IV and Oral-sedation

Get Months and years of dental work done in one to two appointments
Experience Dentistry like you never have – without feeling pain, experiencing unpleasant sights or smells.
Safe Intravenous (IV) and oral (pill) sedation is available in our office which puts you in a very relaxed “twilight state” for anxiety free dental visits.
Any procedure can be done under IV and oral sedation! Traditionally, people who are having teeth removed from their mouth have been sedated on a routine basis; however, now with the advancement of extremely safe and wonderful drugs like Versed and Fentanyl (given IV form), and Midazolam, Triazolam & Lorazepam (given orally) you can undergo sedation for almost any procedure – from impressions to deep cleanings to fillings and crowns.

Expert in Sedation Dentistry:

Dr. Kaushesh is only one of less than 100 dentists in the entire world who is a Master of the College of Sedation in dentistry and a Fellow of the Dental Organization for Conscious sedation. All staff goes through at least 10 hours of re-training to keep you comfortable in our office. Most people say something like “It feels like the most beautiful feeling to know that you don’t remember the dentistry at all”. If you need help, we are here. Don’t put off your treatment because of a fear or bad experience. We know how it feels like to be have a dental phobia and we treat it so well that after a few visits, our patients do not even need sedation anymore!

What does it feel like? Will I be asleep?

A lot of dental offices use terms such as “sleep dentistry” or “twilight sleep” when talking about IV (and oral) sedation. This is confusing, because it suggests that IV sedation involves being put to sleep. In reality, you remain conscious during IV sedation. You will also be able to understand and respond to requests from Dr. Kaushesh – so we call it “twilight state” instead.

However, you may not remember much about what went on because of two factors: firstly, in most people, IV (and pill) sedation induces a state of deep relaxation and a feeling of not being bothered by what’s going on. Secondly, the drugs used for IV (and pill) sedation can produce either partial or full memory loss (amnesia) for the period of time when the drug first kicks in until it wears off. As a result, time will appear to pass very quickly and you will not recall much, or perhaps nothing at all, of what happened. So, it may indeed appear as if you were “asleep” during the procedure.

Is it still necessary to be numbed with local anaesthetic? Will my dentist numb my gums before or after I’m sedated?

The drugs which are usually used for IV sedation are not painkillers (although some pain-killing drugs are occasionally added in our office such as Fentanyl), but anti-anxiety drugs. While they relax you and make you forget what happens, you will still need to be numbed.

If you have a fear of injections, you will not be numbed until the IV sedation has fully taken affect. If you have a phobia of needles, you will most likely be relaxed enough not to care by this stage. Your dentist will then wait until the local anaesthetic has taken effect (i.e. until you’re numb) before starting on any procedure.

How is IV sedation administered?

“Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand. This needle is wrapped up with a soft plastic tube. The needle makes the entry into the vein, then is removed leaving the soft plastic tube in place. The drugs are put in through that tube (which is correctly referred to as an “indwelling catheter”, ). The tube stays in place throughout the procedure.
Throughout the procedure, your pulse and oxygen levels are measured using a “pulse oximeter”. This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you’re getting low on oxygen. T. Your blood pressure will be checked before and after the procedure with a blood pressure measuring machine (a tongue-twister called “sphygmomanometer”, which for obvious reasons is referred to as “sphyg”).

Is it safe? Are there any contraindications?

IV (and pill) sedation is EXTREMELY safe when carried out under the supervision of a specially-trained dentist like Dr. Kaushesh – who is the Master of the College of Sedation in Dentistry – the highest honor and achievement available in Sedation Dentistry. Purely statistically speaking, it’s even safer than local anaesthetic on its own!

However, contraindications include early pregnancy, known allergy to benzodiazepine class of drugs, alcohol intoxication, CNS depression, and some instances of glaucoma. Cautions include psychosis, impaired lung, kidney or liver function, and very advanced age. Heart disease is generally not a contraindication. Patients who have severe obstructive sleep apnea and/or obstructed airways due to a disease or severe obesity also do not qualify for IV and pill sedation; for them, a light anxiolysis by valium or Hancion is indicated.

What are the main advantages of IV sedation?

