One effective form of sedation that is used to facilitate dental procedures is intravenous (IV) sedation, the next step if oral sedatives are not adequate to produce a calming effect.
For this moderate method, a drug is administered to the patient through a catheter or tiny needle placed in a vein within the inner elbow or back of the hand. The dentist can continually control the level of sedation throughout the process. This method is known as conscious sedation because the patient is not asleep nor unconscious, but in a semi-conscious or semi-awake state of reduced anxiety that allows them to relax and undergo necessary treatment.
In this way, IV sedation is distinct from general anesthesia, also called unconscious sedation, during which the patient is put into a sleep that won’t be disturbed by painful stimulation or discomfort. During general anesthesia, a patient receives breathing support and their heart rate, blood pressure and pulse must be monitored.
Patients who receive IV sedation do not require medical assistance to support life-giving functions, but their vital signs are still monitored. The patient also has the ability to respond to verbal commands under IV sedation, although their speech may be impaired. Because the drug delivers an amnesic effect, however, the patient is likely to have little or no memory of the procedure.
By offering this experience in a safe environment, more patients who are prone to anxiety or fear, or who possess a dental phobia, can receive the important procedures they need with relative comfort.
Popular IV sedation medications
In the dental industry, th most popular class of drugs used for IV sedation are benzodiazepines, which include diazepam (Valium), lorazepam (Ativan) and midazolam (Versed). Today, midazolam is most often used for dental procedures. Compared to other older drugs, it wears off faster, acts quicker and irritates the veins less. However, for certain patients, such as those with compromised liver function, lorazepam is a better option because it is metabolized in the bloodstream rather than by liver enzymes, as both midazolam and diazepam are.
In conjunction with the sedative medication, dentists frequently will include pain-reducers or opioid analgesics to control pain during and after invasive procedures. These also reduce the need for larger doses of sedative drugs.
If a patient has a fear of needles, the dentist may use nitrous oxide during the start of an appointment to prepare the individual to receive the IV by reducing their anxiety. A local anesthetic may also be applied to the area that will be worked on.
Who is a candidate for IV sedation?
Although sedation is targeted toward individuals who experience a keen sense of fear or trepidation when it comes to dental work, it also is suitable for those with sensitive teeth, a low pain threshold, antsiness or a sensitive gag reflex.
To offer IV sedation, dentists must be certified by the American Dental Association, complete the Commission on Dental Accreditation (CODA) program and pass a comprehensive exam administered by their respective state’s dental board. Professionals also must regularly acquire additional hours of emergency training and continuing education to maintain their permit. For this reason, only a small percentage of dental offices offer this form of sedation.