Sleep dentistry, or intravenous sedation, is a very safe, highly effective way to make your visit a relaxing, sleepy and comfortable experience. It is also known as twilight sedation or twilight anaesthesia.
What is IV sedation and what are the benefits?
A combination of intravenous anaesthetic, sedative and pain relieving medications is administered to create a very sleepy and pleasant dream-like state for the whole procedure so that you will be relaxed, comfortable and unaware of your surroundings while still maintaining the ability to breathe on your own, move and able to obey commands. The vast majority of people have no memory of the procedure. Memory before and after IV sedation is usually not affected. Patients often comment that the whole procedure has passed in only a few minutes when in reality it may have been several hours. Intravenous sedation also allows patients to avoid the risks, cost and time involved with having a general anaesthetic. It allows your dentist to care for you at their clinic and is safer, allows you to recover quickly and has minimal side effects compared to undergoing a general anaesthetic.
Who can have IV sedation?
Intravenous sedation is available and very effective for any dental procedure. It is suitable and extremely safe for most people. No procedure is too small for IV sedation. Intravenous sedation is beneficial for patients who:
Have anxiety or fear/phobia or are nervous about dental procedures or avoid going to the dentist
Have had traumatic or negative dental experiences in the past
Require complex, multiple, extensive or long dental treatments
Dislike needles, drills, pain/discomfort, sights, sounds/noises, tastes or smells associated with their dental procedures
Have sensitive teeth or gums
Require removal of wisdom teeth, teeth extractions, dental surgery/oral surgery, dental implants, root canal treatment, fillings, periodontal or gum treatments, crowns and bridges, full mouth restorations, bone grafts, All on 4, emergency procedures, and so forth
Have limited time and wish to undertake their dental procedures in one appointment instead of multiple appointments
Are uncomfortable with dental treatments
Have difficulty feeling numb with local anaesthetic injections
Have a strong gag reflex
Find it difficult to keep their mouth open or have jaw problems
Feel embarrassed about the condition of their teeth
Find it difficult to sit still in the dental chair
Are anxious, fearful or nervous about injections/needles or who have a low-pain threshold
How is IV sedation performed?
You will be continuously monitored with all the Australian and New Zealand College of Anaesthetists (ANZCA) recommended standard hospital grade full monitoring along with intravenous fluids as well as 100% oxygen therapy available via nasal prongs during the entire intravenous sedation and dental procedure.
An advanced programmable syringe driver, routinely used in all hospital theatres in Australia, will administer an accurate and continuous infusion of intravenous anaesthetic, sedative and pain relieving medications via a small IV cannula/drip placed in your arm or hand. The intravenous medications work quickly and are very effective and you will drift off into a relaxed, sleepy and pleasant dream-like state and you will be comfortable and unaware of your surroundings and the vast majority usually have no recollection of the procedure.
Local anaesthetic and/or any nerve blocks(for intra-operative and post-operative pain relief) are only administered once intravenous sedation is working so that there is no awareness and no memory of the needles or dental procedure in the vast majority of patients.
The comprehensive continuous patient monitoring performed (which includes end tidal CO2 levels(EtCO2), respiratory rate and pattern, oxygen saturation (SaO2), blood pressure, pulse/heart rate and rhythm, electrocardiogram(ECG) as well as anaesthetic medication levels monitoring) allows the anesthetist to accurately adjust and titrate the intravenous medications to the appropriate level required throughout the dental procedure. Although intravenous sedation is extremely safe, there will still be emergency and resuscitation medications and equipment available in the clinic in accordance with the Australian and New Zealand College of Anaesthetists(ANZCA) recommended guidelines.
Are there side effects?
Side effects and complications are rare with IV sedation. A very small minority of patients have dream-like recollections of the experience and can recall features of the clinic or verbal conversations but these are not distressing. IV sedation is generally very well tolerated and side effects/complications are rare and are more infrequent than compared with general anaesthesia. Transient minor side-effects can include dizziness and nausea. Intravenous anti-nausea medications are also given prophylactically so the risk of nausea is extremely low.
Are there any contraindications to IV sedation?
The relative contraindications or conditions where intravenous sedation should be ideally performed in a hospital setting instead of in a dental clinic include the following:
Paediatric patients younger than 15 years old
Significant/Severe Obstructive Sleep Apnoea(OSA)
Morbid Obesity with BMI > 40
Diabetic patients on Insulin
Unstable severe medical conditions
Symptomatic, severe or unstable cardiac or respiratory conditions