Dental patients with generalized anxiety, belonephobia, prior dental trauma, or generalized fear of the dentist can take oral medication in order to reduce their anxieties. A variety of single and incremental dose protocols are used to medicate the patient as early as the day before treatment. Medication additionally helps reduce memory or the sights and smells of the dental office to avoid recall of any trauma. The sedative effect allows more dentistry to be completed in fewer appointments as well as allowing complex procedures to be performed in less time.
Drugs
Valium is the most widely recognized drug in the group. It has been around since the 1960s and is a well known and time-tested sedative with amnesic properties. Valium has a longer half-life than some of the other medications, so it is particularly useful for appointments where extensive dentistry is being performed.
Halcion is most well known for the treatment of insomnia. It is highly effective when used in oral sedation protocols, and if deemed appropriate by your dentist, can be used in conjunction with an antihistamine.
Sonata is similar to Halcion in that it is also commonly used for the treatment of insomnia.
Ativan is commonly prescribed for the treatment of anxiety. It possesses many of the desirable effects of other benzodiazepines with amnesic properties. It is an effective sedative with a medium length half-life and is useful for appointments that are longer than two hours.
Vistaril while classified as an antihistamine has also been shown to have anxiolytic effects. It also works in conjunction with many of the benzodiazepines but has no amnesic properties.
Versed has the shortest half-life of all of the benzodiazepines, lasting about an hour, and making it ideal for short appointments or simple procedures. It has many of the same anxiolytic and amnesic benefits of other benzodiazepines, but is less commonly used because of its duration.
Risk mitigation
Drug characteristics must be carefully considered when choosing the appropriate medication. Matching factors, such as where the drug is metabolized and any underlying diseases requires a good medical history and thorough knowledge of the drug's characteristics. All risk factors, individual characteristics, and procedural complexities can be taken into account in order to provide the best drug choice.
Education and training requirements to administer sedation vary by state. The ADA has set forth general sedation guidelines that have been adopted or modified by many states. There are typically dosing limitations involved with anxiolysis, usually a single dose the day of treatment not to exceed the maximum recommended dose of the medication in order to achieve the intended level of sedation. However, these sedation laws vary from state to state. Anxiolysis protocols are designed to treat healthy ASA I & II patients ages 18 and up for one to four hours of treatment. Some states now require a permit even for nitrous oxide administration and/or anxiolysis.
Advantages
The main advantages of oral sedation versus other sedation methods are:
