Patients guide to sedation dentistry

What is Sedation Dentistry?

Sedation dentistry goes by several names – conscious sedation, sleep dentistry, relaxation dentistry or oral sedation – but the effect is the same. Your pain and anxiety are kept under control as you remain just below the level of consciousness during your dental procedure. Because you are thoroughly relaxed and comfortable, the doctor can perform procedures that might ordinarily take years to complete in only one or two visits.
Are You a Candidate for Sedation?
Your overall health, as well as physical and mental conditions you may be battling at the time, are important to be able to safely undergo certain types of sedation – especially in the dental office. Certain of these conditions may require clearance from a physician: cardiac disease, hypertension, diabetes and respiratory diseases should all be addressed prior to a given type of sedation. He or she may also ask you to receive medical clearance from your physician.

The different types of Sedation Dentistry

There are several ways to administer the relaxing benefits of sedation dentistry:

• Laughing Gas: Probably the most common form of sedation in the dental office is nitrous oxide, or "laughing gas." Also, called inhalation analgesia – and used to alleviate pain when giving birth, according to the National Institutes of Health (NIH) – nitrous oxide does not put you to sleep, and is effective at reducing your anxiety about a dental procedure. It is very safe and provided in most dental offices. Local injections of anesthesia, which are still used in combination with nitrous oxide, now see consistent effectiveness, and some are practically painless. Nonetheless, the gas can be administered by a machine to further reduce the discomfort of the injection

• Enteral Sedation: The next type of sedation comes in the form of a pill or liquid that you take orally. This is called enteral sedation. Like local anesthetics, oftentimes it is used in combination with nitrous oxide. You may still be awake, but not nervous about the dental work

• IV Sedation: Intravenous (IV) sedation is another common method of anti-anxiety wherein the sedative is directly injected to a vein. This technique will allow the dentist to provide a deeper sedation, although you will still be awake but less aware of the procedure. The process requires recovery time after you leave the office

• General Anesthesia: General anesthesia is a form of sedation by which you will be asleep for the entire procedure. It is practiced using drugs that are directly injected into a vein, along with the possible inhalation of a gaseous anesthetic. A thorough recovery time in the office may be required before leaving.

What does a Sedation Dentist do?

Basically, a sedation dentist is any qualified dentist who uses sedative medication to provide patient relaxation, ease dental anxiety in phobic patients, or achieve patient co-operation in mentally or physically handicapped patients. The use of sedatives in dentistry can make an invasive dental procedure much more comfortable and tolerable for the patient.
Sedation dentists are sometimes called also ‘sleep dentists’ but the term is incorrect when referring to dentists who offer conscious dental sedation. Sedation does not necessarily mean that the patient will be asleep, although the patient may not remember much of what happened while he/she is sedated. Only dentists offering deep sedation and general anesthesia should be referred as ‘sleep dentists’.
Sedation Dentistry is not one of the recognized dental specialties, but using the term ‘sedation dentist’ must be strictly limited only to qualified dentists. Sedation dentistry qualified dentists are those who meet the educational requirements, and have acquired the necessary permit or licensing in accordance with their state rules and regulations for the appropriate level of sedation they offer to their patients.
The American Dental Association and most state dental boards require dentists to have specialized training in sedative techniques, equipment, medications and medical history analysis to ensure that they are appropriately skilled in the practice of sedation dentistry. Training and licensing requirements differ significantly depending on the specific level of sedation.
The main ‘duties’ of a sedation dentist include:

Before the procedure:

• Evaluates the need for sedation

• Obtains and reviews patient’s medical history and drug usage

• Checks suitability for sedation dentistry

• Proposes one or more suitable types of dental sedation

• Provides info about the advantages, disadvantages and risks of the proposed sedation method/s

• Decides along with the patient if nitrous oxide, oral, iv sedation, or general anesthesia will be used

• Verifies that the Informed Consent form is signed

• Prepares treatment plan

• Arranges for additional staff required for patient monitoring and safety measures

