Dental Fear & Sedation

Quite a few new patients, who have come to Stockholm Dental Clinic over the years, have had varying levels of fear from previous dental treatment; most often due to a traumatic experience with a school dentist as a child. Some of these patients even needed to have someone else make the initial dental appointment for them. However, no matter what level of dental fear the patients experienced initially, the absolute majority of them felt much more relaxed after only a few visits.

For patients who feel they are unable to cope with any form of dental treatment, sedation could be an option.

IV (Intravenous) Sedation or Conscious Sedation

Intravenous Conscious Sedation is when a drug, usually an anti-anxiety drug, is administered into the blood stream during dental treatment. You are not sleeping during IV-sedation. Instead, you are able to understand and respond to requests from your dentist. However, to you as a patient it may afterwards appear as if you have been sleeping. There are two reasons for this:

• Firstly, Conscious Sedation induces a state of deep relaxation.
• Secondly, the drugs usually used for Intravenous Sedation produce at least a partial memory loss for the time period the drug is used. As a result, you will not recall much of what has happened during the dental treatment. Some patients do not remember anything at all.

Is local anesthesia needed?

Drugs for IV-Sedation are not painkillers, but anti-anxiety drugs. Therefore, local anesthesia is still needed. However, the local anesthetic is not given until the conscious sedation has full effect, and at that stage you will not be bothered.

How is IV Sedation given?

Intravenous means the drug is put into a vein. A very thin needle is placed in the back of your hand and stays in place throughout the procedure.

During the procedure, your pulse and oxygen levels are measured using a pulse oximeter, which is clipped onto a finger. It measures the pulse and oxygen saturation.

Which drugs are used?

The most commonly used drugs for IV Sedation are benzodiazepines, for example Diazepam (Valium). It is a short acting anti-anxiety sedative drug. Benzo-diazepines which are given intra-venously have three main effects:

• They relax you (reduce your level of anxiety).
• They make you sleepy.
• They produce amnesia (make you forget at least some of what has happened during the procedure).

The needle is left in place during the procedure so that the sedation can either be topped up or so that the antidote for benzodiazepines (Flumazenil) can be put in, once your dentist has finished the procedure.

Is IV-sedation safe?

IV sedation is extremely safe, especially at Stockholm Dental Clinic, close to Marbella, where the IV-Sedation is carried out by an Anesthetist.

However, there are a few contraindications for IV-Sedation with benzodiazepines:

• Pregnancy
• Known allergy to benzodiazepines
• Alcohol intoxication
• Depression
• Some types of glaucoma
• Heart disease is generally not a contraindication.

If you have been taking benzodiazepines for many years, for example Valium (Diazepam) your tolerance may be very high. Therefore, it is important that you inform Dr. Mattis Mamusa about this fact.

Before IV sedation

You are allowed to have a light meal at the latest one hour before you arrive at Stockholm Dental Clinic in Puerto Banus (close to Marbella).

After IV Sedation:

• Have a family member or friend take you home. You should rest for the remainder of the day.
• Have someone stay with you until you are fully alert.
• Do not drive a motor vehicle for the rest of the day.
• Do not eat any heavy meal immediately. If you are hungry, eat something light.
• If you experience nausea, lie down for a while or drink a glass of coke.
• Do not drink any alcohol for the rest of the day.
• Take medications prescribed by your dentist.

Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult.

Oral Sedation

The alternative to IV-sedation is Oral Sedation, which is not as reliable or as effective as IV-Sedation. The onset of the sedation is slower and the dose and level of sedation is more difficult to adjust in order to meet the patient’s needs. Therefore, the effect is not as reliable. With oral sedation the maximum level of sedation, which can be reached is not as deep as with IV-Sedation.