semi unconscious dental sedation
treat your teeth despite the fear of the dentist
our zero fear zero pain COMMITMENT:
YOUR DENTAL CARE UNDER SEMI-CONSCIOUS SEDATION
SEMI UNCONSCIOUS SEDATION OF TEETH
TAKE CARE OF YOUR TEETH DESPITE THE FEAR OF THE DENTIST
Any type of protocol that puts the patient into “artificial deep sleep” but not into an “artificial coma” is called “semi-unconscious sedation”.
Semi-conscious dental sedation is performed by an anesthesiologist in the office or in a clinic. The patient is put into an artificial sleep that is close to natural sleep but without awareness of his or her environment.
The use of one or the other of these techniques depends on the training of the anaesthetist, the desire and need for comfort of the patient, the level of invasion of the procedures to be performed, their duration, their frequency and the legislation in force in the country where these procedures are performed and of course, the degree of fear of the dentist or the phobia of the patient of dental care.
WHO CAN BENEFIT FROM SEMI-CONSCIOUS SEDATION DENTISTRY?
Also called vigorous sedation, semi-unconscious sedation dentistry is the second level of sedation dentistry, after conscious sedation dentistry, and beforeunconscious sedationdentistry, in this classification.
Semi-conscious dental sedation is particularly indicated for the following patients:
Patients with a fear of the dentist or a phobia of the dentist requiring oral care that would be impossible to tolerate without appropriate dental sedation;
Patients who are far from regions with specialized dental care centers. In order to minimize the loss of time and travel expenses, these people can group and compact their oral care sessions, under dental sedation in the greatest comfort;
Patients whose work activities are very time consuming. These people have little time for their oral health. In the same way as before, they can group and compact the maximum number of oral care sessions in a minimum amount of time, while maintaining maximum comfort;
Fragile, elderly patients, those in poor health or simply those seeking maximum comfort who wish to have the soothing presence of an anesthesiologist during dental care;
The anesthesiologist will accompany these fragile patients to reassure them and make them feel safe thanks to a gentle dental sedation and a monitoring of vital functions at the office or in the clinic during oral care.
The CHOICE OF SEMI INCONSCIOUS sedation
The gold standard of intravenous sedation for a wide range of care
DIAZANALGESIA
The main technique of semi-unconscious sedation, diazanalgesia, is so named because it consists of injecting the patient intravenously with anxiolytic sedatives of the Benzodiazepine family. The patient remains in an altered state of consciousness, comfortable and non-anxiety inducing, while the dentist concentrates on the procedure. It represents the dental sedation technique of reference for many patients who have to undergo oral surgery such as dental implants, gingival grafting, pre-implant bone grafting or denture placement, conservative care. The indication of this dental sedation technique is for any relatively long oral care during which discomfort, stress or lassitude may occur. Because of its great flexibility and reversibility, diazanalgesia can be prolonged as long as necessary. The anaesthetist-resuscitator, during dental sedation by diazanalgesia, accompanies the dental surgeon at all times during oral care. He re-injects the patient with intravenous doses of sedatives so that the session takes place in the best conditions of comfort, both for the patient and for the dentist. The difference with narco-hypnosis is that the anxiolytic sedatives are injected in larger quantities, which exempts the anesthesiologist from practicing hypnosis by self-suggestion. However, the protocol rollover is similar and the instructions almost identical.
Injected intravenously, Benzodiazepines make the patient both unaware of what is happening in the operating room and of the duration of his oral care, while allowing him to respond to simple instructions. The rapid elimination of sedative and anxiolytic drugs allows the patient to wake up immediately after the operation. Hence, the other name for diazanalgesia: “vigorous sedation”.
The patient, placed in a deep sleep, is thus totally uninhibited and in the best conditions to conduct the procedure correctly.
The anxiolytic sedative will be injected regularly, causing induced sleep. It will be reversible very quickly, as soon as the injection is stopped.
Because of the very rapid elimination of Benzodiazepines, this protocol can be repeated the next day, if necessary. It is particularly well suited to long, compact dental care sessions.
The major advantages compared to conscious sedation, by taking anxiolytic tablets relaxing tablet or inhalation of MEOPA gas lie in its non-random character.
Indeed, if the effects of the anxiolytic sedative tablet or the inhalation of MEOPA gas are relatively variable from one person to another, it is not the same for diazanalgesia. On the contrary, its progress is perfectly controlled by the anesthesiologist. The latter regularly administers intravenous quantities of anxiolytic sedatives according to the need for immediate sedation. Direct injections into the bloodstream are much more potent and controllable than oral Benzodiazepine tablets whose active amount depends on their passage through the digestive barrier.
As for the relaxing tablet, MEOPA gas or narco-hypnosis, this method of dental sedation does not replace local anesthesia, which must in all cases be performed by the dental surgeon.
At the end of the session, the patient wakes up immediately. He has a conscious exchange with the health care team. In some cases, he may not remember this exchange a few hours after returning home: this is called retrograde amnesia. Indeed, the injected drugs have a perfectly normal amnesia effect. That is why the patient must be taken home by a relative.
All patients are eligible for this technique. Indeed, being immersed in a deep sleep with the constant presence of an anesthesiologist is the most soothing and reassuring way to be cared for, while being unawareof what is happening around you.
But some people need dental sedation more than others:
— Anyone who is anxious about a dental appointment can request this type of sedation;
– Dental sedation by diazanalgesia is of primary interest to people who are afraid of the dentist or even phobic of the dentist ( stomatophobe).
— But also people who have a phobia of injections ( achmophobic person), or phobia of blood ( hemophobic person);
– Sedation dentistry is the only protocol available to dentists to help patients who are at risk of not receiving care due to psychological apprehension;
– Patients who regularly experience gag reflexes during oral care.
Some people, when approaching the dentist’s instruments, have an uncontrollable nausea reflex. These nausea reflexes are purely psychological and disappear with the loss of consciousness. These patients will be greatly soothed by this type of sedation. They will not see these instruments and therefore will not feel any apprehension, since their brain is totally disconnected from reality.
– People who are far from specialized dental clinics.
When you live in a place that does not have facilities adapted to the specific needs of patients, dental sedation by diazanalgesia is very practical to be treated away from home. It offers the possibility of compacting large-scale oral care, with long and very close sessions in total comfort. This gain in time and peace of mind is extremely valuable.
– People with time-consuming jobs.
Some people are unable to devote the necessary time to their dental health because of a busy schedule. They will also be very interested in this type of semi-unconscious sedation. Indeed, it will be an opportunity for them to treat in depth dental problems of all kinds, such as dental implants, bone grafts such as sinus fillings, dental veneers or any other time-consuming and/or painful oral care protocols.
Oral care will be compacted into four to five hour sessions until the treatment plan is completed. The total number of sessions will be reduced to a minimum. These sessions can be held closer together or further apart, depending on the patient’s specific needs.
– People who are used to a comfortable lifestyle.
Some people like to live in maximum comfort and do not want to experience painful or even just delicate moments in a dental office. They will inevitably be seduced by the absence of unpleasant sensations during semi-unconscious sedation. Paradoxically, these sessions become very pleasant as they plunge the patient into a state of “bliss”.
If you have chosen to use diazanalgesia for your dental care under sedation, you should know that the procedure, conducted by the dental surgeon, will be at the side of the anesthesiologist during all oral care. This protocol is designed to be as secure as possible.
During the procedure, the anesthesiologist, who performs the diazanalgesia, constantly monitors the patient’s vital functions and degree of unconsciousness, so that the patient is in a constant state of maximum comfort.
Monitoring requires a cardiac monitor, oximeter, blood pressure monitor, a safety column to ventilate the patient in case of apnea, as well as all the medical gases such as oxygen, necessary to deal with emergency situations.
Generally speaking, the equipment available in the dental office equipped for dental sedation is the same as in a clinic recovery room, in order to guarantee the highest level of safety.
It is important to know that the fear of the dentist or the stress in a dental office, can generate discomfort that is much more dangerous than a dental sedation well conducted by an anesthesiologist with appropriate equipment.
It is important to check that dental offices have the appropriate resuscitation equipment for this type of anesthesia. Emergency training should be that of a resuscitation professional, even though most dentists have had basic training in their education.
A conclusion is in order:
– The control of the fear of dentistry and stress in a dental office, as well as the control of the vital functions of the patient by trained anesthesiologists, allow to secure even heavy interventions, paradoxically better than interventions considered light, with an absence of all the resuscitation equipment and skills mentioned above.
