Sedation Dental Care – What’s it All About?

Patients unfamiliar with sedation dentistry can find it confusing and wonder about safety. They often don’t understand how or if it is used in conjunction with “traditional” anesthetic approaches used in dentistry. One of the most significant changes in the field of dentistry is the availability of sedation dental care – providing the same levels of comfort that are routinely provided by doctors of general medicine and related fields of specialty. The ADA and regulatory state dental boards across the U.S. are facilitating this change in dentistry and helping to ensure that dentists who provide sedation dentistry do it safely. The questions and answers below are intended to help you understand both some of the history as well as a broader explanation of how dentistry is safely being made more comfortable than ever for patients.

When did dentists start using sedation?

Perhaps the better question is, “When did dentists start providing pharmacological pain management techniques?” Horace Wells, a Connecticut dentist, introduced the use of nitrous oxide in the 1840s. One of Wells’ students, William Morton, demonstrated the use of ether as anesthesia. They were progressive thought leaders in the field of pharmacological pain management for not only the field of dentistry, but also the field of medicine. Many, many decades have elapsed since then – long enough for the effects of many different types of anesthesia – both localized and general – to be very precisely understood. Different types of anesthesia are most appropriate for different types of treatment. The fields of dentistry and medicine at large now have an excellent understanding of the risks associated with all types of sedation/anesthesia.

What role does sedation play in providing comfort in dentistry?

There are actually two issues – anxiety and pain – that are often tightly intertwined when it comes to making patients comfortable during dental procedures. Dentists receive a tremendous amount of training that helps them understand this. They are taught about two techniques for managing both anxiety and pain – the psychological approach and the pharmacological approach.

Most patients have little or no awareness of dentists’ training in psychological anxiety/pain management, or that those techniques have been applied to them. At best, they will think that the expert in the psychological approach is nice, gentle, and caring – and that’s OK! Don’t worry, though – there’s nothing deviant about the approaches dentists use to make you more comfortable during your visit.

For many decades, the pharmacological approach used by general dentists has been centered on the administration of local anesthesia (often with needles) to numb the affected area. With new, expert training programs, dentists are starting to use broader approaches that nicely complement the use of localized (more traditional) pharmacological approaches. Patients are put in a relaxed state so they don’t mind having necessary or elective dental procedures performed. Sometimes this is needed to manage patient anxiety – including a phobia about the use of needles. Once the sedation is in use, the patient may become unaware of or uncaring about the use of a needle that is used to provide localized suppression of pain. So, expert pharmacological management of pain and anxiety involves the use of the right mix of sedation and local anesthesia – as appropriate for the procedure being performed.

Why don’t dentists use general anesthesia?

While general anesthesia (where the patient is rendered unconscious) is used by dentists in some fields of dental specialty (most notably oral surgeons), it carries with it a significantly greater patient risk. It also requires very specialized training. For this reason, general anesthesia is generally administered only in a hospital setting where an artificial airway can be maintained to facilitate an instant resuscitation attempt. Needless to say, the hospital setting (or equivalent investment in facility, equipment, and specialized staff members) makes it a costly option. Oral surgeons usually advise that lesser sedation techniques be used in conjunction with local anesthesia whenever practical to avoid the additional patient risk. Insurance coverage (or lack thereof) for using general anesthesia for lesser procedures is another consideration.

Are there different levels of sedation dental care?

The American Dental Association (ADA) has a general policy that discusses minimal, moderate, and deep sedation. The policy is fully described in Guidelines for the Use of Sedation and General Anesthesia by Dentists. However, it is important to realize that the ADA does not formally regulate the provision of dental care in the U.S.; the regulatory responsibility lies with each individual state.

The regulatory requirements on dentists who provide sedation dental care can vary from state to state. Some states provide requirements that define more granular levels of sedation dental care – each with an appropriate corresponding level of training and/or experience – for both the dentist and staff members. For example, the moderate level might be split into orally administered moderate sedation and intravenous moderate sedation. The latter carries with it greater patient risk. Some states are considering or have enacted new regulations for sedation dental care because of the increased public demand for sedation dentistry.

Aren’t all general dentists trained to perform sedation dentistry?

The state-administered regulations for sedation dentistry (when they exist) may be in addition to whatever state guidelines currently exist for the administration of “traditional” localized forms of anesthesia. (The use of local anesthesia may often be regulated by states by certifying that the practitioner holds a Doctor of Dental Surgery (DDS) from an accredited dental school, and may include some additional continuing education requirements.) The ADA is supportive of dentists who are appropriately trained in the use of minimal, moderate, and deep sedation. And of course, the ADA recommends that no dentist use drugs or techniques for which they have not been appropriately trained.

Across the U.S., there is training on sedation dental care available through pre-doctoral, post-graduate, graduate, and continuing education programs which may be appropriate for some levels of sedation. Again, each state defines what training and certification procedures are appropriate for dentists practicing in the state – including sedation dentistry. The ADA indicates that deep sedation and general anesthesia training are beyond the scope of either pre-doctoral or continuing education training programs. Check with the state dental board for your state for additional information about sedation dentistry regulations that apply to you and your dentist.