Sedation & Dental Anxiety

Options for patients who find dental treatment difficult, from nitrous oxide to IV sedation.

Written by the Shield Dental Care team, Burke VA

Sedation dentistry is not one thing. It is three different levels of medication, doing three different jobs, with different costs and different rules about who drives you home. Choosing between them is easier once you know what each one actually does to you.

Who it is for

Anxiety and dental phobia are the reasons people think of first, and they are the most common. But sedation is also used for a strong gag reflex that makes treatment difficult, for patients whose anaesthetic wears off faster than average, and for long or complex appointments where staying comfortable in the chair for two hours is the real obstacle. If a previous bad experience is what has kept you away, that is a reason to ask about it, not a reason to avoid mentioning it.

The three levels

Nitrous oxide

Inhaled through a small mask, often called laughing gas. It takes effect within minutes, leaves you awake and able to answer questions, and — the practical point — wears off within minutes of the mask coming off. You can drive yourself home. It is the lightest option and the only one that does not disrupt the rest of your day.

Oral sedation

A prescription tablet taken before the appointment. Deeper than nitrous and suited to moderate anxiety or longer treatment. You will be drowsy, and you will need someone to drive you home.

IV sedation

Delivered into the bloodstream, and the deepest level offered here. It produces what is usually described as a twilight state: you remain responsive, but most patients remember little or nothing of the procedure.

It is worth being clear about what IV sedation is not. It is not general anaesthesia. You are not unconscious, you keep breathing on your own, and recovery is faster. Dr. Ghorbani is certified in IV sedation and monitors heart rate, blood pressure and oxygen levels continuously throughout. A pre-sedation health screening happens first, because the medication has to be right for you specifically.

What each level costs

  • Nitrous oxide — typically adds $50 to $150 to the visit.
  • Oral sedation — typically $150 to $500 per visit.
  • IV sedation — typically $250 to $900 per visit, depending on how long the procedure runs.

Insurance sometimes contributes when sedation is judged medically necessary rather than elective, which is worth checking before rather than after.

Afterwards

Nitrous leaves your system almost immediately. Oral and IV sedation do not: plan for a companion to take you home, and plan to do nothing much for the rest of the day. IV sedation typically wears off within one to two hours, though grogginess can linger until you have slept.

What sedation does not change

Sedation manages how the appointment feels. It does not replace local anaesthetic — that still numbs the area being treated — and it does not change what the treatment itself involves. It is worth saying plainly because patients sometimes expect sedation to substitute for the numbing injection rather than sit alongside it.

What happens on the day

For nitrous, nothing needs arranging in advance beyond telling us you want it. For oral sedation you take the tablet before you arrive, so you will already be drowsy when you get here — which is precisely why the driver has to be organised the day before, not on the way. For IV sedation there is a health screening first, and you will be given instructions about eating and drinking beforehand that are worth following exactly.

During treatment under IV sedation, monitoring is continuous rather than periodic: heart rate, blood pressure and blood oxygen are watched throughout, not checked at intervals. That monitoring is the reason the deepest level of sedation is also a controlled one.

Which procedures it is used for

Sedation is not reserved for surgery. It is commonly used for implant placement, extractions, root canal treatment and longer restorative appointments — and equally for an ordinary cleaning, if that is the appointment a patient has been avoiding. There is no threshold of seriousness you have to meet before asking.

Is it safe?

Sedation is safe when it is administered by a trained provider who is monitoring you, and the honest caveat is that those two conditions are what make it safe rather than the drugs being harmless. The pre-sedation screening exists to catch the medical histories and medications that change the calculation. Tell us about everything you take, including supplements — interactions are the thing screening is looking for.

Children

The approach is more conservative. Nitrous oxide is the usual first step for an anxious child. Oral sedation may be appropriate for more significant anxiety or a longer appointment, and IV sedation is generally reserved for older children undergoing extensive treatment. As with adults, the decision follows a conversation about the child's health rather than a standing rule.

Treatments at Shield Dental Care

What we do for this, and what each appointment involves.

Articles

23 articles from the Shield Dental Care team, all reviewed by Dr. Pejman Ghorbani, DDS.

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