We Bring State of The Art Dental IV Sedation
Our IV sedation services offers you the opportunity to practice dentistry and focus on your procedures without the worries associated with dental anaesthetic management. Grow Your Practice And work more efficiently, provide maximum comfort, and safety to your patients, while you offer more extensive procedures during a visit. Collaborating and Planning with Our Team We will perform a pre-assessment and health history analysis for each patient and review the information with you and the patient prior to the scheduled appointment. We will also provide the patient with detailed pre-operative and post-operative instructions for dental anaesthesia recovery. Our team will provide your patient with the utmost attention and care through this process. Advanced Technology In Dental IV Sedation Matters With advanced anaesthesia techniques, current medications, and full monitoring equipment, we will prepare and monitor your patients throughout the entire dental procedure. Moderate Dental IV Sedation (Conscious Sedation) Moderate IV Sedation is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. Patients will feel drowsy and sleep through the procedure, and may or may not remember being in the procedure room. We will continually monitor vital signs, including heart rate, blood pressure and oxygen levels, which will be watched closely. |
Pain Management
The management of pain in dentistry encompasses a number of procedural issues, including the delivery of anaesthetic and the management of post procedural pain, as well as pain diagnosis, management strategies for oro-facial conditions that cause pain in the face and head, and the management of pain in special populations. Given the extensive nature of the topic, this article reviews pain definitions and mechanisms, acute versus chronic pain, and focuses on management strategies related to anaesthetic delivery and the control of pain following dental procedures. Dental Patients with Special Requirements
We provide IV sedation for patients with special considerations. Our expertise in IV sedation and anaesthesia enables us to choose the best protocol for each patient, so that you can work comfortably and without the risks that often exist with certain types of patients:
We can delivery different capabilities based on special requirements and patient needs. Schedule an introductory call to learn more. |
Introduction to Sedation for Dentists
Most dental patients are able to accept dental treatment with local analgesia and sympathetic management. Some, however, require additional help from a range of techniques, including conscious IV sedation.
This document is intended to provide an informative, but easy-to-read, guide to referring patients for conscious sedation.
It is intended for dental practitioners who are unused to sedation techniques and are presented with anxious or phobic patients whose dental treatment is difficult to complete with behaviour management and local analgesia alone.
Conscious sedation is an important part of pain and anxiety control. The application of conscious sedation techniques to dental procedures can greatly reduce the need for general anaesthesia.
Many practitioners offer various sedation techniques as part of their day-to-day dentistry. Others may choose to refer patients who require conscious IV sedation to practitioners who are both happy to accept referrals and who have the necessary expertise and facilities. This document is designed to assist the referring dentist in patient selection, treatment planning and the referral process.
Definition Conscious sedation is defined as:
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.
The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to respond to verbal commands.
Range of Techniques:
Intravenous sedation with midazolam
Inhalation sedation with nitrous oxide and oxygen
Oral sedation with benzodiazepines
The majority of anxious or phobic patients can be treated with these techniques or a combination of them. Others may respond better with alternative techniques such as:
Intravenous sedation with more than one drug
Intravenous sedation with propofol
Transmucosal sedation (nasal, sublingual)
Some reasons for prescribing sedation:To treat anxious or phobic patients who would otherwise be denied access to dentistry.
To enable an unpleasant procedure to be carried out without distress to the patient.
To avoid general anaesthesia
Selection of patients:
Reasons for anxiety:
Needle phobia
Patients who cannot accept an injection in the mouth can often be persuaded to accept venepuncture. If not, inhalation sedation may be acceptable either to provide sedation for the treatment itself or to provide sufficient anxiolysis to enable venepuncture to be performed. Oral sedation may provide a satisfactory alternative.
Other fears
Fear of “the drill”, sharp instruments and the dental environment can be reduced with conscious sedation.
Pronounced gag reflex
This distressing condition is greatly reduced by inhalation sedation. Alternatively, intravenous sedation may be more effective.
Degree of anxiety
Whilst anxiety scales such as Corah are useful for research, the practitioner needs only assess levels as severe, moderate or mild. Severe anxiety may suggest that intravenous sedation may be more appropriate.