IV (and pill) sedation tends to be the method of choice if you don’t want to be aware of the procedure – you “don’t want to know”. The alternative in the U.S. is oral sedation using Halcion, but oral sedation is not as reliably effective as IV sedation.
The onset of action is very rapid. The drug dosage and level of sedation can be tailored to meet the individual’s needs. This is a huge advantage compared to oral sedation, where the effects can be very unreliable. IV sedation, on the other hand, is both highly effective and highly reliable.
The maximum level of sedation that can be reached with IV is deeper than with oral or inhalation sedation.
Benzos produce amnesia for the procedure.
The gag reflex is hugely diminished – people receiving IV sedation rarely experience difficulty with gagging. However, if minimizing a severe gag reflex is the main objective, inhalation sedation is usually tried first. Only if that fails to diminish the gag reflex should IV sedation be used for this purpose.
Can be ideal for those with a phobia of dental injections.
Unlike General Anaesthesia or Deep Sedation, conscious IV sedation doesn’t really introduce any compromises per se in terms of carrying out the actual procedures, because people are conscious and they can cooperate with instructions and there is no airway tube involved.

Are there any disadvantages?

A very thin catheder has to be put in the arm or hand (“venipuncture”). If you have a general phobia of very thin needles, this isn’t much fun but good news is – most people don’t “feel” this part because of a numbing agent applied to your skin and the gentle techique Dr. Kaushesh uses. If you cannot tolerate this, having inhalation sedation (“laughing gas”) before the venipuncture helps a lot, because it relaxes you and produces a tingling feeling in arms and legs which distracts from the venipuncture.
It is possible to experience complications at the site where the needle entered, for example hematoma (a localized swelling filled with blood) – all of which usually clears up in just a few days without any major complications.
While IV sedation is desired precisely because of the amnesia effect (i. e. forgetting what happened while under the influence of the drug(s), there can be a downside to this: if you can’t remember that the procedure wasn’t uncomfortable or threatening, you can’t unlearn your fears. However, it depends on the precise nature of your phobia and the underlying causes to which extent this may be a problem. Some people would voice a concern that some patients can’t be “weaned off” IV sedation, as dental anxiety tends to returns to baseline levels. As a result, people who rely on IV sedation may be less likely to seek regular dental care. Other people would argue that this is not a concern if IV sedation is readily available to people.
Recovery from IV administered drugs is not complete at the end of dental treatment. You need to be escorted by a responsible adult, go home and rest for the remainder of the day.
You should WANT to be sedated. If, for any reason, you’re unwilling to “let go”, for example because you don’t like not being in control, it will be more difficult to be successfully sedated.

Before IV (and oral) Sedation:

You may not have anything to eat or drink (including water) for eight (8) hours prior to the surgery.
If you take routine oral medications, please check with Dr. Kaushesh prior to your surgical date for instructions on which medications to take prior to your surgery
No smoking at least 12 hours before surgery. Ideally, cut down or stop smoking as soon as possible prior to the day of surgery.
A responsible adult must accompany the patient to the office, remain in the office during the procedure, and drive the patient home.
The patient should not drive a vehicle or operate any machinery for 24 hours following the anesthesia experience.
Please wear loose fitting clothing with sleeves which can be rolled up past the elbow.
Contact lenses, jewelry, and dentures must be removed at the time of surgery.
Do not wear lipstick, excessive makeup, nail polish or high-heeled shoes on the day of surgery.
If you have an illness such as a cold, sore throat, stomach or bowel upset, please notify the office.

After IV (and oral) Sedation:

Have your escort take you home and rest for the remainder of the day.
Have an adult stay with you until you’re fully alert.
Don’t perform any strenuous or hazardous activities and don’t drive a motor vehicle for the rest of the day.
Don’t eat a heavy meal immediately. If you’re hungry, eat something light, e. g. liquids and toast.
If you experience nausea, lie down for a while or drink a glass of coke.
Don’t drink alcohol or take medications for the rest of the day unless you’ve contacted your dentist first.
Take medications as directed by Dr. Kaushesh.
If you have any unusual problems, call Dr. Kaushesh on his direct cell phone number 928-412-0409.

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