Too many Americans are going without regular dental health care – and that’s the perfect recipe for letting minor dental issues develop into major problems that are much more costly-to-repair. Dental anxiety or unusual sensitivity to pain can result in people not getting regular checkups. That’s why one of the most important changes in the world of dentistry is that sedation dentistry is so much more readily available. This information is an opportunity for you to understand a bit about its history, current approaches, and why it is a very practical and safe consideration for dental patients.
How new is sedation dentistry?
You may not have heard much about it until the past few decades, but it’s been around for a long, long time. One of the sedation techniques that is still used today dates back to the 1840s. That is when Connecticut dentist Horace Wells first experimented with and introduced the use of nitrous oxide, sometimes called laughing gas. And it was actually another dentist (one of Wells’ students) who introduced the use of ether as a form of general anesthesia.
Since that 19th century progressive thought leadership in the field of dentistry and pain management, the range of techniques and medications used has broadened, and great strides have been made in providing safe administration of dental sedation. In the 21st century, both the world of dentistry and the world of medicine at large have an excellent understanding of the risks associated with all types of sedation and anesthesia.
In addition, dentistry also has a much better understanding of how two different issues – anxiety and pain – are so tightly intertwined. Dentists also are highly trained in the use of both psychological and pharmacological approaches that can be used to manage either or both issues.
Are there different types of sedation dentistry?
In October, 2007, the ADA (American Dental Association) adopted guidelines that address three different levels of sedation – minimal, moderate, and deep sedation. (While the document Guidelines for the Use of Sedation and General Anesthesia by Dentists is accessible on the ADA website, it is written in language more suited to those in the field of dentistry.)
What the general public should understand, though, is that these are guidelines – not legal requirements for practicing dentists. In the United States, the regulatory responsibility for the practice of dentistry lies with the individual states. Some states have recently adopted specific laws that govern the practice of sedation dentistry as a service to the residents of the state – to afford them the assurance of safety in the use of this increasingly popular dental service. Individual states are not bound to adoption of the ADA guidelines; they can define their own levels of sedation as well as the training, experience, and accreditation process that will be used. That is not to say that the ADA is not highly influential in the individual states’ decision-making process.
What kind of sedation is likely to be right for me?
That is an excellent question, but also one to which there is no accurate answer unless you are well-versed in dentistry. Some of the difficulty lies in the fact that there are different levels of sedation dentistry available, and that the number and names of those levels can vary among states where regulations are in place. And the answer can also be specific dental procedure(s) being performed. However, this basic information can be helpful to you as you start considering sedation dentistry for yourself or a family member.
– Sedation, as well as general anesthesia, is a pharmacological way of altering your level of awareness of what is happening around you (i.e., your level of consciousness).
– Your level of awareness/consciousness does not “step down” by specific levels, it is a continuous scale. (That’s why defining specific levels of sedation is, technically speaking, somewhat fuzzy. Levels are normally tied to a range of awareness/consciousness, which will have some overlap with the level above and below.)
– The medications used to provide sedation can vary. In addition, some are administered orally, some by inhalation, and some intravenously (in the veins). Sometimes medications are used in combination. Both the type of medication and how it is administered are usually factors in how various states define their regulatory statutes and levels of sedation.
– Different people respond differently to the same medication, even if they have the same physical characteristics and the exact same dose is administered. That’s why training, experience, and safety measures are important in sedation dentistry.
– Patient risk (and the potential need for resuscitation) rises as the patient’s degree of awareness and consciousness lessens. In general, you should not ask to be sedated more than your circumstances would suggest.
– Sedation dentistry is not a substitute for local anesthesia (numbing agents). Some people assume that their dentist will only use one or the other. The decision to use sedation is, for the most part, a separate decision from that to use local anesthesia, even though both are pharmacological methods used to provide patient comfort.