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ConsciousSedationEasesTreatmentAnxietyforYoungDentalPatients

While pediatric dentistry has made great strides in making young patients’ dental visit experiences more relaxing, some children and teenagers still have difficulty with anxiety. Their anxiety in turn can make necessary care much harder to provide.

For difficult cases, many dental providers for children now incorporate a technique known as conscious sedation to help ease anxiety. With this technique, they’re able to perform procedures like cavity-filling or tooth-extraction that are more difficult with an anxiety-prone patient.

While general anesthesia creates a total loss of consciousness, conscious sedation uses precise medications to suppress consciousness at different levels ranging from light to deep suppression, and create a relaxed state for the patient. A child under sedation can still breathe normally and respond to certain stimuli, including touch and verbal commands. For only a light or minimal effect, a dentist normally administers the sedation drug as a pill the child takes orally. For deeper sedation, the medication is most likely delivered through a vein (intravenously).

Sedation reduces fear and anxiety but not necessarily pain, so it’s often accompanied by some type of anesthesia, either a local anesthetic delivered by injection to the procedure site or with a nitrous oxide/oxygen gas combination that’s inhaled through a mask worn by the patient.

Even though the child isn’t completely unconscious, one of the dentist’s staff will monitor vital signs (heart and respiration rates, blood pressure and blood oxygen level) throughout the procedure. This continues even after the treatment is over until the child’s vital signs return to pre-sedation levels. Once released, they will need a ride home and should rest for the remainder of the day. They can then return to school and resume other normal activities the next day.

With the advent of newer and safer drugs, conscious sedation is becoming a more widespread technique in both medicine and dentistry. Using it to ease a child’s anxiety increases the chances they’ll receive all the dental care they need without unpleasant memories of their visit that could follow them into later life.

If you would like more information on the role of conscious sedation for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sedation Dentistry for Kids.”

ConsciousSedationcanMakeYourChildsDentalVisitMorePleasant

Anxiety in a child during dental procedures could interfere with the care they need. But recent advances in sedation drug therapy can calm pediatric patients safely and allow us to perform more invasive procedures without general anesthesia.

In contrast to general anesthesia, conscious sedation allows a patient to relax and feel calm while still breathing normally on their own and able to respond to certain stimuli. Conscious sedation can be deep, moderate or minimal. Deep sedation is akin to sleep and will also cause the child not to remember details of the procedure when they awaken. At the other end of the spectrum is minimal sedation, the most common type used in pediatric dentistry, which allows patients to respond to touching or verbal commands. Deep sedation drugs are usually administered intravenously, while those used for minimal sedation are administered orally with syrup. Conscious sedation doesn’t prevent pain, so it must also be accompanied by local anesthesia or other pain-relieving methods.

After you arrive for your child’s procedure, we’ll normally conduct a pre-sedation evaluation to be sure there are no medical problems that might interfere with the sedation. We typically use Midazolam (under the brand name Versed) or Hydroxyzine (also known as Vistaril or Atarax) to achieve sedation. Both are very safe, fast-acting and exit the body quickly after treatment.

During the procedure, a designated member of our staff continuously monitors your child’s vital signs, including pulse and respiration rates, blood pressure, temperature, and blood oxygen level. After the procedure your child will remain in recovery until vital signs return to pre-sedation levels. You should then take your child home and monitor them for the remainder of the day — definitely no return to school until at least the next day.

Safety is a top priority when using any sedation therapy — dental professionals follow strict procedures and protocols, as well as adhere to certification requirements enforced by many states. Performed in this manner, conscious sedation can help ensure your child’s experiences in our office are pleasant, and will hopefully result in a greater willingness when they grow up to continue professional dental care.

If you would like more information on conscious sedation for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Sedation Dentistry for Kids.”

By David A.Susko DDS, PC
August 04, 2014
Category: Oral Health
HatsOfftoEtherandEvenBetterAnesthetics

The next time you’re visiting Boston, why not make time for a stroll in the city’s renowned public garden? It’s got a little something for everyone: acres of greenhouses and formal plantings, a picturesque pond where you can go for a paddle in swan-shaped boats, and the first (and perhaps the only) statue dedicated to an anesthetic gas.

Yes, the Ether Monument (also called “The Good Samaritan”) is a vaguely Moorish-looking sculpture that commemorates the first use of anesthetic in a medical procedure. This ground-breaking event took place at nearby Massachusetts General Hospital in 1846. But if it seems that perhaps the park designers were feeling a bit light-headed when they commissioned this statue* then just think of what it would have been like to have a tooth drilled without it!

Today, of course, ether is no longer used for anesthesia; that’s because medical science has developed far better ways to make sure you don’t feel pain when you’re having a procedure. However, we do still use a gas for people who need a little more help relaxing during dental treatment. It’s called nitrous oxide, but sometimes goes by the nickname “laughing gas.”

This sweet-smelling gas, mixed with oxygen, is often administered in a process called inhalation conscious sedation. It doesn’t put you to sleep — you can still follow directions and respond to verbal cues — but it makes you very comfortable, and may even induce a slightly euphoric feeling, which wears off quickly when the gas is stopped. That’s what makes it ideal for some dental procedures: It’s quite effective for people who might otherwise have a great deal of dental anxiety, yet it’s quick, easy and safe to administer — and you can usually drive yourself home afterward.

