Intravenous (IV) sedation is a method of providing safe, effective pain and anxiety control. Adjustments to the dose and depth meet each patient's specific needs. Many patients prefer this sedation option for dental care due to its rapid effects and ease of reversal.
Like other forms of sedation dentistry, IV sedation makes the patient relaxed and completely comfortable. IV sedation also drastically reduces dental anxiety and pain. The patient will not be asleep during the appointment and will still respond to verbal cues. Because the patient is completely relaxed, you can accomplish more high quality dentistry in less time.
IV sedation also gives the dentist greater control of the amount of medication administered. It also allows the dentist to readily increase or decrease the level of sedation as needed, quickly and comfortably.
An additional benefit of IV sedation includes faster onset of the sedation medications, meaning patients feel the effects of the medication quickly.
Conscious sedation is a level of sedation, while IV sedation is a route of administration used to achieve this level. IV sedation means that the patient takes medication(s) to control anxiety through an IV line directly into the circulatory system bypassing the digestive system.
Patients with high anxiety, dental fear, difficulty becoming numb, and patients who are prone to gagging, benefit most from IV sedation. In short, any patient who would benefit from oral sedation may also choose IV sedation as an option.
Fear of needles is not uncommon, and some patients won't tolerate IV sedation for this reason. However, most people describe the sensation as a slight pinch or prick. Also, dentists can further reduce the feeling by giving an oral sedative beforehand and/or applying a topical anesthetic to the skin.
IV sedation dentists perform a thorough pre-operative evaluation, including a review of medical and medication history. The medications are evaluated for any possible negative drug interactions and sophisticated yet easy-to-use dental-specific drug interaction software can automatically cross-check a patient's medications (even herbal and nutritional supplements) with sedative medications.
The IV sedation dentist takes a thorough medical history from each patient, performs a drug interaction screening, and uses patient monitoring (with equipment such as a pulse oximeter with a blood pressure monitor and capnography). These help ensure IV sedation dentistry is safe and effective.
Each patient may respond differently to IV sedation. Therefore, each patient's recovery time is different. However, many patients begin to feel more alert soon after the IV medication stops. Patients are instructed not to operate heavy machinery or vehicles or perform any activity requiring mental alertness for at least 24 hours. Nausea is also possible, but medications are available to control this. In the event the patient experiences any nausea after treatment, a prescription to help may be provided.
Patients are encouraged to sleep and drink plenty of water and clear fluids for the remainder of the day.
Many sedation patients report significantly reduced pain levels the day after their treatment. There are multiple theories for why this is, but the common thought is that because a sedation patient is relaxed and not tense during their appointment. The dentist can often use less force and access the mouth more easily.
● Anterograde amnesia. Due to the amnesic effects of the medications, patients have little or no recollection of the treatment.
● Less post-operative soreness. When patients are afraid, their threshold for pain is much lower. Fear and anxiety trigger the release of certain chemicals in the brain, like adrenaline, which puts a patient's "fight or flight" instincts on high alert. They anticipate that something will hurt, so they tense their muscles leading to additional soreness post-treatment. A patient's apprehension and hypersensitivity to pain are virtually eliminated with sedation. This increased comfort level reduces the likelihood and severity of post-operative discomfort.
● Dry mouth. Sedative medications will decrease salivary flow and allow the dentist to perform treatment in a dryer environment.
● Nausea. A small percentage of patients will experience nausea.
Generally, the doctor will allow extra time to initiate the IV, monitor the patient, recover in-office, and determine if the patient is ready to be discharged.
IV sedation has been proven to be very safe and effective. Patients will release less of the endogenous substances that raise blood pressure and increase the heart's oxygen consumption. Patient selection and assessment are of utmost importance to minimize any adverse outcomes. Only trained, experienced individuals should practice it.
Certain safeguards must be followed to protect the patient's airway. In many ways, it is easier to work on a sedated patient. The relaxed state of the patient usually allows for a wider opening of the mouth, less movement of the patient in general, and more cooperation.
Contact your carrier for the specifics of your situation, but carriers generally will not raise your premiums for performing IV sedation.
Many dental insurance carriers will pay for sedation. Again, there is wide variability in this area.
Monitoring, airway management, and emergency equipment are required. Also, specific medication and administration materials such as IV catheters, IV solutions, and IV administration sets are required. Each participant in the IV sedation course has an equipment/supply list and sources for these supplies and the specific regulatory requirements in the participant's jurisdiction.
The team should be involved in the training process. While only a trained, permitted individual should administer the sedation, the team should supports the administrator with supplies, sterile procedures, and patient management techniques. Most states require that one or more trained individuals be present in the operatory during IV sedation.
No. A general anesthesia permit is required before you can say "sleep dentistry" in your advertising. An IV permit only authorizes you to administer conscious sedation or moderate sedation, depending on which state you practice. In those states, it would be proper to say "sedation dentistry" instead. Be sure to check your state regulations before advertising sedation.