IV Sedation Dentistry

Intravenous IV is a method of providing safe, effective pain and anxiety control. The dose and depth can easily be individualized to meet each patient’s specific needs. Because of its rapid effects and ease of reversal, many patients prefer this relaxation option for dental care.

Effective anxiety and pain relief, and little or no recall of any unpleasant procedures.
Just like other forms of sedation dentistry, IV sedation is designed to make the patient relaxed and completely comfortable. IV sedation also eliminates dental anxiety and pain. The patient will not be asleep during the appointment and will still be able to 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 optimum control of the amount of medication administered and 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 you’ll be able to feel the effects of the medication quickly.

Conscious sedation is a level of sedation, while IV sedation is a route by which conscious sedation can be achieved. IV sedation simply means that the patient is given medication(s) to control anxiety through an IV line, directly into the circulatory system.

Patients with high-anxiety, dental fear, fear of needles and sharp dental tools, difficulty becoming numb, and patients who are prone to gagging. 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 aren't able to tolerate IV sedation for this reason. However, most people describe the sensation as a small pinch or prick. Also, dentists can further reduce the feeling by giving an oral sedative beforehand and/or applying a topical anesthetic where the needle will be placed.

IV sedation dentists are trained to 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 is used that automatically cross-checks a patient’s medications (even herbal and nutritional supplements) with sedative medications.

In addition to taking a thorough medical history from each patient, drug interaction screening and patient monitoring (with equipment such as a pulse oximeter with a blood pressure monitor), helps ensure IV sedation dentistry is completed safely and effectively.

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 is stopped. 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 as well as 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 put a patient’s “fight or flight” instincts on high alert. They anticipate that something is going to hurt and so they tense their muscles, even if it is subconsciously, leading to additional soreness post-treatment. With sedation, a patient’s apprehension and hypersensitivity to pain is virtually eliminated, thus reducing 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 extra time is allotted 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 oxygen consumption of the heart. Patient selection and assessment is of utmost importance to minimize any adverse outcomes. It should only be practiced by trained, experienced individuals.

Certain safeguards must be followed to protect the patient’s airway. In many ways, it is actually 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.

Possibly, contact your carrier for the specifics of your individual situation. There are carriers who will not raise your premiums for 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 will be given an equipment/supply list and sources for these supplies.

The team should be involved in the training process. While only a certified, trained individual should actually administer the sedation, the team should be able to support the administrator, with supplies, sterile procedures, and patient management techniques. Many states require that one or more trained individuals are 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 in which state you practice. In those states, it would be proper to say “sedation dentistry” instead.

John P. Bitting, Esq. completed his undergraduate work at the University of California in History and earned his JD at the University of San Francisco School of Law. Originally from Pacific Palisades, California, he lives and practices law in Seattle, Washington. His legal practice is focused in the area of dental regulations with special emphasis on sedation. John travels to and works closely with the regulatory authorities of each state and province in North America to promote the making of sensible regulations for safe and effective sedation dentistry based upon science and the standard of care.

In his spare time, John enjoys watching baseball, playing softball and football, and hunting with his redbone coonhound, Hawkeye.