Age
Elderly
Care must be taken in using intravenous sedation for older patients. Age is not a contraindication however as long as the patient is physically fit.
Young
Intravenous sedation with benzodiazepines is not predictable for children and early teenagers. Inhalation sedation can be used for children of any age. Currently there is insufficient scientific evidence in Australia to support the routine use of intravenous sedation for children.
Medical History
A full medical history is required for all patients. This must be recorded and retained with the patient’s records. When sedation is to be considered, special note should be made of the following conditions:
Cardiovascular disease
Respiratory disease
Liver or kidney disease
Pregnancy
Psychiatric conditions
Medication
All drugs that are currently being taken should be recorded., This includes prescribed medication, alternative remedies and recreational drugs. Special note should be made of central nervous system depressants.
There are no absolute contraindications for sedation, apart from allergy to the sedative agent, but relative contraindications may arise from the medical history.
Blood Pressure
Measurement of blood pressure forms an important part of the assessment of the patient for sedation.
American Society of Anaesthesiology Classification of Physical Status (ASA)
Care must be taken in the choice of technique and where it is to be provided, depending on the severity of the patient’s condition. The ASA classification helps when making this decision.
I -Normal, healthy patient
II -A Patient with mild systemic disease
For Example:
Well controlled diabetes or epilepsy
Mild asthma
III -A patient with severe systemic disease limiting activity but not incapacitating
For example:
Epilepsy with frequent fitting
Uncontrolled hypertension
Recent myocardial infarct
IV -A patient with incapacitating disease that is a constant threat to life
V -Moribund patient not expected to live more than 24 hours with or without treatment.
Only patients who fall into the ASA categories I and II are suitable for treatment in general practice under IV Sedation. ASA IV and V are normally hospitalized or bed-ridden and are generally only seeking emergency dental treatment. ASA III patients are best treated in an environment where more experienced support is available. This should be in a hospital based clinic or a sedation clinic where medical support is available.
Dentistry required
Most dental treatment can be performed under conscious sedation, but detailed treatment planning is best left until the level of cooperation under sedation has been determined. Access problems may limit the provision of some procedures. Some dental procedures are sometimes impractical with inhalation sedation due to the presence of mask and tubing.
Attitudes
Discussion with the patient will ascertain whether the aim of treatment is to retain teeth or not. Any recommendations need to be tempered with the possibility that patients’ attitudes may alter once a satisfactory means of providing treatment has been established.
Social background
Sedation requires that patients leave the surgery in the company of a responsible adult escort. If the patient is unable to comply with this instruction, sedation cannot be considered. Exceptions may be made occasionally in the case of inhalation sedation with nitrous oxide and oxygen when, at the discretion of the sedationist, the patient may leave unaccompanied if the patient is medically fit and responsible
Most dental patients are able to accept dental treatment with local analgesia and sympathetic management. Some, however, require additional help from a range of techniques, including conscious IV sedation.
This document is intended to provide an informative, but easy-to-read, guide to referring patients for conscious sedation.
It is intended for dental practitioners who are unused to sedation techniques and are presented with anxious or phobic patients whose dental treatment is difficult to complete with behaviour management and local analgesia alone.
Conscious sedation is an important part of pain and anxiety control. The application of conscious sedation techniques to dental procedures can greatly reduce the need for general anaesthesia.
Many practitioners offer various sedation techniques as part of their day-to-day dentistry. Others may choose to refer patients who require conscious IV sedation to practitioners who are both happy to accept referrals and who have the necessary expertise and facilities. This document is designed to assist the referring dentist in patient selection, treatment planning and the referral process.
Definition Conscious sedation is defined as:
A technique in which the use of a drug or drugs produces a state of depression of the central nervous system enabling treatment to be carried out, but during which verbal contact with the patient is maintained throughout the period of sedation. The drugs and techniques used to provide conscious sedation for dental treatment should carry a margin of safety wide enough to render loss of consciousness unlikely.
The level of sedation must be such that the patient remains conscious, retains protective reflexes, and is able to respond to verbal commands.