• Gives preoperative instructions to patient and obtains baseline vital signs

During the sedation procedure

• Administers the sedative drug (in oral sedation, the patient has taken the sedative pill prior to the procedure)

• Checks that the required sedation level for patient comfort has been achieved

• Checks that patient does not enter a deeper sedation level than the intended one

• Monitors vital signs to ensure patient’s safety

After the procedure

• Checks if the patient has sufficiently recovered before leaving the dental office

• Ensures that there is someone to drive the patient home (not necessary in case of nitrous oxide sedation)

• Gives postoperative instructions for safe patient recovery.

The sedation dentist is responsible for providing the optimum level of relaxation and comfort in combination with minimizing the potential risks and maintaining patient’s safety

Selecting a good sedation dentist

Choosing a dentist to deal with your dental problems is an important task. For patients suffering from dental anxiety or with certain special needs it becomes a much more difficult task. Patients who have a fear for the dentist may have a major problem due to the additional fear that they may make the wrong choice of dentist.

A sedation dentist can help patients to fight their dental anxiety or handicap and get proper dental care. Due to the risks involved with sedation dentistry (especially in deep sedation and general anesthesia) the sedation dentist must be carefully selected.

• Check that he/she is actually a sedation dentist. Different types of sedation require different levels of training and licensing. Check for proper licensing for the sedation method offered

• You may also ask about the dentist's participation in organizations that carry out continuing education for sedation dentistry, to make sure that the dentist is informed about recent techniques and protocols.
• Ask which types of sedation dentistry are offered. If the dentist offers only one, this may not be the most appropriate for your needs

• Ask for the dentist’s experience in sedation dentistry. Some dentists may provide sedation only rarely, having less experience than a sedation dentist who uses it every day

• Ask for the available equipment for patient monitoring and if there is the necessary trained dental staff available for patient monitoring and responding to an emergency situation (especially in case of moderate and deep sedation)

• A sedation dentist will always take full medical and drug usage history. Failure to do so may cause life threatening complications. If these are not requested from you, look for another dentist

• Check the Informed Consent form, and ask for clarifications. Your dentist must provide all the requested information and disclose the potential complications and risks of the procedure.

At this point, if you still do not feel comfortable with the specific dentist, it is better to look for someone else

Is Sedation Dentistry Safe?

During your dental treatment, the doctor constantly monitors your vital signs to make sure everything is normal. The doctor has been carefully trained in sedation dentistry, so there is no need for any additional worry! Many dentists around the world now use sedation dentistry because it is considered to be so safe.
Sedation dentistry allows your dentist to offer you the optimal environment to complete multiple treatments in only one or two appointments. You remain calm and relaxed while we do all the work to improve your smile.
Although most of the patients can have their dental treatment under sedation, some patients who take specific medications or with certain medical conditions may not be good candidates for dental sedation or for a specific method of sedation dentistry. The sedation dentist will always check the patient’s medical history to identify any contraindications or restrictions to the use of sedation dentistry prior to the procedure.

Cost of Sedation Dentistry

The additional cost of dental sedation may be an obstacle for many people who would like to take advantage of the painless and comfortable treatments that sedation dentistry can offer. Light to moderate conscious sedation dentistry will generally cost much less than IV sedation or general anesthesia. In some cases, you may get some dental insurance coverage for sedation dentistry, but in general it is not covered. Therefore, you may have to seek for some tips to reduce the cost and achieve more affordable sedation dentistry treatment fees.

The Benefits of Sedation Dentistry

The ideal candidate for sedation dentistry is someone who suffers from any of the above-mentioned conditions: anxiety, fear, nervousness, strong gag reflex, painful or sensitive teeth or advanced neglect.
If you have any kind of anxiety about undergoing dental treatment, whether it’s a routine examination or advanced surgery, sedation can really help you.

