Sedation in dentistry

Sedation in dentistry – Different types of dental sedation

The different types of sedation dentistry are

Intravenous sedation: is the procedures by which drugs are administered that depress the central nervous system intravenously with the aim of reducing the psychic and / or motor unrest in patients.

Conscious sedation: A minimum level of consciousness depression is achieved that allows the patient to maintain the integrity of his airway independently and to continue responding to physical or verbal stimuli in a normal way. Conscious sedation is necessary for patients with very little time available, since the number of sessions that would be necessary for dental implant treatment or other dental treatments is drastically eliminated.

Deep sedation: It is a controlled state of depression of consciousness that involves the partial loss of protective airway reflexes among which are the ability to breathe and respond to physical and verbal stimuli.

Combined conscious sedation: Obtained by means of the simultaneous administration of enteral drugs and sedatives.

Different types of dental sedationMinimum sedation: It is a state induced by drugs the patient responds normally to stimuli but their cognitive function and coordination are diminished but is aware of everything that happens around them.

Moderate analgesia: It is induced by drugs and in it the patient can respond adequately to orders is aware of what is happening around him.

Deep analgesia: It is also a state induced by drugs and although the patient will not respond easily, there may be response after tactile stimulation. In this case the patient may require assistance to maintain their airway and breathing and this type of sedation is applied by a specialist an anesthesiologist.

If you are anxious about dental treatment and you want relaxing and anxiety free experience, then sedation dentistry is good option for you. The technique is very easy and painless, even there is no requirement of injection and medications provide you a very comfortable experience throughout the treatment.

Advantages of sedation for dental implants

  • Elimination of fear of the dentist and anxiety.
  • Greater safety and stability of the patient.
  • A great possibility to carry out all the treatments with the dentist or implantologist in a single session.
  • Complete patient collaboration and facilitation of the dentist’s work.
  • Very good recovery and better postoperative result.

Conscious dental sedation allows, through the administration of intravenous drugs, to obtain a state of relaxation and tranquility on the part of the patient , which contributes to the patient being given a complete treatment without discomfort and complete freedom for the specialist in carrying out the complete dental treatment.

If you are willing for sedation dentistry, the best option for anxiety free and comfortable experience is Dentist In Dubai, you can expect an easier procedure and a shorter recovery time.

Types of sedation in implantology

In implantology, when we have long interventions, and although patients are not anxious, we need more than local anesthesia.

Conscious sedation : Orally, the best medication we can use is Triazolam . It is a benzodiazepine that begins its action at 15 minutes and the effect is maximum at 60 minutes, its action lasts from 2 to 4 hours, producing a rapid recovery of the patient and rarely lasting the residual sedative effect 6 hours. The dose used is 2 tablets in adults (0.25 mg) and in patients over 65 years of age a single tablet (0.125 mg) is recommended. One advantage of this drug is the low depression it produces in the respiratory and cardiovascular system compared with other sedatives. An additional advantage of Triazolam is that it frequently produces anterograde amnesia, so the patient does not remember what happened during the intervention and so it is not traumatic for him.

Sedation with nitrous oxide : The best options for a dentist are the nitrous oxide oxygen inhalation technique that has a high level of success in very anxious patients and is very safe; This technique does not need an anesthetist and can be used by a general dentist.

General anesthesia: It is a very safe procedure after a couple of hours and the anesthesiologist will authorize you to return home without major inconveniences. Practically the discomforts are minimal, in addition it will be given during and after the intervention, analgesics, anti-inflammatories and antibiotics as indicated by the dentist. It gives you the advantages of not knowing anything, and of performing multiple treatments in a single session. It decreases the surgical time since we will be able to work faster controlling all your vital signs. All the treatment will be carried out in a medical center or clinic duly equipped and approved to carry out said treatment.

We must also add that in implantology  we are facing a relatively simple and painless intervention , especially if we consider that today there is the possibility of undergoing intervention by the assisted sedation technique, a novel technique that will allow the Patient relax as well as be more tolerant with the usual discomforts that exist in any dental procedure.

Recommended Article: A Profitability Comparison of Nitrous, Oral, and IV Sedation

Drugs used in sedation

Lorazepam : Its onset of action and its metabolism are slow. Its maximum effect is manifested at 10-12 hours and it is also the one with the most important cumulative effects, that is, successive doses produce an exponential duration of the effect. It has a good retrograde amnestic power. The dose is 0.05 mg / kg orally . It is indicated in the treatment of anxiety of the hours / days prior to the appointment with the dentist.

Flunitrazepam : It is the most powerful. The initial effect is rapid and the maximum reaches it at 60-90 minutes with residual drowsiness that lasts from 12 to 24 hours. It also has an important cumulative effect, although less than lorazepam. Indicated for the prophylaxis of anxiety in the previous 24 hours, 0.03 mg / kg can be administered orally or intramuscularly 1-2 hours before or rectally at doses of 0.05-0.08 mg / kg.

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Diazepam : Its initial effect is fast (30-40 minutes) and it is maximum at 60-90 minutes. The recovery lasts up to 12 hours. Less cumulative than lorazepam, its intravenous dose is 0.3 mg / kg. Injection into the peripheral vein is painful and should be slow to observe its effects.

Midazolam : The initial effect of the intravenous dose is practically immediate, so its injection must be slow, especially in elderly patients, due to its important depressant effect. Recovery is the fastest and has no cumulative effects at repeated doses which makes it the drug of this group for the purpose of sedation. It can be administered orally, nasally, rectally, intramuscularly and intravenously. The retrograde amnestic power is important. It is presented in vials of 5 ml with 1 mg / ml and vials of 3 ml with 5 mg / ml. The intravenous dose is 0.1-0.2 mg / kg, which, as we have said, should be injected slowly, observing the anxiolytic and sedative effects, achieving very effective effects. It is possible to resort to the nasal route in children by instillations with a dropper of 0.3 mgr / kgr distributed in the nostrils about 5-10 minutes before treatment. It is also used rectally at a dose of 0.4 mg / kg diluted in a few milliliters of saline. It has good sublingual absorption with doses similar to the nasal route (0.5 mg / kg in a few milliliters of juice about 30 minutes before).

Ketamine : It is an anesthetic derived from phencyclidine that has been used for years. Due to its excellent hypnotic and analgesic characteristics, it is a little respiratory depressant and stimulates the cardiovascular system. It has the advantage of being able to be administered in many ways(oral, rectal, intranasal, intramuscular and intravenous) and continues to be a versatile and safe drug. It produces a type of anesthesia called dissociative in which the patient is isolated from the environment that surrounds him, preserving breathing and protective reflexes and sometimes it happens that he suffers from hallucinations during the awakening period, especially if this is done in a quiet environment with strong visual or auditory stimuli. For superficial sedation of short duration, it can be used intravenously at doses of 0.5 mg / kg. or intramuscularly at 2-8 mg / kg. It can be diluted in water or juice orally 15-20 minutes before the procedure at a dose of 6-10 mg / kg. To administer it rectally, a small enema can be prepared by diluting 10-15 mg / kg in a few milliliters of water or serum.

Propofol: It is the most used intravenous anesthetic today. Its pharmacokinetic characteristics and pharmacodynamics make it almost ideal for use in both induction and maintenance of intravenous infusion sedation. It has a very fast onset of action, it is not cumulative and the awakening is also quick and pleasant for the patient. The infusion rate can be easily controlled to obtain the desired degree of sedation, from states of light somnolence to levels of anesthetic depth. We must not forget that as all hypnotics and anesthetics can produce dose dependent respiratory depression.

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