Dr. Irfan (Ivan) Atcha

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Consumer Guide on Sedation & Sleep Dentistry

The Purpose of this Guide The latest trend in the field of dentistry is the use of sedation to better enable some patients to receive dental treatment. This is a great development for patients and dentists alike: Patients who may not have otherwise received care can get care and dentists are able to provide care more easily. But with Hundreds of dentists now advertising Sedation and Sleep Dentistry, many people have questions. This guide is intended to provide comprehensive information on all sedation modalities used in dentistry so that you may better understand your options and choose the one that is right for you.

What Is Sedation Dentistry? What Is Sleep Dentistry?

Sedation is a continuum, or journey, if you will, that starts from a point of being awake and progresses to a state of decreased anxiety and then drowsiness before reaching a state of being totally asleep. Sedation dentistry refers to all sedation modalities that are used during dental treatment.

It can be sub-divided into two groups: “Conscious Sedation Dentistry?and “Sleep Dentistry.? Conscious Sedation Dentistry refers to the sedation range in which you are awake and aware. Sleep Dentistry refers to the sedation range in which you are asleep and completely unaware.


Simply put, the difference between the two groups is that some modalities are not meant to produce sleep and some do produce sleep.

There are different modalities, or methods of achieving these states of sedation, and choosing the one that is right for you involves considering the following factors:

Which method do you prefer are you most comfortable with?
Which is most appropriate for your safety and health?
Which can best accommodate your treatment plan?

Making these choices can be likened to determining a vacation plan in that some of the first questions to be addressed include:

Where do you want to go?
How do you want to get there?
How long do you want to stay?

Relaxed, less aware
No pain, taste,
sound or memory
General Anesthesia No pain, taste,
sound or memory
(laughing gas)
Oral conscious
Sedation (pills)
  I.V. Sedation   General Anesthesia
ADMINISTERED BY: General Dentist General Dentist   General Dentist & possibly an
General Dentist & possibly an
Anesthesiologist, usually in Hospital.
M.D. involved in managing case
Minimal fear or anxiety Mild Fear
Mild gag reflex
Shorter case
  Moderate to severe fear
Conditions as treated with Oral Conscious Sedation,plus:
Down Syndrome Autism
Developmentally disabled
Cerebral palsy
Severe gag reflex
Difficulty getting numb
Shorter treatment plans
Severe fear or phobia
Medical conditions as treated with I.V. Sedation,plus:
Complex medical condition
Combative or non-compliant
Morbidly obese
Need for extensive and/or complex
treatment, involving more than
one specialist
Allergy or intolerance to local
Longer treatment plans

Age 18-65

Healthy patients

Age 18-65

Healthy patients
high blood pressure, controlled
Diabetes, controlled

Age 2-8

High blood pressure, controlled heart disease,stable Diabetes,controlled Cancer Bleeding disorder Smoking Asthma high cholesterol obesity Bulimia History of drugs abuse Psychiatric Conditions

All ages,including over age 80

Taking more than 4 medications High blood pressure, uncontrolled Heart disease,significant Angina Recent heart attack or Stroke Congestive heart failure Arrhythmias Respiratory conditions, significant Diabetes, uncontrolled liver disease Seizure disorder.

PLANNING Can drive after treatment
No dietary restrictions
Must have a responsible
companion present to take you
home. Take on an empty
Must have a responsible companion
present to take you home.
No food or drink for 8 hours prior to
Must have a responsible companion
present to take you home.
No food or drink for 8 hour prior to appointment


The Four Methods of Sedation Dentistry

1: Nitrous Oxide (“Laughing Gas?:

Nitrous oxide is a gas that helps decrease anxiety and allows you to feel more relaxed when inhaled. It is administered through a small rubber inhaler placed over your nose. The recovery time is very short, and the effects pass within minutes, so you will be able to drive yourself home. Nitrous oxide is best used for patients with mild anxiety and a short, uncomplicated dental treatment.


Nitrous Oxide helps to reduce mild anxiety.

2: Oral Conscious Sedation (Pills):

This method involves taking a pill about an hour before your treatment, which makes you feel relaxed and drowsy. You will, however, remain awake and be able to interact with and respond to the dentist. The sedative effects can last for up to four hours. The most commonly used oral conscious sedation medications are Halcion or Valium.