When the procedure is over, you wake up gently, because the effect dissipates very quickly when the Benzodiazepine supply stops, as the half-life of these products is very short.
Stop the stress! Even if there is no such thing as “zero risk” in medicine, you have chosen to surround yourself with recognized expertise in dentistry and anesthesia. You will wake up with a diffuse, soft and rather pleasant memory of this experience.
This dental sedation protocol makes it possible to compact oral care into one or a few sessions and considerably reduce the overall duration of care.
All oral treatments can be done without pain and without fear as for example:
– Conservative dental care;
– Dental prostheses, such as ceramic crowns or ceramic bridges.
It is particularly indicated for large-scale care, such as all oral surgery procedures.
For example:
– Pre-implant bone grafts (sinus fillers, alveolar bone grafts, dental extractions)
– Implant surgery, maxillofacial surgery preimplant ;
– Gum surgery (muco-gingival and periodontal surgery).
Dental sedation by diazanalgesia changes the patient’s state of consciousness. The latter is plunged into a deep artificial sleep. He is as unaware of his medical environment and the oral care he receives as he would be with neurolept-analgesia or general anesthesia. However, these techniques are very different. The latter two should only be used when absolutely necessary. Only Switzerland allows these levels of deep sedation in the dental office. Unlike France, which has not yet legislated in this sense and still prefers a hospital environment.
The oral care sessions under dental sedation by diazanalgesia can be repeated at a very close rhythm, because of the very fast elimination by the body of Benzodiazepines.
Because of the injections of antibiotics, anti-inflammatory drugs and powerful intravenous analgesics, the post-operative effects and pain are minimal;
There are very few contraindications to this method of dental sedation. However, precautionary principles are applied:
– Each dental sedation by diazanalgesia does not exceed a duration of five hours, as a precautionary principle;
– Dental sedation by diazanalgesia is strictly supervised by an anesthesiologist. He will have taken note of your state of health during the obligatory preoperative consultation and will not have identified any medical contraindication to this mode of semi-inconscious sedation;
– You must fast, that is to say, stop eating and drinking, six hours before your procedure;
– The memory of the interventions is diffuse and rather pleasant. However, you may not remember waking up or going home: This is the phenomenon of postoperative retrograde amnesia. It is a normal side effect of injected anxiolytic sedatives. That’s why you need to be accompanied home by a loved one;
– It is advisable not to spend the night after your intervention, alone at home;
– It is forbidden to drive during the 12 hours following anesthesia, as an obvious precautionary measure;
– You are not allowed to consume alcohol or tobacco;
– Depending on the type of surgery performed, you may be able to resume your daily and professional activities the next day.
NARCO-HYPNOSIS OR MEDICATED HYPNOSIS
Narco hypnosis or medicated hypnosis as dental sedation for patients with fear of the dentist or phobia of dental care. It combines the intravenous injection of a mild sedative and hypnosis by autosuggestion.
Its main advantage is that it minimizes the injection of intravenous sedative doses, since the patient is already placed in a hypnotic state by the anesthesiologist through autosuggestion.
The sedation dentistry technique begins with the placement of a venous access or catheter to allow for the injection of antibiotics, anti-inflammatories and painkillers or any other useful medications.
It is important to note that the venous approach is a guarantee of safety for the patient. In fact, comfort or emergency medications can be immediately injected by the anesthesiologist if needed, in addition to dental sedation for fear of the dentist.
For achmophobic patients (patients who are afraid of injections), the application of an EMLAPATCH, containing 5% local anesthetic, on the veins of the elbow crease, makes it possible to feel nothing when the catheter is inserted.
The catheter also provides permanent access to the body to inject medication in case of emergency or medical distress. This is an undeniable guarantee of safety for the patient, whatever his state of health or stress. This safety is particularly important for patients who are afraid of the dentist or have a phobia of dental care.
All the techniques previously described in the chapter on conscious sedation, such as the use of anxiolytic tablets and inhalation of MEOPA gas, can be combined with the techniques of semi unconscious sedation, in order to prepare the patient, who is afraid of the dentist or has a phobia of dental care, to a total relaxation
The combination of injection of a mild benzodiazepine sedative and Ericksonian hypnosis-type autosuggestion involves a certain receptivity to hypnosis in general. However, people with strong personalities or patients with a fear of the dentist or a phobia of dental care (patients with stomatophobia) are not very receptive to hypnosis. Some of them are even totally resistant.
