Sedation is one of the anaesthesia methods applied before dental treatments in order to reduce anxiety, pain and pain sensations by relaxing the patient. Sedative drugs with sedative properties are given by mouth or intravenously.
Local anaesthesia, sedation and general anaesthesia methods are used in dental treatments. Local anaesthesia is usually applied to the area to be treated. If the patient can be treated comfortably under local anaesthesia, sedation is not required. However, if the anxiety and fears of the patients are serious or if they have different disease histories, sedation or general anaesthesia is applied to make the treatment procedures more comfortable. Additional doses of sedation may be required for treatments that will last longer than planned.
Sedation is assessed by an adequately equipped anaesthesiologist, taking into account the patient’s entire medical history. If there are special conditions, chest x-ray, ECG and some blood tests are requested. Prior to the application, preliminary preparations should be made against possible emergency complications. The experience of the dentist who will work with the anaesthetist in treating the sedated patient is also important to minimise the risks.
After sedation is applied, the patient’s heart rhythm, blood pressure and oxygen level are continuously monitored during the treatment. After the treatment is completed, the patient is kept under control for a certain period of time in order to observe the side effects and allergic conditions that may be caused by sedation drugs.
Sedation is divided into three levels according to the dose and drugs administered: minimal, moderate (Intravenous-IV) and deep sedation. Cardiovascular functions are not expected to be affected in all sedation levels except general anaesthesia. Suppression of consciousness increases with increasing dose levels. Sedation cannot completely prevent pain and aches that may occur during treatment. For this reason, local anaesthesia is applied in addition to sedation to prevent pain.
Generally, sedation is recommended for patients with dental anxiety, gag reflex, fear of needles, claustrophobia (fear of confined spaces), excessive tooth sensitivity. In addition, patients with involuntary muscle movements such as Parkinson’s, Alzheimer’s, Cerebral Palsy, diseases affected by stress and anxiety such as cardiovascular occlusion, hypertension, asthma, epilepsy, mental retardation or children under 8 years of age require sedation at a level appropriate to the patient. Sedation is not applied to patients with a high probability of complications due to their disease and pregnant patients.
Minimal sedation is applied by inhaling nitrous oxide gas, also called laughing gas, or by taking oral medication. The patient’s consciousness is not completely lost, relaxation and sleepiness occur. The patient can respond normally to verbal stimuli. After the treatment, the effect of sedation may take between 20-30 minutes depending on the patient’s condition. When the effect disappears completely, the person can drive, go to work or school.
The patient under moderate sedation feels drowsy and can fall asleep in a semi-conscious state. The procedures related to the treatment are mostly not remembered. Reaction to verbal and physical stimuli decreases. Although the effect varies according to the person, it is accepted for an average of one day. After the treatment, the person cannot drive until the next day and cannot go to work or school. For this reason, there must be a relative to accompany the patient after treatment.
Deep sedation is the highest level of sedation in which consciousness is largely suppressed. While no change is observed in the cardiovascular functions of the patient, respiratory support may be needed. They may react to severe and painful stimuli. After treatment, the patient cannot reach his/her initial mental state until the next day.
Side effects such as nausea, vomiting, headache, fever, dry mouth, drowsiness, bruising, allergic reactions may be observed after sedation. After sedation and local anaesthesia, liquid-weighted foods that do not require chewing are preferred until the feeling of numbness in the mouth disappears. Depending on the treatment applied by the dentist, attention to nutritional recommendations and oral careaccelerates the healing process.