Ultimately, the goal of oral conscious sedation is to !nd a balance where you are relaxed, but not asleep. The disadvantages to oral conscious sedation relate to the difficulty in controlling and measuring the level of sedation, because the medications do not take immediate effect, vary in their efficacy from one person to another, and their impact can last for hours. For this same reason, the level of sedation cannot be increased or decreased quickly.
To prepare for oral conscious sedation, you should not eat or drink for at least 6 hours prior to your appointment, and you must have a responsible companion present to take you home. If your treatment plan calls for a lot of dental work to be done, you will likely need multiple appointments. If you are a person in good overall health, with mild anxiety to dental treatment, oral conscious sedation may be a good choice for you. Oral Conscious Sedation helps to reduce mild anxiety.

3: Intravenous (I.V.) Sedation:

I.V. sedation produces a lowered level of consciousness so that you may undergo dental treatment while asleep. I.V. sedation is fast-acting, taking effect in approximately 1 minute, and can be controlled to increase or decrease your level of sedation safely and precisely. If you are afraid of receiving dental treatment, you will not have to “get over?your fear by the time of your appointment, because you will sleep through your treatment. When you receive I.V. sedation during your dental treatment, you will feel no pain; you will not hear, smell or taste anything, and you will have no memory of the procedure. This modality is predictable, comfortable, and ensures that your dental treatment can be easily completed. The recovery is simple and quick.

To prepare for I.V. sedation, you should not eat or drink after midnight the night prior to your appointment, and you
must have a responsible companion present to take you home. If you are a person in good overall health, with moderate to severe fear, or with a disability, I.V. sedation may be a good choice for you. You may also want to consider I.V. sedation if you have a lot of dental work that you would like to have completed in one visit.

I.V. Sedation is Sleep Dentistry.


4: General Anesthesia:

General anesthesia produces a state of unconsciousness wherein you are completely asleep during your treatment. It is typically performed in a hospital by an anesthesiologist. General anesthesia is fast-acting, taking effect in approximately 1 minute, and can be controlled to increase or decrease your level of sedation safely and precisely. If you are afraid of receiving dental treatment, you will not have to “get over?your before your appointment, because you will sleep through your treatment. If you have special needs ?physical or mental disabilities, are in recovery from an addiction, or have a complex medical condition, general anesthesia may be the safest option for you. When you receive general anesthesia during your dental treatment, you will feel no pain; you will not hear, smell or taste anything, and you will have no memory of the procedure. This modality is predictable, comfortable, and ensures that your dental treatment can be easily completed. The effects can last for several hours and many patients safely return home within 2 to 4 hours after their treatment is complete. In the interests of safety, patients who have had very extensive dental work or who have complex medical conditions may be admitted overnight for observation or to receive assistance with any post-operative concerns.

To prepare for general anesthesia, you should not eat or drink after midnight the night prior to your appointment, and you must have a responsible companion present to take you home. General anesthesia is typically the best modality for patients who: are highly anxious and phobic; are not physically or behaviorally able to cooperate with the dentist; have special needs or a medical condition that places them at risk. It can also be the ideal method when multiple procedures need to be accomplished in one visit.

General anesthesia is also Sleep Dentistry.


How to Choose a Sedation or Sleep Dentist

As you now know, there are several sedation options available for people requiring dental treatment. After you've determined which modality is best for you, it's time to find a dentist who offers it. Bear in mind that few dentists offer every option: Most dentists today offer nitrous oxide, some dentists offer oral conscious
sedation, even fewer dentists offer I.V. Sedation, and only a handful offer general anesthesia.

To return to our trip analogy, let's say you've decided to take a train. Now that you know where you want to go (your “sedation destination?, you are ready to determine which train can get you there. Which stop is your sedation destination? Does your dentist “go there? If you are unsure which sedation modality is right for you, your best bet may to consult a dentist who offers every option and who can make a recommendation that is specific to you. A dentist with limited sedation offerings may be more likely to make a ecommendation based on what is offered at his/her office.

“If the only tool you have is a hammer you treat everything like a nail.?/h1>


Myths and Facts about Sedation and Sleep Dentistry


Myth: Sedation Dentistry is the same as Sleep dentistry.
Fact: Sedation Dentistry is not the same as Sleep Dentistry.

