Sedation dentistry - realistic expectations

[Idiopathic]

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So, I need a lot of little things done (i.e. minor fillings) as well as a dental implant and a chipped tooth repair. Will a dentist work on 10+ teeth in one sitting? If so, are there contraindications to sedation (other than the obvious) and what types of sedation are used? Is it all nitrous and benzos or are there other alternatives? Im sorry for the ignorance, but Im just curious. Lets assume $$$ is no object.

 

[drhobie7]

Propofol GA...it's dreamy. 😴

 

[Idiopathic]

Okay. So that necessitates an anesthesiologist being present right? Again, Im not concerned with cost, as long as I can get everything done at one time. Is this considered 'dangerous' (that many procedures in one sitting) as far as the 'dental code' goes? (or whatever you guys use😉)

 

[drhobie7]

Okay. So that necessitates an anesthesiologist being present right? Again, Im not concerned with cost, as long as I can get everything done at one time. Is this considered 'dangerous' (that many procedures in one sitting) as far as the 'dental code' goes? (or whatever you guys use😉)

Assuming you're a normal, healthy person you can have dentistry done on as many teeth as you want in one appointment, provided your dentist's hands don't cramp up. You don't need any special sedation to do it either. You can get full mouth extractions under local.

 

[Idiopathic]

Assuming you're a normal, healthy person you can have dentistry done on as many teeth as you want in one appointment, provided your dentist's hands don't cramp up. You don't need any special sedation to do it either. You can get full mouth extractions under local.

Okay, Im sure you can. But the whole point is to be sedated 😉

Ive read that 5-6 hours is about the limit for that.

 

[aphistis]

Okay. So that necessitates an anesthesiologist being present right? Again, Im not concerned with cost, as long as I can get everything done at one time. Is this considered 'dangerous' (that many procedures in one sitting) as far as the 'dental code' goes? (or whatever you guys use😉)

Sedation doesn't require an anesthesiologist, just a GP who knows what he's doing. You can go oral, inhaled, or IV, it all depends on the individual doc & what s/he feels comfortable having in his/her office.

You ought to be fine. If they really are "minor" (i.e. small & uncomplicated) fillings, even with the implant it shouldn't take anywhere close to 6 hours. I hope it goes well for you. 👍

 

[Dr. Pedo]

Sedation doesn't require an anesthesiologist, just a GP who knows what he's doing. You can go oral, inhaled, or IV, it all depends on the individual doc & what s/he feels comfortable having in his/her office.

Hey aphistis: It is semantics but "sedation" is a very broad term. Conscious sedation doesn't require an anesthesiologist but does require a license in nearly all states and proper equipment. In fact, American Board of Anesthesiology is currently trying to increase requirements----and basically strip privileges from all unholy. 😀

"Deep" sedation and general do require a dental/medical anesthesiologist or Oral Surgeon (i.e. using ketamine) and obviously for general.

It isn't worth it for most dentists (overhead: insurance, time, training, equipement etc...) to practice conscious sedation dentistry. Although there are many that do--- Oral surg and pedo are typically the DDS's who will use it on a normal basis.

 

[aphistis]

Hey aphistis: It is semantics but "sedation" is a very broad term. Conscious sedation doesn't require an anesthesiologist but does require a license in nearly all states and proper equipment. In fact, American Board of Anesthesiology is currently trying to increase requirements----and basically strip privileges from all unholy. 😀

"Deep" sedation and general do require a dental/medical anesthesiologist or Oral Surgeon (i.e. using ketamine) and obviously for general.

It isn't worth it for most dentists (overhead: insurance, time, training, equipement etc...) to practice conscious sedation dentistry. Although there are many that do--- Oral surg and pedo are typically the DDS's who will use it on a normal basis.

I'm not going to disagree with you that a lot of general dentists are uncomfortable doing sedations in their office, and obviously GA will require an anesthesiologist, but I'm sticking to my claim that oral & IV sedations don't. For example...

New York: http://www.op.nysed.gov/dentanes.htm#educ

Missouri: http://pr.mo.gov/boards/dental/seda...arenteral_conscious_sedation_requirements.pdf

South Dakota: http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=20:43:09:04

You may well be right that some states are more restrictive in their laws; but it's not a universal requirement by any stretch of the imagination.

