IV Sedation and When to Introduce an Anesthesiologist

Every sedation dentistry case is different, so it's important to know when to bring in a specialist.


There are several distinct levels of sedation provided to dental patients, but not all dentists are sure what situation calls for specific methods and when to call in the big guns – general anesthesia. Let’s take a look at the main options:

  • Local Anesthesia is administered via injection or topical and typically ends in -caine.
  • Minimal Sedation leaves the patient relaxed and awake, and able to respond normally to stimuli.
  • Moderate Sedation often provides a dream-like state and although the patient is awake and able to respond purposefully, they may not remember the procedure.
  • Deep Sedation is barely awake but can be roused with stimulation when necessary.
  • General Anesthesia (GA) results in complete unconsciousness and amnesia.

Most of the levels involve the use of nitrous oxide, enteral sedation, or intravenous (IV) administration. IV sedation can be used to provide anywhere from minimal to deep sedation levels as well as general anesthesia. However, all forms of sedation and GA have different qualifications and legal requirements based on state regulations.

Why Sedation?

An estimated 93 million people in the U.S. live with some degree of dental fear. Perhaps due to traumatic childhood experiences, unpleasant appointments as an adult, an aversion to lengthy appointments, or the untimely interruption of a pandemic – whatever the reason, far too many people have avoided routine dental care.

Thanks to the advances in sedation medications and treatments, plus the growing number of dentists offering sedation, there are more safe solutions for anxious and fearful patients.

Most dentists provide some level of sedation, but many are investing in further sedation education in order to level up their practice and serve a wider variety of patients in need. With additional qualifications, a dentist can market their practice to a broader audience and generate more revenue from a wider range of services that might otherwise be referred out to specialists.

As Dr. Michael Silverman wrote, “The ability to combine oral and IV sedation will make your day more efficient and allow you to reach and satisfy the needs of medically complex patients and patients who do not respond quickly enough, or long enough, to oral sedatives alone.”

When does a dentist need to take the added precaution of including a specialist to administer deeper sedation or general anesthesia?

When to Introduce an Anesthesiologist

A dental anesthesiologist (DA) is a physician or a dentist who has completed a Commission on Dental Accreditation (CODA) program for deep sedation and GA. Depending on state regulations, they may be permitted to administer anesthesia within the dental office. A Certified Registered Nurse Anesthetist (CRNA) completes, at minimum, a 2-year program and additional clinical experience following completing nursing school.

These professionals provide the sedation for the patient while the dentist performs the dental procedure itself, thus delivering advanced sedation and pain management.

When determining whether to bring in a specialist to provide sedation, patient assessment is key. There are several types of patients who often need particular evaluation when considering sedation levels, including:

  • Patients needing extensive procedures involving multiple quadrants and a long procedure time.
  • Children and adults with high levels of fear or anxiety.
  • Special needs patients.
  • Patients with certain comorbidities or health risks.

As with any sedation procedure, communication is crucial to get a full medical history and medications or conditions that could merit deep sedation or general anesthesia.

There may be a lack of patient cooperation that requires deeper sedation. This could be due to age, prior trauma, or the patient’s inability to control their movements such as with cerebral palsy. In this regard, it’s a decision for the safety of the patient as well as the dental team.

In the case of pediatric dentistry and sedation, evaluating when to bring in a specialist is critical due to the age of the patient and the unique challenges posed by the pediatric airway. (DOCS Education looks at pediatric case selection, drug assessment, parental communication, and selection, as well as legal considerations in this relevant course.)

Ultimately, every case is different. Sedation dentists should always perform a comprehensive evaluation before proceeding – with or without a specialist. A good doctor also understands the value of a second opinion.

For more information, visit IV Sedation Certification by DOCS Education. You can also schedule a complimentary consultation with our Clinical Program Manager, Lindsay Olsen, or email us at [email protected]