Sedation Dentistry refers to dental treatment combined with the use of any sedation modality, and includes both conscious (awake) and unconscious (asleep) sedation options. Sleep Dentistry refers to dental treatment that is combined solely with the sedation modalities that produce an unconscious state ?I.V. sedation and general anesthesia. Why is this distinction important? There are a lot of advertisements that make this terminology confusing. Ads such as “wake up to a new smile? “snooze through your appointment? “sleep through your dental treatments? and “you will be in a sleep-like state?can be misleading because they appear to refer to Sleep Dentistry and imply you will be asleep.

The most commonly advertised modality of sedation dentistry is oral conscious sedation. Although pills like Halcion or Valium can reduce your anxiety and make you feel more relaxed, a pill should not put you to sleep. You will still be awake and aware, and you will hear the dental drill along with other sights and sounds of the dental office. Because a pill will not allow you to sleep through your dental treatment, some states have made it illegal to advertise oral conscious sedation as “sleep dentistry? If you are seeking Sleep Dentistry, make sure that is what is really being offered. Do your research, and read the !ne print.

If you don’t want to be awake and aware of what is happening
in your mouth, you want to be asleep!


Myth: Dental fear, anxiety and phobia can all be treated the same way.
Fact: Dental fear, anxiety and phobia are different, and should be treated accordingly.

Depending on what article you read, anywhere from 15% to 50% of Americans do not receive adequate dental care because they are afraid of the dentist. Such fear is typically a matter of degree, as follows: Fear: Fear is a normal human emotional reaction characterized by apprehension or a state of alarm ?it is a built-in survival mechanism with which we are all equipped. Anxiety: The physical and mental tension of anxiety is very similar to a state of fear but with one important difference ?the feeling is based on the anticipation of danger or of something bad that could happen, and not on clear and present danger.

Phobia: A phobia is an intense, unreasonable fear of a thing or a situation. The associated distress and angst usually lead a phobic person to avoid the object or situation they fear.

Why is this distinction important? A person who has fear or anxiety can usually tolerate dentistry with a mild form of sedation such as laughing gas or pills. They may not look forward to the experience, but treatment can be tolerated with a lower level of sedation. A person with a phobia, however, has so much apprehension that just thinking about dental treatment may cause them to avoid even simple preventative maintenance (like professional cleanings by a dental hygienist) for years.

Phobic patients are often caught in a vicious cycle ?they avoid preventative maintenance, which eventually leads to decay, even with the most meticulous at-home dental hygiene. Over time, the decay worsens and leads to pain and discomfort, which creates more fear and anxiety. Thus the cycle of fear and avoidance of care continues.
Treating a phobic patient requires not only that a dentist and staff understand the phobia, but also that they provide
an environment and plan for the sedation modality that best demonstrates the understanding of that distress ?Sleep Dentistry.


Phobic patients often have a “reservoir of courage? that is almost empty. It is important to provide the necessary care in as few visits as possible.


Myth: You must overcome your fear, anxiety or phobia to receive dental treatment.
Fact: You do not need to overcome your fear, anxiety or phobia to receive dental treatment.

Why is this important? It may take years of therapy to resolve your dental anxiety or phobia, and you will most likely require dental care before that time. The longer you go without dental care, the higher the likelihood that you will incur such problems as bad breath, broken teeth, cavities, gum disease and pain. By not keeping up with “preventive maintenance,?you run the risk of increased time, pain and cost of treatment down the road, along with the need for more advanced procedures to get you back on track, like extractions and implants or root canal treatments. Bacteria in your mouth can create long-lasting infections and chronic inflammation, which may contribute to the development of heart disease; make diabetes harder to control; increase the risk of stroke, pneumonia or respiratory problems; and in pregnant women, increase the risk of having a pre-term, low birth weight baby. An unhealthy mouth can also have an adverse effect on proper nutrition, intimacy with others and self-esteem. But you don’t have to avoid dental care, or even get up the courage to face it ?you can sleep through it! Sleep dentistry provides the opportunity for you to receive your dental care with; No pain, No smells, No taste, No sounds, No sensation, and No memory of the procedure.

