IV Sedation Dentistry compared to Oral Sedation(pills)

Dr. Bill Thompson | August 19, 2011

IV Sedation VS. Oral Sedation : The real story

I had a patient in yesterday who had asked for IV sedation for her dental appointment. Suzie (not her real name) needed a root canal treatment and four crowns and was pretty nervous. This is the type of patient that I took my IV sedation dentistry training for-she would like to not be aware of what was being done or remember her time in our Columbus dental office.

Suzie and I chatted for a bit and I started her IV uneventfully in about five seconds. I prepared the IV drugs and began with the starting dose.

The beauty of IV sedation is that it is very precise in the sedation level for the patient and it works within seconds. If the patient is still alert after a standard starting dose, we administer enough additional medication to ensure that the patient is comfortable. The other nice thing is that with IV sedation, we have the drugs to reverse the effect of the sedation drugs if the need arises.

Comparing IV Sedation Dentistry to Oral Sedation

The problem with oral sedation is that the dosing is based on averaging and largely on guesswork. Also, if the first dose is inadequate to get the patient comfortable, to administer more oral drugs is unsafe, and is illegal. The other problems are that it takes an unpredictable amount of time for it to work and the drugs are not readily reversible (unless you start an IV!).

So after the initial starting dose, Suzie and I were still chatting away. I carefully added additional meds until she really was comfortable, but it took enough that the dosage could not have ever been predicted with oral sedation dentistry. If fact, I reflected on the situation that if she had been given oral sedation, the drugs would have had almost no effect after waiting 30 minutes to an hour to work. The only options would have been to have the patient come back and try a stronger dose (guesswork again) or to proceed with the dental treatment without adequate sedation, something no one wanted and would have totally wasted Suzie’s time.

To summarize, Suzie’s treatment went smoothly and she will have a nice result. She commented that she had awakened a couple of times. When that happened, it was not that she was startled awake, but had simply slipped into a more conscious state. We were monitoring Suzie’s sedation level and simply gave her a little more sedative to make her relaxed again. Working with IV sedation makes for a very pleasant experience for the patient, and gives me the satisfaction of having provided a very comfortable experience for my patient.