In India maximum mount of the population is scared to visit a dentist. Most of them do not have a regular dentist which they or their family visits for a dental condition. This is all due to the dental phobia that you experience. If you are hell scared to see a dentist and mostly dread to sit on that dental chair then you have a dental phobia.
It’s a good news for the residents of Ashok Vihar, New Delhi because Dr. Rajat Sachdeva’s Dental Institute offers you the option to get the treatment done. I am sure you will be curious what actually happens. So let’s begin.
There are different type of sedation that can be achieved via drug administration. Different drugs are known to cause different levels of sedation. Drugs can be administered via the following ways:
- Inhalation
- Parental- IV administration
- Oral or transmucosal
- Combination of the above.
What are the most common drugs used in sedation dentistry?
Most common drugs or agents you see used in the dental clinic for achieving the level of anesthesia are:
- Inhalational sedation : Nitrous oxide with oxygen
- IV administered drugs: Diazepam, Midazolam etc.
- Oral sedative drugs: Midazolam, Diazepam, Lorezepam etc.
Please remember that these drugs are only given if you are very anxious and cannot get the procedure done under the local anesthesia. These drugs have to be administered under continuous supervision and can’t be taken on your own. These medicines are only available under a proper medical prescription from the doctor.
When is sedative dentistry used in the dental clinic?
Sedation dentistry is only practiced for certain patients, which are as follows:
- Anxious / Phobic patients especially children and those with dental phobia.
- Patients who have medical conditions which get aggravated by stress.
- Special needs
- Patient with severe gag reflex
- Patients with movement disorders associated with differently abled patients.
- Surgical extraction of 3rd molars.
- To avoid the use of general anesthesia.
However this doesn’t mean that sedation can be done on everyone. It has the following contraindications:
- Children suffering from a congenital heart diseases associated with chronic heart failure
- Severe obesity
- Neurological impairment with poor pharyngeal coordination
- Upper respiratory tract infection
- Obstructive sleep apnea
- Increased intracranial pressure.
What is usually observed/seen when a patient is under conscious sedation?
The characteristics seen in a patient who has gone under conscious sedation are as follows:
- The patient remains awake and responsive to the verbal commands from the doctor.
- Responsive to pain sensation except in the area under Local anesthesia.
- Protective reflexes of breathing and coughing are intact.
- Cognitive functions are modestly impaired.
What should be checked before the patient is put under conscious sedation?
The doctor shall do a proper medical check up of the patient who has to undergo the procedure of conscious sedation using nitrous oxide and oxygen. The steps are as follows:
- Consent of the patient.
- Proper medical, dental and social history of the patient.
History shall include the following:
- Recent illness in the past
- Recent upper respiratory tract infection
- History of asthma.
- Medication taken by the patient.
- Allergies to drugs.
- Previous sedation experience.
Physical examination :
- Airway obstruction
- Heart rate
- Blood pressure
- Respiratory rate
- Categorize the patient by the ASA chart.
What is the ASA ( American Society of Anesthelogists) chart?
It is the physical health chart that categorizes patients into four categories which helps doctors to know whether sedation will be possible in them are not.
What care should be taken by the patients?
Dr. Rajat Sachdeva suggests, steps can be broadly classified into before and after.
BEFORE:
- That you shall carefully read and listen to the instructions given to you to follow before and after the procedure.
- Fasting is usually not required before conscious sedation, but if your dentist has recommended you to fast then you shall follow the instructions. This is mainly asked in patients who have a strong gag reflex and chances of vomiting during the procedure are likely.
- Avoid taking alcohol or large meals on the day of the procedure.
- Patients must be accompanied by someone (responsible adult of the family) for the procedure and should never come alone. They will be responsible for the post sedation care needed for the patient.
- Avoid taking food 2 hours before the procedure.
- Please inform the doctor if there is any change in health on the day of your appointment like fever, cough or cold.
- You shall visit the washroom just before the procedure.
- You shall not wear any make up on the face. You shall wear loose and comfortable clothes.
AFTER:
- After the procedure you should not drive or do any work for the next 18 hours of the day, as you shall feel drowsy and will be recovering from the procedure.
- Do not travel be public transport after the procedure.
- Do not drink alcohol for the rest of the day.
- Contact your dentist immediately if there are any problems.
- What are the advantages of oral sedation?
- Oral sedation is the procedure of giving sedatives by the oral route or the mouth. The advantages of the procedure are as follows:
- Easily administered to the patient.
- Less technique sensitive
- Cost effective.
- Great patient acceptance
- Non invasive
- What are the disadvantages of oral sedation?
- Different onset of action on different patients
- Inability to titrate reliably
- Excessive effect and duration in elder patients
- Less successful in young patients.
What are the advantages and disadvantages on parental sedation?
Advantages-
- it can be titrated as required.
Disadvantages-
- Special instruments required.
- Special training required.
- Not cost affective.
