Appletree Dental Care’s sedation service is ideal for patients who may be anxious or fearful when it comes to a visit to the dentist. This page aims to explain the sedation process in detail and to answer the queries you may have.

COST

Many of our treatments can be carried out under sedation for an additional cost of between £120 to £200 per session.

When a drug, usually of the anti-anxiety variety, is administered into the blood system during dental treatment, this is referred to as Intravenous Conscious Sedation (aka “IV sedation”).

This page answers the most common questions regarding conscious IV sedation.

WHAT DOES IT FEEL LIKE? WILL I BE ASLEEP?

You may not remember much about what went on because of two factors: firstly, in most people, IV sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on.

Secondly, the drugs used for IV sedation can produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off.

As a result, time will appear to pass very quickly and you will not recall much, or perhaps even nothing at all, of what happened. So it may, indeed, appear as if you were “asleep” during the procedure.

IS IT STILL NECESSARY TO BE NUMBED WITH LOCAL ANAESTHETIC? WILL MY DENTIST NUMB MY GUMS BEFORE OR AFTER I’M SEDATED?

The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added, see below for a more detailed discussion), but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.

If you have a fear of injections, you will not be numbed until the IV sedation has fully kicked in. If you have a phobia of needles, you will very probably be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (i.e. until you’re numb) before starting on any procedure.

HOW DOES THE DENTIST KNOW WHETHER I’M NUMB?

You check the local anaesthetic has worked by asking the patient. Just because you are sedated doesn’t mean you can’t answer.

HOW IS IV SEDATION ADMINISTERED?

A Venflon “Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand. This needle is wrapped up with a soft plastic tube.

The needle makes the entry into the vein, then is slid out leaving the soft plastic tube in place. The drugs are put in through that tube. The tube stays in place throughout the procedure.

WHAT DRUGS ARE USED? ARE THERE DIFFERENT TYPES OF IV SEDATION?

MIDAZOLAM AND DIAZEPAM
Mostly the drug used for IV sedation is a short acting benzodiazepine, or “benzo” for short. This is an anti-anxiety sedative. IV administered benzos have 3 main effects: they reduce anxiety/relax you, they make you sleepy, and they produce partial or total amnesia (i. e. make you forget what happened during some or, less frequently, all of the procedure). Total amnesia is more common with midazolam compared to diazepam (see below).

IS IT SAFE? ARE THERE ANY SIDE EFFECTS?

IV dental sedation in Scotland is EXTREMELY safe when carried out under the supervision of a specially-trained clinician, as we have at Appletree Dental Care.

However, contraindications include pregnancy, known allergy to benzos, alcohol intoxication, CNS depression, and some instances of glaucoma. Cautions include psychosis, impaired lung or kidney or liver function, and advanced age. Heart disease is generally not a contraindication.

WHAT ARE THE MAIN ADVANTAGES OF IV SEDATION?

IV sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”.

The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulty with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.

Can be ideal for those with a phobia of dental injections.
Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions, and there is no airway tube involved.

ARE THERE ANY DISADVANTAGES?

A needle has to be put in the arm or hand (“venipuncture”).
It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood).

While IV sedation is desired precisely because of the amnesia effect (i.e. forgetting what happened while under the influence of the drug/s), there can be a downside to this: if you can’t remember that the procedure wasn’t uncomfortable or threatening, you can’t unlearn your fears.

Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.

You should WANT to be sedated. If, for any reason, you’re unwilling to “let go”, for example because you don’t like not being in control, it will be more difficult to be successfully sedated.

AFTER IV SEDATION

Have your escort take you home and rest for the remainder of the day.
Have an adult stay with you until you’re fully alert.
Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.

Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e.g. liquids and toast.

If you experience nausea, lie down for a while or drink a glass of coke.
Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.

Take medications as directed by your dentist.
If you have any unusual problems, call your dentist.