How It’s Done: Sedation Dentistry vs. Sleep Dentistry

Posted on October 30th, 2020 at 1:23 PM
How It’s Done: Sedation Dentistry vs. Sleep Dentistry

In previous blog posts, we’ve defined sleep dentistry as distinct from sedation dentistry, in that it refers to procedures performed under dental general anesthesia. General anesthesia is a state of total unconsciousness; you cannot awaken from it until its effects are reversed or wear off, and involuntary processes like breathing are controlled by a certified anesthesiologist during the procedure.

Dental sedation is not so absolute. Most patients retain some level of consciousness and they can maintain vital functions independently, although some higher cognitive functions like speech and memory might be impaired. Even with deeper sedation, it is still possible to rouse the patient, although it may require an especially strong stimulus to do so. That is not the case in true sleep dentistry under general anesthesia. 

Breaking down sedation

Now that we’ve recapped, let’s look into how dental professionals induce these effects. Sedation can be administered in one of three ways.

  1. Inhaled sedation: Nitrous oxide (aka “laughing gas”) is delivered via a nasal hood as you continue to exhale through the mouth. Nitrous oxide does a few things for you physiologically — it blocks neurotransmitters that cause anxiety; it stimulates norepinephrine production (dulling your body’s pain signals), and it lights up the pathway for dopamine release (one of your “happy” brain chemicals). It has few adverse side effects, takes effect, and wears off quickly, and dosages can be adjusted easily on the fly. 
  2. Oral sedation: The patient takes a pill an hour before the dental procedure, with the sedative effect ranging from mild to moderate depending on the dose. The medication you will be prescribed belongs to a class of drugs called benzodiazepines, which are used to treat anxiety and insomnia — most commonly Halcion (triazolam) or Valium (diazepam).
  3. Intravenous sedation: Sedatives are delivered directly into the bloodstream to quickly affect relaxation and/or drowsiness. You may be in a twilight state or fall asleep completely during this process.

general anesthesia and sleep dentistry

Elements of general anesthesia

Sleep dentistry, or general dental anesthesia, utilizes any combination of intravenous or inhaled medications. The medications fall into three categories:

  1. Analgesics: These drugs either suppress or eliminate your body’s pain response.
  2. Amnesia-inducing: Result in temporary memory loss and/or unconsciousness.
  3. Muscle relaxants: Relaxes muscles of the windpipe for intubation; crucial for supplying oxygen during the procedure and protecting lungs from blood and fluids. 

Research into anesthetics is ongoing, but it is believed they target proteins in cell membranes that affect neurotransmission and communication. In any case, carefully balancing these medications and avoiding dangerous interactions is the essential work of a certified dental anesthesiologist (such as Dr. Kevin Mahoney), who will also constantly monitor heart rate, blood pressure, body temperature, breathing, and fluids during the procedure. 

Although it may seem like a lot to juggle, not to worry! General anesthesia is extremely safe, with a 99.97 percent success rate. If you or a loved one could benefit from sleep dentistry, do not hesitate to give our offices a call.