James A. Snyder, DDS, MS
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James A. Snyder, DDS, MS
Oral Conscious Sedation Alexandria
Oral conscious sedation is a method that involves the administration of a pill or pills that make the patient feel sleepy and relaxed. The level of sleepiness felt can differ widely from patient to or from time to time for the same patient because of a variety of factors.In dental anesthesia the use of oral sedatives to make otherwise unpleasant activities more acceptable has also been in practice for a very long time. What has changed is the drug(s) used. Chloral Hydrate (the storied ‘Mickey Finn’), first used in the 19th century, is still sometimes prescribed. It has a wide safety margin, is inexpensive and causes a hypnotic (time compressed, sleep-like) state for most people who have normally functioning brains. It is not reliable for physically large people and for persons with certain abnormal brain functions. Newer drugs have been found that expand reliability without much loss of safety. The drug family benzodiazepine, containing diazepam (Valium™), triazelam (Halcyon™) and many others, is the most commonly used. All drugs in this family have similar effects on memory but differ in time of onset, duration of action, potency and propensity for unwanted effects.
All oral conscious sedation strategies share the same shortcomings:
- The patient must be willing and able to take oral conscious sedation medication.
- A driver / chaperone is needed for a period of time that may involve most of the day.
- At least one full day away from ‘executive thinking’ (driving, decision making, etc.) is required.
- The exact dosage needed to provide comfort cannot be known in advance so the amount prescribed may be too little or too much for the circumstances. Titrating (gradually giving the drug to the desired effect) is not possible.
- The time to best effect is always long (more than one hour) and is quite variable. The variability may occur even with the same person and the same drug as a result of that person’s physiological activities on a given day. Sometimes the desired effect doesn’t occur until hours after the patient has gone home.
- The duration of effect is also variable. Drowsiness may last for hours after the procedure is complete.
- The level of sedation may cause a sleep-like appearance and even a loss of memory for a period of time but MAY NOT prevent the patient from reacting to the treatment. Dental treatment usually involves sights, sounds, smells, vibrations, pressure, heat, cold, sharp pain and other stimuli that may be unpleasant or trigger an unpleasant memory. Just because you don’t remember what happened, doesn’t mean it didn’t occur. If what happens provokes a reaction that prevents the dentist from proceeding, the treatment may not get done or be done sub-optimally.
Despite these shortcomings, oral conscious sedation is the safest, easiest and cheapest of options. If effective, it can make a potentially very unpleasant experience disappear.