IV Sedation Dentistry

Intravenous (IV) sedation dentistry is also known as conscious sedation. During this type of dentistry, you will be given a sedative that acts as an anti-anxiety medication, helping to keep you calm throughout your procedure. You will be in a twilight state, able to answer questions, breathe on your own, and respond to commands. However, it will be difficult to remember the procedure and you will be resting peacefully.

Will I be asleep during my procedure?

IV sedation is not sleep. You can talk and respond. However, the medication makes it difficult for you to remember and often you made those off. Once you’ve been given the sedation medication, you will feel very calm and relaxed, but you will be fully awake and able to respond to questions from your dentist. One of the side effects of the medication however, is that you may not remember much about your appointment once it is over. This is because the medication makes you so relaxed, you may feel as if you don’t really care about what’s going on, and you won’t pay much attention to your appointment. Secondly, some of the IV sedation drugs do cause partial memory loss from the time it takes effect until it wears off. This makes it seem as though time is passing very quickly for you, and you may not remember much. This is completely normal, and shouldn’t cause you any concern.

Will a local anesthetic still be used if I’m sedated?

Yes. The medication given to you during IV sedation won’t act as painkillers. Therefore, you will still need to receive a local anesthetic to ensure your maximum comfort throughout your appointment. If you are fearful of the injection, your dentist can wait until after you’ve received your sedative medication to administer the local anesthetic. This will keep you calm even if you have a fear of needles. He will then wait until the local anesthetic has taken full effect to begin any procedures. Because you will be fully conscious, you will be able to communicate with your dentist whether or not the area to be treated is numb or not.

How is IV Sedation administered?

IV sedation medication will be given to you through a vein. This will require your dentist to place a very small needle into one of the veins in your arm or hand that is close to the skin. The needle will be covered by a small plastic tube. Once inserted, the needle will be removed, and the tube will remain. The medication will be administered through the tube. If you wish, your dentist can place some numbing cream over the IV site to ensure that you will not feel the insertion.

The types of IV sedation medication

Depending on your individual case and dentist, you may be offered a number of different medications to be used for your IV sedation:

  • Benzodiazepines - Diazepam and Midazolam are anti-anxiety medications that will affect you in three ways: they will make you feel very relaxed, they will make you feel slightly drowsy, and they will result in at least partial amnesia. These are by far the most common medications used during IV sedation. Of the two medications, Midazolam is usually the first choice because it wears off more quickly.
  • Opiods – Demerol, Morphine, Stadol, Nubain, Sublimaze, or Talwin are pain relieving medications that are sometimes used as an add-on to either the benzodiazepines or barbituates that are given for IV sedation. These medications are commonly used with barbituates, because barbituates can potentially lower your normal threshold for pain.
  • Barbituates – these medications are no longer used for conscious sedation in the U.K at all, and are rarely used in the US. In fact, only one medication, Nembutal is only used occasionally. This is because these medications require the presence of a separately trained anesthesiologist during their use.
  • Propofol – Propofol is used by many dentists in place of a benzodiazepine medication. This is because patients can recover from the use of Propofol in as little as five minutes. For this reason, the medication must be given continuously by the anaesthetist. This medication may be used with patients who have developed a tolerance to benzodiazapines. In the UK this is classified as a general anesthetic, and is not used for conscious sedation.
  • Others – there are a number of other medication that can be used for conscious sedation, but the ones listed here are the most common. In general, Midzolam will be the first choice among most dentists.

Is IV Sedation Safe?

Conscious sedation is very safe – it is only performed by specially trained dentists, and in most cases is considered to be even safer than general anesthesia. However, it is important to know that there are some instances when IV sedation should not be used:

  • With patients who are pregnant
  • With patients who are allergic to benzodiazepines
  • With patients who are intoxicated
  • With patients who are experiencing clinical depression
  • With some patients who have glaucoma

Other instances where caution is called for include patients with impaired kidney or lung function, patients who suffer from psychosis, patients with sleep apnea, and patients who are advanced in age. If you snore, it is important that you let your dentist know, as many patients with sleep apnea have not be diagnosed.

What are the advantages of IV sedation?

IV sedation has a number of advantages for you as a patient:

  • It keeps you calm and comfortable, while allowing you to remain awake.
  • It takes affect very quickly, and doses can be tailored to your individual needs as a patient.
  • IV sedation can be deeper than what is achieved with oral sedation.
  • You experience amnesia of your procedure, ensuring that you have no uncomfortable memories.
  • Reduced gag reflex.

What are the disadvantages of IV sedation?

IV sedation has very few disadvantages, including:

  • You may experience a small hematoma near the IV site.
  • You will need someone to drive you to and from your dental appointment.
  • IV sedation dentistry is more expensive than regular dentistry.

Points to remember

  • Do not attempt to drive after your sedation dentistry appointment.
  • Stay home and rest for the remainder of the day following your appointment.
  • Have someone stay with you until the sedation medication has fully worn off.
  • Do not eat a big meal right away. Eat something light if you’re hungry, such as toast or broth.
  • Laying down can help prevent nausea, as can drinking a carbonated beverage.
  • Do not drink any alcohol following your appointment.
  • Take medications only as directed.

If you have any unusual symptoms following your appointment, call your dentist.