 

[drhobie7]

To the OP: why don't you just get N2O for the 6 hrs or whatever it takes. You'll be flying high and can still drive home afterwards.

 

[Idiopathic]

To the OP: why don't you just get N2O for the 6 hrs or whatever it takes. You'll be flying high and can still drive home afterwards.

No problem. If I can have 6 hours of drilling/filling/pushing/pulling/poking etc. and not be terribly uncomfortable (i.e. more than just local) then great!!

What about versed and N2O?

 

[DrJeff]

Okay this naswer is from a practing dentist, in a state where if I choose, I can do oral sedation or "light inhalation" (i.e. nitrous) without any special permit/credentials. I am eligible to obtain my anesthesia permit for IV conscious sedation, but have not and in fact don't plan on it - I'll elaborate on that in a minute.

First off, from the perspective of many practicing dentists out there, 10 fillings, a chipped tooth repair, and a single implant placement is characterized as minor and/or simple procedures and could easily be done in 1 setting (albeit a long one) if the dentist is comfortable with it. Sometimes a case that large would be what we'd term a full mouth rehabilitation and the dentist for the simple purpose of having a "constant" with which to verify the final outcome of the work may choose to divide your mouth into 2 sides and do them over 2 days (i.e. if you work on the right side one day, your left "untouched" side can be used as a constant or guide to evaluate how your jaw closes with respect to the new restorations - remember your jaw is the only joint in your body where something on both the right and left side needs to work together)

Secondly, and it may sound a bit arrogant on my part, but with the exception of the very, very young and the special needs patients, I can comfortably treat all of my patients with the exception of MAJOR oral surgical procedures (i.e. the reduction/stabilization of a fractured jaw, sinus lifts, etc) without any form of sedation, and in fact don't sedate any of my patients. main reason safety. Even the simpliest of inhaled or oral sedatives increases the risk of medical complications to my patients and in my practice, 99% of the people don't need sedation and are very comfortabelt and satisfied with their treatment. I have come to realize in the years I've been doing this that if a normal adult comes in and requests sedation for "routine" procedures that the chances of them being a PITA (Pain In The A$$) patient is very high, and the likelihood of me wanting to treat them goes down dramatically. Also as a loose generalization from what I've seen in my area, Docs that advertise themselves as "sedation dentists" tend to overtreat their patients - where a patient comes back with a proposed treatment plan for a second opinion and they often have fillings scheduled for replacement not because inadequacies in their integrity, but simply because of their color. Additionally if you really want to be sedated for your treatment, find a dentist that uses a seperate dental anesthesiologist for a large case like yours. After all with all the work you need, you'll want your dentist giving 100% of their thought/attention to all your restorations and not also managing/worrying/monitoring your vitals also, thats where the dental anesthesiologist comes into play.

In general, I've found that the cost-benefit/stigma associated with sedation in my office isn't worth it for me. It tends to attract a "crazier" population that tends to be higher maintenance, and they also tend to be less accepting of proposed ideal treatment and more of the "patch and pull" mentality, and that just simply isn't the patient that I ideally wnat in my practice.

Just my 2 cents 😀

 

[Idiopathic]

i appreciate your honesty, and as a soon-to-be anestheiology resident, i appreciate the inherent dangers of anesthesia.

i just am concerned about the discomfort associated with that many repairs. I also want to have everything done at once (at the worst, twice) and figured that i would need to be sedated to do 10+ teeth, even if all were minor.

 

[drhobie7]

i appreciate your honesty, and as a soon-to-be anestheiology resident, i appreciate the inherent dangers of anesthesia.

i just am concerned about the discomfort associated with that many repairs. I also want to have everything done at once (at the worst, twice) and figured that i would need to be sedated to do 10+ teeth, even if all were minor.

You'll be fine with just local nerve blocks with lidocaine. An experienced dentist can do a filling on a tooth in under 15 minutes. He/She could probably do all 10+ teeth in a morning. You won't feel a thing. Bring some headphones and just zone out for a few hours.

 

[BigBottomGirl]

The only things sore will be your jaw from staying open for so long and your arse.

