Without doubt, great majority of cases like routine restorative techniques or surgery in dental office may be satisfactorily managed through the use of local anesthesia alone. Yet, the possibility of pain and fear of local anesthesia or L.A. do exist in patients of all age groups.
Local Anesthetic Injection
How can we manage these overly fearful patients? The answer is to induce a state of consciousness in which a person is more relaxed and carefree than previously.
A variety of techniques are available to the dental and medical professionals to aid in the management of a patient’s fears and anxieties regarding dental care and surgery.
Over the years many names are given to this state. Terms like chemamneria, twilight sleep, relative analgesia, co – medication were used which is now called as sedation. This state of altered consciousness allows the dentist to control pain reaction as well as pain perception with patient in a conscious state.
What is Sedation Dentistry
Sedation in dentistry refers to the use of various pharmacological agents to relax the patient and decrease the anxiety before and during a dental appointment. It is also known as concious sedation.
Sedation is one of the stages of anaesthesia in which the patient is still conscious but is under the influence of a depressant drug. (Central nervous system depressant)
The class of drugs used for the same are called sedatives. These pharmacological agents act on central nervous system and depress the areas responsible for awareness which is conscious and hence these drive the name concious sedation.
Oral Conscious Sedation
The sedation can be mild , moderate or deep depending upon the degree of central nervous system depression. For the patient is relaxed and less anxious but responds to te stimulus which are physical and verbal then it is mild sedation but if he is qite relaxed and responds to the purposeful stimulant then it is moderate sedation but if he does not respond at all to the stimulus then it is deep sedation.
Few terms about sedation dentistry we need to know
General anesthesia - it refers to the elimination of all sensation, accompanied by the loss of consciousness.
Conscious sedation – In conscious sedation the person responds to the physical and verbal stimulus and is able maintain independently and continuously the airway and this effect is produced b pharmacological and non pharmacological methods or with the combination of both. It is the minimal depressed level of consciousness
Deep sedation – It is achieved by pharmacological means i.e. through medication. There is partial loss of protective reflexes like maintain the airway and patient does not respond to verbal stimulus but responds to purposeful stimulus and patient cannot be aroused easily.
Objectives of Sedation in Dental Treatment
The goal of sedation is to have a responsive patient, whose fear or anxiety is diminished.
1. The patient’s mood must be altered: The primary objective of sedative techniques in sedation dentistry is to alter the patient’s mood so that a procedure that was previously psychologically unacceptable now becomes readily acceptor.
a)· This helps patients undergo treatment in a relaxed, comfortable, safe state.
b)· Sedative technique is not used to control or criminate pain.
c)· The goal of conscious sedation is to eliminate fear and apprehension and thereby aid in control of pain reaction. Control of pain perception will be gained by judicious addition of regional analgesia.
2. The patient must remain co-operative: certainly when regional analgesia is being used for the control of operative pain, the co-operation of the patient is imperative. However, if the fearful patient has been calmed and his mood altered, pt. co-operation will follow.
3. The pain threshold should be elevated: Though dentists rely on regional analgesia for the control of operative pain, it is advantageous to choose drugs for conscious – sedation that also elevate the pain threshold at CNS system level.
4. All protective reflexes must remain active: In the conscious state, the pt. will maintain his airway clear of secretions and patent at all times.
a)· The possibility of airway obstruction of soft tissue, as occurs when consciousness is lost, is absent.
b)· In addition, the presume of respiratory system. Reflexes will prevent the patient from becoming hypoxia.
5. There should be only minor deviations in the patients vital signs :Patient’s physiology is not altered to the extent seen in an unconscious state.
6. There may be a degree of amnesia : Depending on the drugs and dose used, amnesia may be produced. This may easily be accomplished if desired in the conscious patient.