No matter how severe, you do not need to overcome
your fear to receive dental treatment.


Myth: People with special needs cannot receive dental treatment unless they can cooperate with the dentist.
Fact: People who are unable to physically or mentally cooperate with the dentist can ?and should! –receive dental care.

Why is this important? Patients with disabilities often require accommodations that are not available at a typical
dental office, and it is important that a dentist and staff understand the limitations and medical considerations for a
specific disability. For example, a person with cerebral palsy may not be able to remain still, and a person with autism may not understand why it is important or how to cooperate with the dentist. Though a few people with special needs may be able to use conscious sedation, many will need to be asleep for their dental treatment. This assures not only that they can receive their treatment safely, but that it can be done completely.

When you are seeking a dentist to treat your loved one with a special need, and an offce that offers all the sedation
options. That way you can be sure that the dentist will not try to force a sedation modality onto your loved one simply because it is the only option he/she offers.

Choose a dentist who offers the complete range of sedation modalities to ensure you accommodate your loved one’s needs, not the dentist’s.


Questions You Should Ask a Dentist

There are a few more questions you should ask to determine if a dentist is right for you:

Q: Does the dentist routinely treat patients with conditions or circumstances similar to yours? If they answer “yes? ask how often ?daily, weekly, monthly, or only occasionally?

A: If you are a person with dental anxiety or phobia, you will want to know that the dentist and his/her staff are
accustomed to your fears, knows how to work with you, and does not make you feel ashamed or embarrassed if
you haven’t received care for quite some time.

If you or your loved one has a special need, it is important that the dentist you chose understands the complexities
of your condition and has the skills to manage your treatment safely and appropriately. You should also ask if
the dentist uses restraints such as a “papoose board?as a means for eliciting cooperation.

Q: If you choose Sleep Dentistry, ask who administers I.V. Sedation at their office ?the dentist or an

A: When you receive any type of sedation, someone who is appropriately trained and licensed must monitor the
medications administered, the sedation level achieved, vital signs and adverse effects and must be trained for

Some general dentists have qualification permits to administer I.V. Sedation. In this case, you will need to decide
what your comfort level is for having the dentist monitor the results of your sedation while working on your delicate
tooth structures. Safety should be your biggest concern when undergoing any type of medical procedure,
and dentistry is no different.

When an anesthesiologist is present, he/she is dedicated solely to monitoring your well-being while the
dentist works.

Q: Does the general dentist partner with other dental specialists?

A: Just as a general dentist possesses skills to address specific needs, so do other dental specialists. For example, an endodontist specializes in performing root canals and a periodontist specializes in treating diseases of the supporting tooth structures. Each dental specialist has very speci!c training and experience in their chosen field. If the dentist does work with other dental specialists, ask: Does the dentist coordinate the services of any required specialists for you?
Can your schedule accommodate multiple appointments at different offices?
If you need to have multiple procedures completed in one appointment, can the dentist make that happen?

Q: Do you feel comfortable with the dentist’s experience, personality, and approach to you?

A: Does he/she listen to your concerns? Does he/she take into consideration your lifestyle, limitations and personal desires? Do they take a holistic approach, considering the health and function of your body as well as your mouth?

The Next Step

Sedation Dentistry is a major breakthrough for those who may have avoided traditional dental care in the past due to a disability or fear of dental treatment, among other reasons. Now that you have a better understanding of what Sedation Dentistry is - and how it differs from Sleep Dentistry - you can better assess which modality is best for you, or your loved one.


This consumer guide has been provided courtesy of the The Center for Implants,Sedation and Cosmetic Dentistry. We hope you !nd it helpful and educational.

The definitions and options reviewed within this guide are for informational purposes only and are not intended to replace consultation with or the recommendations of a professionally licensed dental practitioner.

The Center for Implants, Sedation and Cosmetic Dentistry is a private practice dedicated to serving the phobic, disabled and medically compromised communities by providing definitive full-mouth rehabilitation under general anesthesia and I.V. sedation, and is nationally known for their One-Sleep-Visit?Total Dentistry Method.

To learn more about the unique services provided by The Center for Implants, Sedation and Cosmetic Dentistry , please visit www.BestIndianaDentist.com or call us at 1-(888) 416-4109

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