is a very safe reduction in consciousness that allows patients to undergo potentially uncomfortable or stressful procedures with ease. Unlike oral sedation, IV sedation allows for a titrated delivery of medicines that result in a gradual controlled decrease in consciousness to a level of sedation customized for the individualized needs of each patient. If desired, the sedation can be reversed to provide for a more rapid return to full consciousness. Sedation is ideal for patients whose fear of dentistry have kept them from starting badly needed treatment or for those patients who prefer not to experience treatment.
ORAL vs IV SEDATION
Oral sedation is the ingestion of medicine in tablet form to achieve a decreased level of consciousness. In IV sedation, access is gained through peripheral veins usually in the ante-cubital fossae (the triangular space on the front part of the elbow), enabling deposition of medicine directly into the patient’s bloodstream. A common misconception is that oral sedation is safer than IV sedation. However, the reverse is true due to the qualifications required to administer IV sedation and the ability to titrate doses with IV access.
A dental professional needs to only take a one-weekend course to become certified to administer IV sedation. Re-certification is recommended every two years. By contrast, IV sedation permit holders must successfully complete a program which includes 60 hours of course work, including the sedation of at least 20 patients under direct supervision. Additionally, two dental professionals with Advanced Cardiac Life Support certification must be present with the patient during the sedation. Finally, 40 hours of continuing education must be completed annually to maintain the permit.
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Titration is the continuous measurement and adjustment of the balance of a drug dosage in response to a patient’s clinical condition. In oral sedation, the blood concentration of the sedative drug is difficult to determine as an ingested drug must pass through the liver before reaching the bloodstream. As the amount of drug that ultimately reaches the bloodstream differs from person to person based on many factors, the blood level concentration of the sedative drug in oral sedation is much harder to control than it is with IV sedation where a measured amount of drug is administered and the effect immediately assessed by monitoring the patient’s vital signs and level of alertness.
Oral sedation does have a place in sedation dentistry. For example, if a patient is more anxious about having IV sedation than about the undergoing the procedure, if the patient is only slightly anxious or if the procedure is relatively minor, oral sedation might be the best choice. It creates a very relaxed, sleepy feeling making the patients less aware of their environment and offering a deeper level of relaxation than nitrous oxide. Oral sedation is the most economical choice, costing only the price of the pills. Most problems develop if the first dosage does not sufficiently sedate the patient. As the practitioner delivering the drugs has no way of determining how much drug is circulating in the patient’s bloodstream, how much, when or if more drug will be released by the liver, it is not safe to give additional doses of drug when the patient most needs it. Patients presenting with complications with oral sedation often received multiple doses of drug during the procedure only to find that the effects of the drug did not materialize until much later, at times increasing their level of sedation after the patient had left the office. Although, the drugs used in sedation are very safe and it is almost impossible to “overdose” on them, patients under sedation can have difficulty maintaining their airway. The loss of an open airway can be life threatening.
IV sedation provides a much deeper level and continuous level of tranquility than oral sedation. The onset of sedation is very fast. Only the minimal amount of drug needed is used and, if necessary, the drugs we use can be either reversed by administering a reversal agent or their dosage can be increased safely as needed during the procedure. Some drugs used in IV sedation improve airway patency (the condition of being open). IV sedation allows patients to receive treatment without remembering or experiencing the smells, tastes or noises associated with the dental visit. As the patient is more deeply sedated than with oral sedation approaches, prolonged and difficult procedures are more easily accomplished eliminating the need for numerous visits.
Know your options
It is important to keep in mind that, as oral sedation certification is less rigorous than IV sedation certification, dentists who advertise “Sedation Dentistry” may offer only oral sedation. Our practice offers both oral and IV sedation, and we are always happy to meet you to talk about which choice is right for you. A better informed patient makes better choices. If you have dental needs that you have been putting off because of fear of dentistry, call us today to make an appointment to discuss them. You will be glad you did.