 

[DrJeff]

i appreciate your honesty, and as a soon-to-be anestheiology resident, i appreciate the inherent dangers of anesthesia.

i just am concerned about the discomfort associated with that many repairs. I also want to have everything done at once (at the worst, twice) and figured that i would need to be sedated to do 10+ teeth, even if all were minor.

Discomfort factor after all that proposed treatment would be minimal at most - maybe a LITTLE gum tenderness to brushing in those areas that evening, mainly those as mentioned the potential of some jaw soreness from being open for an extended period of time - basically you *might* need a couple of advil later that day 😀 Even the dental implant is a relatively simple, painless proceedure, and I should know since I have one in my own jaw 😳 Basically you feel some moderate vibration as the implant site is prepared, and then some mild-moderate pressure for a few seconds as the implant is placed, and then after that the ONLY thing I felt was the knot in the stitch that was placed until it dissloved a week or so later - absolutely no pain at all associated with the placement of the implant. One of my hygenists used to think that I was exagerating the simplicity of implant placement to my patients when I'd discuss it with them in a very similar manner to what I've just typed, and then she had one placed, and the next day when she came into work, the first thing she said to me when i asked how she was doing was "Da*# you Dr.J , you were right! the stitch is annoying, but no pain at all!"

Believe me, as a rule us in the dental profession (as I'm sure you in your future anesthesia field) like to keep things simple and easy!

 

[Dr. Pedo]

I'm not going to disagree with you that a lot of general dentists are uncomfortable doing sedations in their office, and obviously GA will require an anesthesiologist, but I'm sticking to my claim that oral & IV sedations don't. For example...

Aphistis: Did you read my post----there is nothing I stated to disagree over 😕 . You can stick by your claim as it was never challenged 😛 ; It doesn't matter the route only the DEPTH of sedation.

New York: http://www.op.nysed.gov/dentanes.htm#educ

Missouri: http://pr.mo.gov/boards/dental/seda...arenteral_conscious_sedation_requirements.pdf

South Dakota: http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=20:43:09:04

Proves my point: you don't need an anesth or oral surg for CONSCIOUS sedation but you do need specialized training/license in nearly all states. However, you will NOT be able to do DEEP sedations or GENERAL sedations----to do those see: anesthesiologists, oral surgeons, CRNA under supervision. Hence, the semantics issue on sedations.

You may well be right that some states are more restrictive in their laws; but it's not a universal requirement by any stretch of the imagination.

Route doesn't matter; level of sedation does. Not sure what your post is refuting, proving, or explaining. Let's not hijack the thread---PM me if you have any further comments or things I can help clarify for you.

__________________
Dr. Pedo

Never argue with an idiot; they'll bring you down to their level and beat you with experience.

 

[aphistis]

Aphistis: Did you read my post----there is nothing I stated to disagree over 😕 . You can stick by your claim as it was never challenged 😛 ; It doesn't matter the route only the DEPTH of sedation.



Proves my point: you don't need an anesth or oral surg for CONSCIOUS sedation but you do need specialized training/license in nearly all states. However, you will NOT be able to do DEEP sedations or GENERAL sedations----to do those see: anesthesiologists, oral surgeons, CRNA under supervision. Hence, the semantics issue on sedations.



Route doesn't matter; level of sedation does. Not sure what your post is refuting, proving, or explaining. Let's not hijack the thread---PM me if you have any further comments or things I can help clarify for you.

Fair enough. I must've just misunderstood you before. Thanks for taking the time to clarify.

 

[lnn2]

The only things sore will be your jaw from staying open for so long and your arse.

REALLY?!!! Are you speaking from personal experience?! you're a bad bigbottomgirl you!

 

[lnn2]

So, I need a lot of little things done (i.e. minor fillings) as well as a dental implant and a chipped tooth repair. Will a dentist work on 10+ teeth in one sitting? If so, are there contraindications to sedation (other than the obvious) and what types of sedation are used? Is it all nitrous and benzos or are there other alternatives? Im sorry for the ignorance, but Im just curious. Lets assume $$$ is no object.

For the "little things" including implants, nitrous in addition to anxiolytic (Valium/Ativan...) is often used. Most of the dentists don't do GA/IV sedation. Like DrJeff said, it's not worth it, time/money/liability.

 

[1992Corolla]

Use a double dose of halcion they won't be waking up for anything.