Wednesday, June 22, 2011

What is sedation or "sleep" dentistry?

In this post I will try to quickly and clearly explain what sedation and anxiolysis mean in dentistry.  This is not designed to be a legal or complete explanation but hopefully will help people understand what they hear on those radio adds.

First some definitions -
     Anxiolysis - the process of decreasing a persons anxiety with medications.  This just takes the edge off so the person is a little more relaxed.
     Sedation -  Also called conscious sedation is a minimally depressed level of consciousness but the person can still breath on their own and respond to verbal commands (like open wider, turn this way, etc) and is produced by pharmacological (medications) means .
     Oral Sedation - same as sedation above but the person takes pills or has a pill dissolve under their tongue
     IV sedation - same as sedation above but the person has an IV and the medication is given directly through the IV.
     Deep sedation and General Anesthesia - Controlled state of depressed consciousness with partial (deep) or total (General) loss of protective reflexes (no gag reflex and you may not breath for yourself or respond to verbal or physical commands) caused by medications.

Now to the purpose - sedation dentistry allows the dentist to work more effectively because the patient is calm and comfortable with the use of medications given orally (swallow a pill) Sublingually (pill placed under the tongue) or through an IV.

Medications - there are a multitude of medications used but most are the benzodiazepine class such as Valium or halcion.  Other medications include antihistamines like hydroxyzine and insomnia medications like zaleplon.

Now to the laws in Utah - the exact laws can be found at
http://dopl.utah.gov/laws/R156-69.pdf which is the Utah department of professional licencing.  Here is a quick summary -
First a dentist must have the appropriate training. In Utah there are 4 anesthesia classes or permits. A class II permit is required for using nitrous oxide (laughing gas) and anxiolysis (lower dose of a medication taken the night before a procedure or one hour before a procedure to calm the person - but additional medications are not given)
Class III permit is required for Oral sedation - this often uses the same medication given for anxiolysis but in a higher dose, in repeated doses, or dissolved under the tongue (it absorbs faster than through the stomach) until you get the person more comfortable.
Class IV permit requires much more training and is needed for deeper sedation - often the dentist can bring in a nurse anesthetist or anesthesiologist for deeper sedation.

Most dentists can get a class II permit with their training in dental school and with the DEA licence to prescribe medications or to provide nitrous oxide and anxiolysis.  They can also give minimal sedation with a Class II permit if they can show 16 hours of training.

Utah just passed a law concerning oral sedation -
Effective February 7, 2011: Utah Administrative Code § R156-69-202 requires dentists to complete at least 16 hours of instructive classroom training with clinically-oriented experiences and obtain a Class 2 permit before providing their patients with minimal sedation using oral sedatives (with or without nitrous)*

A Class III permit requires 60 hours of additional training and at least 20 supervised cases for IV sedation. 
In any type of sedation the patient should be monitored with pulse, oxygen, and blood pressure during the procedure. 
All patients that take even an anxiolytic medication should have someone there to drive them after the procedure. 

At Bauman Endodontics we offer the full range of services with Dr Bauman providing nitrous oxide and anxiolytic medications if needed before a procedure.  Most patients who are anxious do very well with a pill one hour before the procedure.  We also have an anesthesiologist that can come to the office for someone who wants sedation or deeper sedation.  The sedation has additional costs but may be worth it for some patients.

Finally - what about the adds I hear that promote "sleep dentistry"!  The object of sedation dentistry is not to put the person to sleep or to make sure they are "out" - sometimes people relax enough to fall asleep but that is just very relaxed.  The goal is to sedate or relax a person.  To really put a person to "sleep" in the anesthesia realm requires a general or deep sedation.

Sorry this is a long post!  Hope it is informative.  If you have specific questions or want more information posted about this subject please e-mail you questions to baumanendo@gmail.com

If you want more details about Dr Bauman or endodontics (root canals) you can contact Bauman Endodontics at 801-590-8687 or visit the website at www.baumanendo.com.

22 comments:

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