Types of Sedation

There are three types of sedation:  Nitrous Oxide, Oral sedation, and Intravenous sedation.   Your sedation depends on your level of fear and the amount of work needed; Dr. Hanah Pham will tailored-fit a sedation dental visit for you according to your needs.   All the types of sedation will still require local anesthetic injection to numb up the teeth, but you will be very comfortable during this procedure with the sedation.

1. Nitrous Oxide Sedation (known as the “laughing gas”) This is the lightest form of sedation and this is for people with mild dental fear, a fear rating on 4 or less out of 10, and (10 being extremely fearful.) This is performed using nitrous oxide/oxygen gas mixture and this is breathed through a nosepiece and helps you relax. This is used to reduce anxiety and keep you comfortable during your visit.  This level provides a light pain control and sedation.  Since it is a gas, the sedation will wear off immediately once the nose piece is removed--you don't need anyone to drive you home. Most patients choose the nitrous oxide sedation because it lets them feel a little more relaxed and reduce some of the anxiety associated with dentistry.  It may have the effect like drinking a couple glasses of wine. If you have more than mild  dental fear,  then Nitrous Oxide may not work, and  a stronger level of sedation may be required, for example, Oral Sedation or IV Sedation.
    

2. Oral Sedation   The next deeper level of sedation and this is for people with moderate  dental fear, a fear rating of 4-7 out of 10 (10 being extremely fearful).  This sedation is deeper than the Nitrous Oxide Sedation, but lighter than the I.V. Sedation.  This level is reached utilizing a pill in combination with the use of the Nitrous oxide (Dr. Hanah Pham added this for a sedation synergistic effect).  For this sedation, all body functions remain normal and the person is able to breathe on their own while they fall in and out of their sleep. The level of sleep all depends on many factors that we cannot control.  Sedative outcomes all depends on genetics, tolerance, medications taken and fear levels…Some degree of amnesia is common, meaning you may not remember a whole lot about the visit because of  the oral sedation medication that is given.  Of course, every patient is unique; therefore, we cannot predict how effective oral sedation will be.  There will be an improvement in the overall comfort level, but we cannot guarantee that your brain will fall asleep.  You will be fluctuating between awake, light and deep sleep state.  Under oral sedation, the length of the procedure will appear much shorter; for example, a 4 hours case may seems like less than 1 hour.   For this level you will need to strictly follow the fasting instructions and must have someone take you home because you cannot operate an automobile while you are under the influence of the medication.  Oral sedation is effective 70-80% of the population;   However, if you have an extremely high dental fear or resistance to nitrous oxide and oral sedation, then you may consider Intravenous Sedation. 
    

3. Intravenous Sedation (I.V. Sedation)   This is the deepest level of sedation you can have and this is for people with an extremely high dental fear, fear rating of 8-10, (10 being the extremely fearful).   This is also for people who have mental and physical challenges or young children who are too young to follow directions or who refuses to sit still for dental procedures.   Most very young children and people with special needs fall in this category.   IV Sedation is the sedation of choice if you want to be totally comfortable and not be aware of your surroundings.  A five hours visit may seem like 5 minutes.  When you wake up, you will not remember anything during the procedures, this similar to a wisdom tooth extraction.      It is extremely safe because it is administered by our Board Certified Anesthesiologist, on staff, Dr. Andy Tran (Click for Dr. Tran info).  Dr. Tran will personally call all his patients the day before IV Sedation dental visit to review their medical history, reviews what to expect on the day of the procedures and after the procedures, and answers any questions that patients may have.   Our patients claimed that receiving this phone call from the anesthesiologist, Dr. Andy Tran, has made them feel more at ease and reassured about the IV Sedation dental visit!
   
   This is the most predictable and well controlled sedation, in which, medicines are administered through the veins directly.   I.V. Sedation is very safe because it allows the body to maintaining all body functions and the patient will be breathing on their own.     I.V. Sedation is not to be confused with General Anesthesia.  General Anesthesia mostly have to performed in a hospital where there are ventilators to breathe for patient and there are much more drugs used.  Some offices still allow general anesthesia in an office settings, but not at Dr. Pham’s office.    She focuses on patient’s safety first. The risk level in general anesthesia is much higher than I.V. Dr. Pham believes that I.V. sedation is the best balance between safety and risk between the two for dentistry. Even though, through Dr. Hanah Pham’s advanced training, she is certified to administer IV Sedation, she conscientiously elect to defer the IV Sedation to the anesthesiologist who can better manage the IV Sedation for the patient while she focuses on the quality and excellence in dentistry.  The greatest advantage of IV Sedation is that the sedative effect can be titrated to the effect with the administration of more medicine.  For people who are under I.V. sedation,   over 99 % do not remember about the visit because of the sedative effect of I.V. medicine. They will be in a state of deep relaxation and a feeling of calmness.    The fasting instructions and the driver needed to take the patient home is the same as with the IV Sedation for safety reasons. IV Sedation and Oral Sedation need to be performed on an empty stomach for safety.  

Ultimately, the choice of sedation rest on you, You must weigh the cost, benefit and fear level. Dr. Hanah Pham will assist you in your decision making and what you feel most comfortable with.