Afraid to Go to the Dentist? Consider the Sedation Solution

For some patients, dental work wouldn’t be possible if they were fully alert.

Dr. Ed Adlesic of University of Pittsburgh Dental School of Medicine says there are a variety of sedation methods and intensities.

Anyone who watches prime time TV likely has seen at least a few commercials offering viewers a pain-free, even enjoyable, dental experience through the use of sedation.

Such advertisements typically are geared toward a specific part of the population — those who associate a trip to the dentist with anxiety. For some more extreme cases, sedation dentistry is a necessity; candidates can include people with intellectual and physical disabilities and advanced medical histories.

“It provides care for patients that don’t have any other options a lot of times,” says Dr. Lorraine Callen, program director of the dental medicine residency program at Allegheny General Hospital.

There are differing levels of sedation, and every state mandates what can be done in a dental office concerning sedation, says Dr. Ed Adlesic, University of Pittsburgh School of Dental Medicine assistant professor of oral and maxillofacial surgery and dental anesthesiology.

In Pennsylvania, dentists can provide anxiolytics, pills patients take about an hour before treatment, typically a benzodiazepine that can be used in combination with nitrous oxide, or laughing gas. Patients are awake, just calmer.

With parenteral moderate sedation, the dentist injects medications intravenously, resulting in deeper sedation than what a pill can provide, though patients still can maintain their own airways and speak. Those dentists must meet special training criteria and pass an office inspection to be certified by the state.
Oral and maxillofacial surgeons and dentist anesthesiologists can provide moderate sedation or deep sedation — general anesthesia. In addition to medications used for moderate sedation, they also administer Propofol, Ketamine and opioids such as Remifentanil, among other medications, in a variety of combinations. They too need to meet specific training criteria and pass an office inspection.

“Those people are asleep,” says Adlesic. “Those people cannot talk to us. We have to protect their own airway for them.”

These levels of sedation can be used for any dental procedure from cleanings to restorations, extractions to implants, depending on the health status and needs of the patient.

Pitt has a large special needs clinic where patients with physical or intellectual disabilities are managed with a variety of techniques, including moderate or deep sedation.

“Some of these cases are actually intubated like they would be in an operating room, and procedures are carried out on them for a period of several hours in our facility to manage their dental needs because they cannot tolerate the procedure without being in that state,” Adlesic says.

Certain patients, particularly those who cannot respond to verbal commands, can’t even have x-rays performed in a traditional dentist office, AGH’s Callen says. “We can’t even get in to do an exam or X-rays on them. So, the day we go to the operating room or do sedation is the first time anyone’s seen in their mouth for years to see what’s even going on.”

In some cases, extreme phobia also can render different levels of sedation necessary.

“I have people that really, really hate coming to the dentist and the only way they will have any dentistry done is if they are heavily sedated,” says Dr. Kathleen Driscoll, director of dental medicine at Allegheny General Hospital. “Also, a lot of times you’ll see patients who need a lot of work done and they don’t have the time to take off work or they just want everything done at one time. They’re good candidates for sedation as well.”

Sedation also can be beneficial for very young as well as more senior patients, Callen says.

“In the correct hands, it can be very safe,” she says. “For children, it’s an amazing opportunity to get things done as necessary.”

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