Sedation Dentistry Risk Factor Pros and Cons
Sedation dentistry, alternatively called relaxation dentistry or oral sedation dentistry, is a process of delivering oral medication or a combination of medications in order to induce a heightened state of relaxation. Sedation dentistry puts the patient at ease and reduces or eliminates fears. It also relaxes both the mind and the body and often produces moderate amnesia of the subsequent dental work performed.
It is estimated that one in seven people harbor deep phobic fears of dentistry. For many, those fears keep them from stepping inside a dentist’s office, sometimes for years and to the detriment of their quality of life. Sedation dentistry is often seen as the answer to their prayers, not only because it delivers pain-free dentistry but because it eliminates fear. And, an added bonus is its relative low-cost.
In 2000, the Dental Organization for Conscious Sedation – a professional dentistry organization – was founded in Philadelphia and now numbers 8,000 members nationwide. The growth of the organization mirrors the growing popularity of sedation dentistry. But the popularity of the procedure is not without its critics.
The medications administered to patients include well-known drugs that treat anxiety and induce sleep, such as Valium, Halcion, and Sonata. What the doctor chooses depends on a patient’s health history, medications they may already be taking, and other indicators, including things like diet. Critics of the procedure insist that if a doctor is going to administer these or similar drugs, it requires the expertise of an anesthesiologist because the risks involved are similar to those for any anesthetic delivered during surgery.
Critics of the procedure insist that if a doctor is going to administer these or similar drugs, it requires the expertise of an anesthesiologist. This is so because the risks involved are similar to those for any anesthetic delivered during surgery. The American Dental Association issued guidelines in 2008 for sedation dentistry, recommending a 25-hour course of training and ten clinical cases required before a dentist can administer the procedure. Responding to reports of over-medication, forty states have already adopted those guidelines and some have adopted or are considering new and more stringent regulations.
For anyone considering sedation dentistry, there are obvious precautions that can be taken to minimize the risk factor. First, consult your own regular physician, especially if you are currently taking any medication. Find out if there are any contraindications you and the dentist should take into account before administering any additional drugs. In addition, find out if you have particular health issues that the dentist should be made aware of.
Second, consult national or local professional dental organizations for recommendations for qualified dentists in your area. Don’t rely on advertisements in the yellow pages for something this important.
Third, don’t be afraid to ask about a doctor’s credentials. Where and when did he or she graduate from dental school? Is the doctor board certified in his or her specialty? How many similar procedures has the doctor performed? What percentage of the procedures, if any, had a less than optimal results.
Good doctors are as protective of their reputations as any reputable professional in any field. Not only will they not mind these types of questions, they will welcome the opportunity to provide answers. So, do a little homework before you choose a doctor.
Don’t forget anecdotal information which can also be useful. Often, dedicated websites will enable you to exchange information with patients who have already experienced the procedure. With a little research, you can minimize whatever risks exist, and the good news is that sedation dentistry seems to have a good track record. Good dental health needs no longer be sacrificed to fear and anxiety.
Tips to Ensure a Successful Dental Implant Recovery
In the past two decades since dental implants have become commonplace replacements for missing teeth, much has been learned about the importance of proper post-operative care to ensure dental implant surgery is successful.
A dental implant is actually a titanium post that is implanted into the upper or lower jawbone, generally by a periodontist, prosthodontist or oral and maxillofacial surgeon. Once implanted, the post fuses to the bone through a process called osseointegration.
After two to six months of this fusing process, a patient’s gum is reopened by the surgeon for attachment of an abutment to the post. Some surgeons now use single-stage implants, which do not require a second procedure to uncover them. The abutment sticks out from the gum line and provides a foundation for attachment of a crown, which looks like a real tooth. The crown is generally created and positioned by a prosthodontist or regular restorative dentist.
Sedation during oral surgery
Patients generally have four options for sedation during placement of dental implants.
Local anesthesia: Anyone who has had a tooth filled is likely familiar with this type of anesthesia, which consists of painkiller injected into the area to be treated.
Nitrous oxide-oxygen: This “laughing gas” mixture is often delivered in conjunction with an oral sedative such as Valium or Halcyon, which the patient would take about an hour before surgery begins.
Intravenous sedation: IV sedation relaxes the patient but takes time to wear off and may cause nausea, which is why the patient should not eat or drink for eight hours prior to surgery. A patient choosing this option must have someone drive him or her home from the appointment.
General anesthesia: This is the strongest anesthesia option and puts the patient all the way to sleep. Like IV sedation, general anesthesia can lead to nausea. So, the patient should not eat or drink for eight hours prior to surgery and requires that the patient has a driver to take him or her home after surgery.
Post-operative tips for dental implants
A patient may have a tooth extracted weeks, months or years before having an implant surgically placed in the gap. In some cases, a patient can have a tooth extracted and the implant placed during a single operation. Either way, the patient will experience bleeding following the implant surgery and will likely need to firmly bite down on gauze pads for an hour at a time during the first 12 to 24 hours.
Persistent bleeding might be controlled by using a moistened black tea bag instead of gauze. It is important to use a tea bag full of black tea rather than another variety as the tannin in black tea is key to controlling bleeding. Keeping the patient’s head elevated above the heart, even while sleeping, skipping hot liquids and foods, and avoiding exertion are also important guidelines for controlling any bleeding and promoting the healing process.
Placing an ice pack outside of the patient’s face where the surgery occurred once an hour for 30 minutes at a time will also help stem bleeding as well as reduce swelling and pain. This process can be continued during the first couple of days after surgery.
It is important that the patient not smoke for a minimum of five days after oral surgery as smoking can drastically delay healing. The patient should closely follow directions for taking any antibiotics and using antibacterial rinses as prescribed by the oral surgeon. Gentle brushing of non-affected teeth can begin 24 hours after surgery. Lukewarm salt water rinses can also start a day after surgery and continue for two weeks to sooth and cleanse the area that was operated on.
Diet after implant surgery
For the first week after surgery, the patient should stick to eating cool and soft foods, such as unheated baby food, yogurt, ice cream and apple sauce. It is important to stay away from hot foods and liquids because these can dissolve the protective blood clots that form in the wound, thus prompting more bleeding and, in the case of an extracted tooth, possibly leading to a painful and infected dry socket.
A patient should also drink directly from a glass rather than through a straw. Using a straw can also dislodge a blood clot and lead to a dry socket. Carbonated drinks should be avoided during the first week after oral surgery as well.
Ibuprofen is often recommended to reduce pain and inflammation after dental implant surgery. Narcotics can also be prescribed for pain, but some people suffer from nausea when taking narcotics.
Dissolvable sutures that were placed during surgery can begin to fall out as early as three days after surgery and might get in the way of eating. They are best ignored and will generally fall out on their own as the patient heals. Stitches that do not come out on their own are generally removed by the operating dentist about two weeks after surgery.
Completing the dental implant process
Depending upon where an implant is placed, a patient may want to have a temporary crown or snap-in plastic tooth made to fill the gap while the implant area heals. Ultimately, the patient will have either a removable, fixed or combination prosthesis created to attach to the implant’s abutment and replace the missing tooth or teeth.
As with any surgery, a dental implant operation can lead to complications. However, a brochure from the American Association of Oral and Maxillofacial Surgeons reports a 95% success rate for dental implant surgery and says the vast majority of implants can be expected to last for two or more decades.