Dental care is an important part of overall health, but if you get anxious at the dentist or you’re worried about the pain, it can be tough to stay on top of your routine visits. Sedation dentistry, in which a dentist or anesthesiologist gives you a sedative drug prior to or during a dental visit, is one way to make uncomfortable dental procedures easier.
Dentists often use sedation for patients. There’s not just one type of sedative. Your dentist may prescribe a pill to help you calm down before a visit, or you may go to sleep for the entire procedure and not remember any of it.
Regardless of the method, it’s important to understand how sedation works and what to expect before your appointment. Here’s what you need to know about getting sedated at the dentist, according to experts.
Why dentists use sedation
In dentistry, as in many other fields of medicine, sedation helps make patients more comfortable during procedures so care providers can do their work safely and effectively, says Bryant Cornelius, program director of dental and maxillofacial anesthesiology at The Ohio State University College of Dentistry,
Anxiety about dental work is one of the most common reasons people opt to be sedated, Cornelius says. Kids or people with special needs who may struggle to stay still for a procedure can also benefit from sedation.
Pete Hehli, a sedation dentist in Appleton, Wis., says patients with a strong gag reflex or people who don’t get fully numb from local anesthesia may also be good candidates for sedation. Being sedated can also help when patients are undergoing complex dental work in one visit, like teeth extraction, dental implants or multiple fillings.
But even during long or complex visits, sedation isn’t always required. It’s a case-by-case situation: Some people may need to go to sleep to stay still for X-rays and a cleaning, while others can tolerate root canals or even wisdom teeth extraction under local anesthesia.
“The goal is to treat patients individually depending on what they want or need,” Cornelius says.
Not all dentists can offer sedation; typically, they need a specific license for it. Each state has its own dental sedation laws and regulations, according to the American Dental Association.
Most general dentists in the U.S. have a license to practice minimal or moderate sedation, Cornelius says. But some states require additional education or licensure to perform any type of sedation. Dentists also sometimes work with nurse anesthetists or anesthesiologists who administer sedatives.
Types of dental sedation
Your dentist will choose the best sedative for you based on your needs and your medical history. There are several types of sedation drugs used in a dental setting, including nitrous oxide (aka laughing gas) and ketamine. Benzodiazepines and opioids are also used.
The methods for administering anesthesia vary. You may breathe in a gas or take a pill before a procedure, or your dentist could give you a shot, or you could receive anesthesia through an IV. Any of these techniques can be used during any procedure, but the dose and each individual’s response may vary.
“Everyone responds to different drugs in different ways,” Cornelius says.
Each type of sedation has a different effect that fall into one of the four levels of sedation:
- Minimal sedation: Under minimal sedation, a patient is responsive to verbal stimulus. You’re awake and totally aware of your surroundings, but you feel calmer—and that’s the goal. “I compare it to a two-beer buzz,” Cornelius says. “You go out on the weekend and you’re talking to people, but you’re much less anxious than you were before.”
- Moderate sedation: While moderately sedated, you’ll still have a “purposeful response to verbal or tactile stimulation,” Cornelius says. In other words, you can close your eyes and check out, but you’ll open your eyes if your dentist taps you on the shoulder.
- Deep sedation: Deep sedation is more like sleeping, Cornelius says, so snapping out of it requires repeated or painful stimulus. You might need to be yelled at to open your eyes, for example.
- General anesthesia: General anesthesia is the sedation you may receive if you’re having surgery. You’re completely asleep, so you won’t respond to any physically painful stimulus. Only dentists who attend residencies in dental anesthesiology or oral-maxillofacial surgery can administer general anesthesia. Because deep sedation and general anesthesia can make it hard for the patient to breathe on their own, some patients may be intubated to assist with breathing during a procedure.
What to know about being sedated
While just about everyone can receive some type of sedation, certain forms of sedation aren’t compatible with specific illnesses or medications. Someone with emphysema, for example, shouldn’t use nitrous oxide because of the way it affects the lungs, and people with certain types of glaucoma shouldn’t receive benzodiazepines.
If you think you’d benefit from sedation, bring it up to your dentist. If they don’t perform sedation, Hehli says they can likely refer you to a dentist who does. Expect the dentist to take your full health history and ask about your medical conditions and current medications in order to find the safest, most effective method of sedation for your procedure.
Before your appointment, it’s also a good idea to understand the financial implications. Some dentists offer sedation as a cash-only service, which means you’ll have to pay for it out of pocket, Cornelius says. In other cases, sedation may be partially or totally covered by dental or even medical insurance.
Call your insurance provider before your appointment to find out whether you have any financial responsibility, and if so, how much.
“You don’t want to wake up to a huge bill,” Cornelius says.