Oral and intravenous sedation

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During the past several years sedation has become less of an exception, and more of a rule when it comes to more complicated procedures at our dental practice. Patient’s requests influenced this development in practice more than anything else, because for the patient lack of pain was always in the first place, while the dentist always puts patient’s responsiveness in the first place.

We distinguish two types of sedation – oral and intravenous.

During the sedation achieved by pills, that is orally, no preparation is needed, nor the presence of an anaesthesiologist. Patient gets one or two sedative pills (Lexilium, Bensedin or simir) one hour before the intervention, which helps relax the patient psychologically and make him handle any dental intervention easier. Patient sedated like that isn’t nervous during the procedure, which makes the dentist job easier to a certain extent. With an oral sedation a local anaesthesia is obligatory given, as for any dental procedure, and this form of sedation is the most practical for smaller interventions, and for patients that have problem enduring long dental procedures and have a fear of the dentist. That is why oral sedation is primarily a psychological instrument, while an intravenous sedation at the same time has that function, but also a classic function of sedation – partial or complete lulling of the patient so that he won’t feel any pain.

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Intravenous sedation is accomplished with the help of an anaesthesiologist..This type of sedation is recommended for bigger surgical and implant interventions, as for grinding a larger number of teeth during facets installation and bridges crafting.

Intravenous sedation starts by taking the patient’s anamnesis, meaning a detailed talk between the patient and anaesthesiologist about patient’s health condition. With the intravenous approach the patient is brought into sedation around 15 minutes before the actual surgical intervention. Patient is then given a local anaesthesia and intervention commences. Patient is in half-aware, half-awake state throughout the whole procedure. Half-awake condition is always a primary choice relative to the total sedation because it enables communication between the patient and the dentist/ anaesthesiologist.

Seeing that the anaesthesiologist is by the patient’s side throughout the whole procedure, he constantly doses the sedation’s presence, so that he can put the patient in the state of complete sedation or to bring him back in the half-awake state, depending on the need. Patient will have little or none recollection of the procedure after it is done, starting from the moment he received the sedative, and the procedure can last for several hours. This is very important for anxious patients for which a procedure with just a local anaesthesia can be carved in the memory in a negative way up to that point that the next time the patient will have a hard time opting for any dental procedure, let alone a complicated one.

During the actual intravenous sedation, the patient receives strong painkillers also, drugs against swelling and antibiotics, which means that the patient won’t need additional medicaments after the procedure.

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Still, the patient is mildly disoriented in most cases, for which it is necessary to secure an accompaniment while leaving the clinic. Some patients will feel a drop in attention, disorientation or other smaller mental difficulties, although a lot of patients inform us the next day that they didn’t have any difficulties. That usually applies for the patients that are physically strong, or used to sedatives in a certain amount. Although, however the patient feels, he shouldn’t operate a motor vehicle for 24h.

Both types of sedations are completely safe, although, as we mention, the intravenous method needs to be “greenlighted” by an anaesthesiologist, which will make the assessment if the patient is healthy enough to pass through an intravenous sedation safely. The price of intravenous sedation is 250€ for the introduction to sedation, plus 100€ for every additional hour. For example, the installation of four teeth implants requires around two hours of working, including the introduction to sedation and gradual awakening, so the price in that case is 300€. All the medicaments that the patient receives during sedation are included in the price. When it comes to oral sedation, the patient pays only for the price of the drug in a pharmacy.

Patient arrived with a great fear of the dentist and a desire to install implants. In agreement with the patient we have decided that the intervention gets conducted under an intravenous sedation with the presence of anaesthesiologist. Her experience was great thanks to the actual sedative that is given during intravenous sedation, the patient doesn’t have the memory of the actual intervention.