The following is a list of individuals who would not be candidates for sedation and includes but not limited to:


1. Diabetics- unless blood sugar is well controlled and patient is compliant with dietary and prescription regimens. Type II are typically better candidates as patients with Type I (insulin dependent) typically experience larger fluctuations in blood sugar and need a quicker response to this fluctuation.


2. Liver and kidney diseases. Patients with liver and kidney disorders are usually not great candidates for sedation because their ability to metabolize drugs is altered or compromised. These metabolism deficiencies can lead to patients hypo or hyperresponding to medications and will also shorten or prolong the response to the medications. Patients with these disorders need clearance from their physician prior to sedation.


3. Thyroid and adrenal disorders. Patients with altered responses to stress, altered metabolisms can affect the response to sedation. Patients that are taking steroids on a regular basis can also have adverse reactions because their body is not conditioned for stressful situations. Patients with these disorders or anything else endocrine in origin should consult their dentist and physician for any proposed sedation treatment.


4. Pregnancy- Patients who are pregnant are not good candidates due to the teratogenic properties of sedation medications but also due to the altered metabolic demands of a fetus on a mother's body. If absolutely necessary, the 2nd trimester is the best choice but I would prefer to defer sedation or any unnecessary dental treatment until after pregnancy.


5. Medications/recreational drugs- Patients that take mind altering medications such as antidepressants and anti-anxiety medications can also respond very erratically or not at all to sedation medications. Patients typically don't respond as well because the body has been conditioned to process mind altering medications that fall along the same categories of sedative medications. Recreational drugs is a huge contraindication as the response is totally unpredictable and could be potentially life threatening.


6. Respiratory- This is the biggest and most frequent complication I run into. Factors such as Asthma, COPD, sleep apnea, sickle cell disease, bronchitis, sinus infections, etc. All sedation medications have some sort of respiratory depressing effects that control a person's breathing. Sedation medications can severely hamper the body's ability to maintain normal breathing and furthermore should be taken with caution. An example of someone who is not always a good candidate is someone that snores on a regular basis as this is already an indication of someone who may be developing respiratory problems.


While this is not an all inclusive list, these are the most frequent disqualifying conditions for sedation dentistry!



Oral Sedation vs. IV sedation

What is the difference between oral and IV sedation?


An ABSOLUTE ton!! While I do all forms of sedation in my dental practice, I would much prefer IV sedation over oral sedation. Before I discuss the differences, I will discuss the similarities:

1. Both will put the patient in a more relaxed state with possible "sleepiness"
2. Both will produce some amnesia so that the patient has very little recollection of what happened.
3. Both will dull a patient's perception of noisy drills, painful injections, and having your mouth open for a long time.

So oral sedation can work roughly the same as IV sedation except:
1. It takes much longer to produce sedation through oral (1 hour to 2 hours) versus
IV sedation (3 min to 10 min).
2. Oral sedation can last much longer than needed where IV sedation can end as
quickly as the procedure is done so the patient is not incapacitated for the
duration of the day.
3. It is much easier to treat an emergency or reverse a sedation with an IV vs oral
sedation. In oral sedation, each person will metabolize oral medications
differently, so it is difficult to predict what it will take to make the patient
comfortable. Also, the patient can be oversedated with oral sedation and much
more difficult to reverse since an IV is not started.

These are significant differences between oral and IV sedation. While oral is an acceptable way to provide relaxation to the patient, IV sedation is more efficient, does not last as long, and is ultimately more safer than other forms of sedation. This is also why the majority of specialists such as oral surgeons use IV sedation as a preferred method of sedation!!