Sometimes, however, you may need even more relaxation — for example, if you’re having multiple wisdom teeth extracted. In this case, it may be best to use intravenous (IV) conscious sedation. Here, the precise amount of medication you need is delivered directly into your bloodstream via a tiny needle. As with nitrous oxide, you’ll remain conscious the whole time, but you won’t feel any pain — and afterward, you probably won’t remember a thing.

Sedation dentistry has come a long way since the days of ether… but making sure you don’t feel pain or anxiety remains a critical part of what we do. Before a procedure, we’ll talk to you about what type of anesthesia is best — and if you have any questions or concerns, we’ll work with you to make sure you have the best experience possible. If you would like more information about sedation dentistry or relieving dental anxiety, call our office for a consultation. You can learn more in the Dear Doctor magazine articles “Oral Sedation Dentistry” and “Sedation Dentistry For Kids.”

By David A.Susko DDS, PC
December 12, 2013
Category: Dental Procedures
FAQsAboutCalmingYourFearsWithOralSedationDentistry

What is oral sedation dentistry? If you become frightened and anxious when facing a dental appointment or procedure, sedatives (also called “anxiolytics” meaning they dissolve anxiety), can completely transform the experience. Oral sedatives (taken by mouth) allow you to relax your mind and body so that you feel comfortable while in the dental chair.

How does anxiety affect my pain response? When you are afraid, your pain threshold is reduced. You experience a rush of adrenalin and you tense your muscles. As a result you end up in a state of heightened sensitivity. With sedation this sensitivity to pain vanishes along with your fear and anxiety.

What are some of the oral sedatives that my dentist may use? Most of the medications used in oral sedation dentistry belong to a class of medications called benzodiazepines, tried and tested over decades to be safe and effective. They are used in the treatment of anxiety, insomnia, and agitation. They include Valium®, Halcion®, Ativan®, and Versed®.

I'd just like to forget the experience after it is over. Can oral sedation help? Some of the medications prescribed as oral sedatives have amnesic properties (“a” – without; “mnesia” – memory). This means you will have little memory of the time in the dental chair when your procedure is finished.

What does my dentist need to know in order to prescribe the right oral sedation? We need a thorough medical and dental history, including all medical conditions you may have, and all medications you are taking — both prescription and over-the-counter (including allergies, alternative medications and even herbal supplements). We will also ask you whether you eat certain foods that could interfere with a sedative's effects.

How are the oral sedatives administered? Oral medications are either placed under the tongue (sub-lingual), and allowed to dissolve and then swallowed, or they may be swallowed whole. They are safe, effective, and fast acting. After the sedation takes effect, it will be easier to experience injections of local anesthesia if needed to numb your gums for the dental procedure.

What do I need to do before and after my appointment? Follow all directions we give you about restricting food and drink before your appointment. Until the medication wears off you may not be able to drive, operate heavy machinery or work so be sure to make arrangements to take time off and to have someone drive you to and from the appointment.

Contact us today to schedule an appointment to talk about any fears you may have about dental treatments. Using oral sedation, we can make sure that you have a relaxing experience. Oral sedation allows you to relax both your mind and body, and focus on feeling peaceful rather than anxious. You can learn more about oral sedation dentistry in the Dear Doctor magazine article “Oral Sedation Dentistry.”

By David A.Susko DDS, PC
September 18, 2011
Category: Dental Procedures

For some people, going to the dentist is just like any other routine healthcare visit that they manage without any qualms. For others, the experience can cause some trepidation or even anxiety. In fact, some people even contemplate canceling appointments and neglecting their oral healthcare. If the latter better describes how you or someone you know feels about going to the dentist — even for a routine exam and cleaning — then we have great news for you! We offer our patients oral sedation (sedation dentistry) that allows you to relax both your mind and body so that you can focus on feeling peaceful and at ease rather than anxious.

What is oral sedation?

Often referred to as “comfortable” or “relaxation” dentistry, sedation dentistry offers an approach to dentistry that includes gentle management of your anxiety by using an anti-anxiety prescription medication that simply dissolves away your anxiety. The medications are administered by mouth (orally) to help transition you from feeling nervous to a more comfortable state of being.

Is it easy to take?

Another reason oral sedation is so popular is because it does not require an injection (shot), so, if you are afraid of needles, you simply do not need to worry. Typically, a pill is first placed under your tongue (sub-lingually) where it dissolves and penetrates the skin going straight into your system and then the rest is simply swallowed. This method and the quick-acting sedation medication make relaxation both effective and safe.

Is it safe?

Pharmacists and health professionals measure medications' effectiveness by measuring their “therapeutic index.” The larger the number is on this scale, the safer the drug. The oral sedation medications we use have the highest numbers possible on this scale and thus they are the least likely to cause any adverse (negative) reactions.

Want to learn more?

Contact us today to discuss your questions or to schedule an appointment. You can also learn more by reading the article “Oral Sedation Dentistry.”



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