Range of Techniques:
Intravenous sedation with midazolam
Inhalation sedation with nitrous oxide and oxygen
Oral sedation with benzodiazepines
The majority of anxious or phobic patients can be treated with these techniques or a combination of them. Others may respond better with alternative techniques such as:
Intravenous sedation with more than one drug
Intravenous sedation with propofol
Transmucosal sedation (nasal, sublingual)
Some reasons for prescribing sedation:To treat anxious or phobic patients who would otherwise be denied access to dentistry.
To enable an unpleasant procedure to be carried out without distress to the patient.
To avoid general anaesthesia
Selection of patients:
Reasons for anxiety:
Needle phobia
Patients who cannot accept an injection in the mouth can often be persuaded to accept venepuncture. If not, inhalation sedation may be acceptable either to provide sedation for the treatment itself or to provide sufficient anxiolysis to enable venepuncture to be performed. Oral sedation may provide a satisfactory alternative.
Other fears
Fear of “the drill”, sharp instruments and the dental environment can be reduced with conscious sedation.
Pronounced gag reflex
This distressing condition is greatly reduced by inhalation sedation. Alternatively, intravenous sedation may be more effective.
Degree of anxiety
Whilst anxiety scales such as Corah are useful for research, the practitioner needs only assess levels as severe, moderate or mild. Severe anxiety may suggest that intravenous sedation may be more appropriate.
Age
Elderly
Care must be taken in using intravenous sedation for older patients. Age is not a contraindication however as long as the patient is physically fit.
Young
Intravenous sedation with benzodiazepines is not predictable for children and early teenagers. Inhalation sedation can be used for children of any age. Currently there is insufficient scientific evidence in Australia to support the routine use of intravenous sedation for children.
Medical History
A full medical history is required for all patients. This must be recorded and retained with the patient’s records. When sedation is to be considered, special note should be made of the following conditions:
Cardiovascular disease
Respiratory disease
Liver or kidney disease
Pregnancy
Psychiatric conditions
Medication
All drugs that are currently being taken should be recorded., This includes prescribed medication, alternative remedies and recreational drugs. Special note should be made of central nervous system depressants.
There are no absolute contraindications for sedation, apart from allergy to the sedative agent, but relative contraindications may arise from the medical history.
Blood Pressure
Measurement of blood pressure forms an important part of the assessment of the patient for sedation.
American Society of Anaesthesiology Classification of Physical Status (ASA)
Care must be taken in the choice of technique and where it is to be provided, depending on the severity of the patient’s condition. The ASA classification helps when making this decision.
I -Normal, healthy patient
II -A Patient with mild systemic disease
For Example:
Well controlled diabetes or epilepsy
Mild asthma
III -A patient with severe systemic disease limiting activity but not incapacitating
For example:
Epilepsy with frequent fitting
Uncontrolled hypertension
Recent myocardial infarct
IV -A patient with incapacitating disease that is a constant threat to life
V -Moribund patient not expected to live more than 24 hours with or without treatment.
Only patients who fall into the ASA categories I and II are suitable for treatment in general practice under IV Sedation. ASA IV and V are normally hospitalized or bed-ridden and are generally only seeking emergency dental treatment. ASA III patients are best treated in an environment where more experienced support is available. This should be in a hospital based clinic or a sedation clinic where medical support is available.
Dentistry required
Most dental treatment can be performed under conscious sedation, but detailed treatment planning is best left until the level of cooperation under sedation has been determined. Access problems may limit the provision of some procedures. Some dental procedures are sometimes impractical with inhalation sedation due to the presence of mask and tubing.
Attitudes
Discussion with the patient will ascertain whether the aim of treatment is to retain teeth or not. Any recommendations need to be tempered with the possibility that patients’ attitudes may alter once a satisfactory means of providing treatment has been established.
Social background
Sedation requires that patients leave the surgery in the company of a responsible adult escort. If the patient is unable to comply with this instruction, sedation cannot be considered. Exceptions may be made occasionally in the case of inhalation sedation with nitrous oxide and oxygen when, at the discretion of the sedationist, the patient may leave unaccompanied if the patient is medically fit and responsible