Here are the benefits to sedation

• Anxiety-free Treatment: Sedation dentistry eliminates fear and anxiety, which encourages patients to receive the routine preventative or restorative treatment they need to keep their teeth healthy

• No More Sweaty Palms and Racing Hearts: It also eliminates many of the physical symptoms associated with fear and anxiety, which includes sweating, trembling, fainting, nausea and panic attacks

• Pain-free Treatment: You don’t need to be terrified of the dentist to benefit from sedation dentistry

• Single Visit Treatment: Sedation dentistry enables dentists to perform longer and more involved procedures, such as dental implant surgery, in a single appointment instead of breaking it down into shorter phases or stages. With more work being achieved in a single appointment, patients are saved the time, inconvenience and expense of multiple procedures

• Eliminates Gagging: Sedation can also be prescribed to those patients who have a strong gag reflex and who struggle to keep their lunch down, even when undergoing a straightforward check-up or cleaning

• Benefits Dentist and Patient: Sedation dentistry is as beneficial to the patient as it is to the dentist. Any decent cosmetic dentist in Newton is wholly concerned about the comfort and wellbeing of their patients and if a patient is seen to be struggling with panic and fear, it’s going to be hard for the dentist to dispense the quality of care they are truly capable of. By sedating the patient, both parties are put at ease and, as such, the dentist can provide the best quality care under much better and more relaxed circumstances. Patients are also calmer and more cooperative under the effects of sedation

• Safe and Easy: Sedation medications are easily metabolized by the body, so they won’t deliver an unpleasant hangover afterwards. They also take effect really quickly and the dentist can easily control the dosage

Dental insurance cover sedation dentistry?

Even if sedation dentistry is not included in your insurance policy, your insurance company may accept to cover some or all the cost in some cases. An insurance company is interested in reducing the overall cost of the treatments that they will have to pay to your dentist. Therefore, if the total cost of your dental treatment will be less by using dental sedation, your insurance will possibly be happy to pay for sedation dentistry.
An example case is when you are undergoing periodontal scaling and root planing of all four quadrants of your mouth, which normally requires four appointments; one quadrant is normally treated at each visit.

If your dentist can provide dental sedation making the process more comfortable for you, and in the same time allowing him to complete the whole treatment in a single appointment saving on disposables and valuable office time, he may make a significant discount to the cost of SRP. If the combined cost of sedation dentistry and actual treatment when sedated is lower than what it will be if it was performed in four separate visits without sedation, there is no reason for the dental insurance to deny paying for the dental sedation.

Getting insurance coverage may be easier for lower cost light sedation using nitrous oxide than for the more expensive intravenous sedation (IV sedation).
Dental insurance plans may cover unconscious (deep) sedation, or general anesthesia, only when it is medically necessary in order to treat a patient. Patients with certain disabilities or medical conditions such as epilepsy, cerebral palsy, autism, or mental retardation, can not receive proper dental care without the help of sedation dentistry.
Many dental insurance companies will cover complicated surgical procedures such as multiple extractions or major oral surgery under IV sedation; however, routine treatments such as fillings and root canal therapy are not typically covered. Depending on the terms of each specific insurance plan, it may cover sedation dentistry for patients diagnosed for severe dental phobia, or when the patient is unable to receive regular dental care due to a disability. Some plans may also cover dental sedation for certain treatments for children under 6 years old.

Why do some dental insurance not cover sedation dentistry?

Despite the many benefits that dental sedation offers to the dental health of millions of patients, a typical dental insurance does not cover sedation dentistry expenses.
Most insurance policies consider dental sedation as a not necessary procedure for the administration of dental treatment, not providing coverage for sedation dentistry, categorizing it in the same group as luxury treatments such as cosmetic dentistry and dental implants.
The cost of sedation dentistry is considerably high, especially for deep sedation and general anesthesia. In some types of treatments the cost of sedation may even double the cost of the overall treatment. Dental insurance companies prefer to exclude expensive dental sedation procedures from the list of covered treatments, otherwise they should have to increase significantly their fees.