Is Sedation Dentistry Safe, and Who Is It Not For?

Fear of the dentist is not a rarity to be kept quiet about. A systematic review and meta-analysis covering more than 72,000 adults estimates that around 15 per cent of people have pronounced fear of dental treatment, and in slightly more than three per cent that fear is strong enough for them to postpone or entirely avoid treatment.¹ For some of these patients, analgosedation can be what makes the difference between further postponement and treatment that finally goes ahead. The question we hear almost every day is this: is analgosedation safe, and is there anyone for whom it is not recommended?

What analgosedation is and why it is considered safe

Analgosedation is a controlled state of reduced consciousness whose depth is matched to the patient and the procedure. With lighter analgosedation you stay awake, breathe independently and can respond to speech and follow instructions, while with deeper analgosedation you can effectively sleep through the procedure and remember little or nothing of it afterwards. The aim is to reduce fear, anxiety and tension and to allow the procedure to pass calmly, with maximum comfort for the patient. This is what distinguishes it from general anaesthesia, in which the patient is in a controlled state of unconsciousness and a different level of anaesthetic support may be required.

The data from practice are encouraging. A regional audit from Wales followed 1,037 sedations across nine centres over the course of a year. The procedure was completed successfully in 92 per cent of cases and the rate of minor adverse events was 2.6 per cent, with the conclusion that the practice observed is safe and predictable.² A systematic review of ten randomised trials in adult dental patients likewise concludes that benzodiazepines such as midazolam, given as a single dose, are effective and safe in controlling anxiety under the conditions described in those studies.³

Safety, then, does not come about by itself. It is the result of assessment before the procedure, appropriate monitoring during it, and the expertise of the medical team carrying out the analgosedation.

How safety is ensured during the procedure

An assessment of health is carried out before every sedation. A medical history is taken, and the medicines you take, your allergies and any previous experience with anaesthesia are checked. The ASA physical status classification is used to assess the patient’s general health and the presence of systemic disease.⁴ The airway is also assessed, for example mouth opening and neck mobility, because assessing it is important for carrying out sedation safely and for providing support with breathing if that becomes necessary. At Ortoimplant DENTAL SPA the patient also has an interview with the anaesthesiologist immediately before the procedure, who makes a further assessment of the factors important for carrying out analgosedation safely.

The patient’s vital signs are monitored continuously during the procedure. A pulse oximeter measures blood oxygen saturation and pulse, blood pressure is checked, and heart activity is also followed with an ECG. At deeper levels of sedation capnography may also be used, which tracks exhaled carbon dioxide and allows early recognition of slowed or inadequate breathing.⁴ For sedation to be carried out safely, oxygen, airway management equipment and the appropriate medicines for handling possible complications are available, including antidotes that can reverse the effect of certain sedatives when needed. Before the procedure the patient also receives instructions on food and fluid intake, which reduces the risk of aspiration during sedation.⁴

For whom analgosedation is not the first choice

Absolute contraindications to analgosedation are not common, but there are conditions that call for greater caution and a more detailed assessment before the procedure, and sometimes for the procedure to be carried out in a hospital setting.⁴ This is a matter of individual judgement, not a list of exclusions. Particular attention is required for:

• serious and unstable systemic disease (higher ASA grades), for example uncontrolled heart conditions or severe lung disease;
• pronounced obstructive sleep apnoea and other conditions with a tendency towards weakened breathing, because benzodiazepines can further reduce respiratory drive;
• known allergies or previous adverse reactions to sedatives;
• myasthenia gravis and similar neuromuscular diseases, in which the use of certain sedatives requires particular caution;
• pregnancy and breastfeeding, when the decision is made very carefully and in consultation with a doctor;
• concurrent use of opioids or other medicines that depress the central nervous system, because of the possible deepening of sedation and the risk of slowed breathing.

None of the above automatically means that analgosedation is ruled out. It means that the assessment has to be more thorough and that the way it is carried out and the depth of analgosedation are matched to the patient’s state of health and to the planned procedure. At Ortoimplant DENTAL SPA analgosedation is carried out under the supervision of an anaesthesiologist and in a hospital setting, which allows an appropriate level of monitoring and safety even for more demanding procedures and for patients who require increased caution.

What side effects are possible

Most side effects are mild and temporary. In the studies mentioned above, the most common were drowsiness, dizziness, nausea and headache, and benzodiazepines also often cause mild amnesia, so that part of the procedure is simply not remembered.³ Serious events, such as a marked drop in blood oxygen saturation or respiratory arrest, are rare, but it is precisely because of them that continuous monitoring and equipment for a rapid response are in place.

After intravenous analgosedation the patient must not drive themselves or, on the same day, carry out activities requiring full concentration and the ability to react quickly. After larger and more demanding implant and oral surgery procedures at Ortoimplant DENTAL SPA we can keep the patient for postoperative observation and allow them to stay the night with us, so that the period immediately after the procedure is spent under supervision and in safe conditions.

How we approach this at Ortoimplant DENTAL SPA

At Ortoimplant DENTAL SPA we offer analgosedation to patients with pronounced fear, dental anxiety or dental phobia, while we apply potentiated intravenous analgosedation as a matter of protocol for more extensive implant and oral surgery procedures. Before the procedure we go through the patient’s medical history, the medicines they take, allergies and other factors important for carrying out analgosedation safely, and immediately before the procedure the patient also has an interview with a specialist in anaesthesiology.

Potentiated intravenous analgosedation is carried out under the supervision of a specialist in anaesthesiology, with a trained medical team, continuous monitoring of vital signs and the equipment needed to monitor them and to handle possible complications. Ortoimplant DENTAL SPA has hospital conditions for carrying out procedures of this kind, including the option of postoperative monitoring and, especially after larger and more demanding implant and oral surgery procedures, keeping the patient overnight.

If we assess that analgosedation is not advisable for a particular patient, we will say so clearly and choose a safer approach. If you are considering a procedure and fear, dental anxiety or dental phobia have held you back so far, the first step can be simply a conversation. The first examination with us is free of charge, and at it we calmly go through your options, including an assessment of whether analgosedation is an appropriate and safe choice in your case.

Frequently asked questions