The solution is to increase the amount of sedative injected intravenously, until the desired state of drowsiness and psychological relaxation of the patient is achieved. Sedatives, administered intravenously, immediately optimize the effects of hypnosis and vice versa.
All people who want to be treated at the dental office are eligible for this dental sedation because it makes dental care very comfortable. But, it is particularly indicated for the following patients:
– Patients undergoing invasive or surgical procedures and/or relatively long procedures may consider this mode of dental sedation.
– Patients with a fear of the dentist or dental phobia, extremely anxious about receiving dental care, or people legitimately anxious about undergoing major surgery, can be treated in maximum comfort and safety.
– People who are geographically distant from the poles of specialization in the rejuvenation of your smile and implantology or large-scale jaw rehabilitation in cosmetic dentistry . This type of treatment plan involves numerous sessions that can be compacted into a reduced number of trips to the dental office.
The patient, placed under dental sedation with an intravenous line and relaxed by self-hypnosis, will detach himself from his lived situation and reach a state of modified consciousness.
Thanks to the intravenous sedative injections and the autosuggestion, his fears and apprehensions disappear. Plunged into a state of artificial sleepiness, he will have the feeling of “floating”, of detaching himself from the oral care in progress.
However, as with the relaxing tablet or MEOPA gas, this method of dental sedation is not a substitute for local anesthesia, which must in all cases be performed by the dental surgeon.
This mode of dental sedation by narco-hypnosis can only be performed by an anesthesiologist trained in Ericksonian hypnosis.
The patient met with the anesthesiologist for the mandatory preoperative consultation. After the doctor has validated the protocol, the procedure is scheduled at the office or clinic.
The patient arrives at the surgery site fasting for at least six hours.
He is placed in a semi-recumbent position on the dental chair. If necessary, he or she may have already taken a relaxation pill. MEOPA gas can also be offered. The anesthesiologist then places the catheter, to diffuse the sedative intravenously, at the place where the EMLA patch has anesthetized the area, at the elbow.
Once the catheter is inserted, the anesthesiologist changes the state of consciousness through self-hypnosis.
The sedative, of the benzodiazepine family, injected intravenously at the same time, decreases the effect of hypnosis, until the patient is completely disconnected from reality.
From this point on, the dental surgeon begins to treat the patient. The latter is no longer aware of the nature of the care administered, nor of its duration.
A minimal dose of sedatives is administered. The reversibility of his condition is immediate at the signal of the anesthetist.
After waking up, the patient leaves immediately. As a precautionary measure, he/she should be accompanied by a relative or friend to his/her home.
He will be able to return to his daily routine the next day.
All types of oral care can be performed under dental sedation by narco-hypnosis in the dental office.
This technique can also be performed in hospitals or clinics for particularly heavy and invasive operations.
All types of oral health care, such as dentures or oral surgery, are eligible for this type of dental sedation.
Discuss this point with your dentist without embarrassment. He or she will advise you on the best way to deal with your stress level and the type of care you should receive.
Zero risk” never exists in medicine even if all precautions are taken. There are rules to follow:
– You must fast, that is to say, stop eating and drinking, six hours before your procedure;
– You are allowed to go home right after you recover from the procedure. But, make arrangements for a loved one to drive you home;
– You will also make sure that you do not spend the next night alone at your home;
– It is forbidden to drive, as an obvious precautionary measure, during the 12 hours following your anesthesia;
– You can have a light meal in the evening, without consuming, of course, neither alcohol nor tobacco.
By respecting these indications, you will keep a diffuse, rather pleasant memory of the intervention.
Due to intravenous injections of antibiotics, anti-inflammatory drugs and strong analgesics, the postoperative effects and pain are minimal.
Depending on the procedure performed, you may be able to resume your daily and professional activities the next day.
SEDATION COMBINED WITH HYPNOSIS FOR PATIENTS AFRAID OF THE DENTIST
YOU ARE UNIQUE!
CLINICAL CASES OF SMILE RESTRUCTURING UNDER SEMI-CONSCIOUS DENTAL SEDATION
