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SEDATION DENTIST AND SLEEP DENTISTRY

The Sedation Dentist and Sleep Dentistry
Levels of Sedation
Ramsay Sedation Scale
Oral Sedation
Medical Concerns
Dental Anxiety and Sedation Dental, Share Your Story!

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WHAT IS A SEDATION DENTIST?

This involves giving the patient medication in some form which alters their state of consciousness, normally in order to decrease dental anxiety. There are several different levels of sedation in sleep dentistry, such as being put completely to sleep to the quickly reversible use of nitrous oxide . If you are put completely to sleep, you probably won't remember anything that happens, whereas with nitrous oxide, you will be completely conscious and coherent, but will be more relaxed.

LEVELS OF SEDATION DENTAL:

Depending on how your situation and the type and amount of dental care that is needed, will help your sedation dentist determine what level of sedation is needed.

The table below illustrates the different levels that can be attained. All levels of sedation are commonly utilized in sleep dentistry, even general anesthesia. Oral surgeons often use it when wisdom teeth are extracted , but patients can also be put to sleep for routine dental work if the situation warrants it.

Level of Sedation Dental	Responsiveness	Airway	Spontaneous Ventilation	Cardiovascular Funtion
Minimal Sedation, Anxiolysis	Normal response	Unaffected	Unaffected	Unaffected
Moderate Sedation, Conscious Sedation	Purposeful response to verbal/touch	No Assistance Needed	Adequate	Usually Maintained
Deep Sedation, Analgesia	Response after repeated painful stimuli	Assistance Maybe Required	Possibly Inadequate	Usually Maintained
General Anesthesia	No response, even to painful stimuli	Assistance Required	Usually Inadequate	Possibly Impaired

RAMSAY SEDATION SCALE:

Another scale commonly used in sleep dentistry to measure the level of sedation dental is the Ramsay Sedation Scale.

Ramsey Sedation Score	Responsiveness
1	Patient anxious and or restless
2	Patient is cooperative
3	Patient response only to commands
4	Patient responds promptly to auditory or tactile stimulus
5	Patient is slow to respond to stimuli
6	Pateint is unresponsive

ORAL SEDATION:

Often times patients are given oral sedatives prior to their sleep dentistry appointment, such as benzodiazepam, which will relax the patient but the patient will remain completely conscious during the appointment. When this is done, the patient normally will need a ride to and from the dental appointment.

Oral sedatives can also be combined with nitrous oxide in order to increase the sedation slightly.

If higher levels of sedation are needed, a sedation dentist may be needed as some form of IV (intravenous) sedation will likely be needed. Along with an IV, additional equipment is needed and you may need to fast or be NPO (nothing by mouth) aside from clear liquids for a certain time prior to your procedure. Your sedation dentist can discuss this with you.

MEDICAL CONCERNS:

Not all people are good candidates to see a sedation dentist. If you have any pre-existing health conditions, that may increase the risk of sleep dentistry sedated procedures.

The American Society of Anesthesiologists (ASA) created a classification system which assesses a patients health prior to surgery. It is not intended to measure risk, but obviously the less medically stable you are (higher ASA classification), the higher the probability of complications.

ASA Category	Health Status	Existing Health Issues
ASA 1	Normal Healthy Patient	No physical or psychological concerns, excluding adolescents or elderly
ASA 2	Mild Systemic Disease	Controlled diseases such as diabetes, hypertension, mild obesity, pregnant, smoker without COPD (chronic obstructive pulmonary disease), no physical limitations
ASA 3	Severe Systemic Disease	Controlled diseases of more than one system, uncontrolled diabetes or hypertension, managed CHF (congestive heart failure), obese, no immediate danger of death, but some physical limitations
ASA 4	Severe, Life Threatening Systemic Disease	At least one disease that is poorly controlled or end-stage, that could cause death, such as unstable angina, kidney or liver failure
ASA 5	Not Expected to Survive >24hours without Surgery	Imminent risk of death, multiorgan failure, severe coagulation issues
ASA 6	Declared brain dead

DENTAL ANXIETY AND SEDATION DENTAL:

Most of the times a sedation dentist is needed due to extreme dental anxiety. There are many common causes for dental anxiety, such as the following:

Fear of shots
Bad experiences as a child
Embarrassed about dental condition
Not knowing what is going to happen or what is going on
Fear of potential dollar costs
Not being able to stop the dentist

WHAT TO DO ABOUT IT:

If your dentist does not ask you about it, MENTION IT.
DISCUSS what you are nervous about, and what the dentist can do to reduce it. Below is a list of common sources of dental anxiety.
If your dentist is NOT WILLING to take the time to discuss your anxiety, you might want to reconsider your choice of dentists.
Consider seeing a Sedation Dentist

Consider NITROUS OXIDE

What Helps Decrease Your Dental Anxiety?

Many people are nervous about seeing the dentist. Feel free to share your story about what caused your anxiety, or what your dentist does to help decrease it.

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