Sedation in dentistry – a current overview
Beyond pure local anesthesia, particularly anxious and / or pain-sensitive patients can benefit from modern sedation procedures. In an interview for the DZW, the Cologne anesthesiologist and emergency doctor Dr. med. Frank Mathers provides information on the current status of sedation in dentistry.
DZW: Dr. Mathers, what is the term “sedation”??
Dr. med. Frank Mathers: The word “sedation” is derived from the Latin term “sedare”, which means “to calm down”. In medicine or dentistry, this means the pharmacologically induced damping of functions of the central nervous system, in which a patient does not necessarily lose consciousness.
DZW: Then sedation is anesthesia?
Mathers: No, that’s exactly not it. The term “anesthesia”, which is actually a synonym for general anesthesia, is sometimes used too carelessly. Sedation is not anesthesia – it lies on the continuum of consciousness between local anesthesia and anesthesia.
DZW: Can you explain that a little bit??
Mathers: In dentistry, drug pain elimination ranges from local anesthesia to sedation to general anesthesia. With the former, the patient is conscious, with the latter not, and the transitions between the stages are fluid. Within sedation one speaks of minimal, moderate and deep sedation.
DZW: When do I need an anesthetist to sedate??
Mathers: You need an anesthesiologist if a patient needs general anesthesia or general anesthesia in order to be treated appropriately. If the patient’s loss of consciousness is not absolutely necessary and / or desirable, there are several sedation procedures that qualified dental professionals can use independently.
DZW: And what would that be??
Mathers: Generally there are titrable and non-titrable sedation methods. With titrable procedures, you can adjust the sedation depth during treatment as required. These include, for example, the nitrous oxide sedation, which is increasingly used in Germany, or intravenous sedation, which is used rather rarely. In the case of non-titrable procedures, you determine the depth and duration of sedation before treatment, but you can only influence or change these during the treatment. Oral drug sedation, for example with benzodiazepines, barbiturates or antihistamines, is the most popular non-titrable procedure in dentistry.
DZW: Which sedation method is best?
Mathers: It depends on the specific treatment situation. Oral sedation and nitrous oxide sedation are common in everyday dental practice.
DZW: What are the advantages of oral sedation??
Mathers: Oral sedation is widely accepted by patients because it is pain free and most people have no problem swallowing a pill. When used correctly, unexpected side effects are extremely rare. In addition, the procedure is inexpensive and dentists do not have to maintain any further human or material resources in practice.
It is important, however, that the dentist not only has active knowledge of the pharmacology of the sedatives used, but also experience in dealing with oral preparations. For example, you have to be familiar with the corresponding latency phases between taking medication and the onset of action, and finding the correct dose can be difficult.
DZW: And the disadvantages?
Mathers: A clear disadvantage is that the sedation depth cannot be adjusted as required during treatment – and there is always the risk that a patient may become unconscious unintentionally. In addition, the medication usually works beyond the duration of the treatment, so that a recovery phase must be planned. Patients are also not roadworthy after ingestion and should not be discharged alone.
DZW: How is it with dental nitrous oxide sedation?
Mathers: Inhalation sedation with nitrous oxide is a safe and effective method that is becoming increasingly popular in Germany. A special mask construction inhales nitrous oxide concentrations of up to 70 percent through the mouth. However, concentrations between 20 and 50 percent are more common. Nitrous oxide is particularly suitable for anxiolysis in anxious patients, in patients with disturbing gagging and / or swallowing reflexes, and in long-term treatments.
DZW: What are the advantages of nitrous oxide sedation??
Mathers: Thanks to a modern generation of application devices, this form of sedation is very easy to handle and use. Because you can control the sedation depth very precisely by titration, an accidental “slipping” into the unconscious is almost impossible. A potential overseeding can also be quickly recognized by professional monitoring: the patient gets a strict look, is poorly responsive and is no longer able to keep his mouth open. Then the dentist only needs to reduce the concentration of the nitrous oxide. The procedure is very safe, mortality cases in dentistry are not documented.
DZW: And the disadvantages?
Mathers: In very rare cases, patients complain of nausea or dizziness after treatment, and not every patient is suitable for nitrous oxide sedation.
For example, patients with chronic lung disease (COPD) should be treated with great caution. The administration of high oxygen concentrations, which is mandatory for nitrous oxide sedation, can cause them to stop breathing. Rare absolute contraindications are pneumothorax, ileus and vitrectomy.
Mentally handicapped people as well as patients with severe psychiatric illnesses or a nasal airway obstruction are also not suitable for the method. Because of the potentially harmful effects of the gas, this also applies to pregnant women, especially in the first trimester. Allergies to nitrous oxide are not known.
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