How can a person be conscious and sedated at the same time?

The very sound of it makes one wonder how a person could be conscious and at the same time sedated. This can happen or would have happened to anyone at some point or the other. For example, there can be situations in the classroom where you find the lecture to be very boring and you are only present there physically but not mentally. All of a sudden when you’re disturbed or asked a question, you respond without a clue of what the lecturer has asked about. You might be able to recollect some information, but not the whole of it. This is exactly what happens in conscious sedation dentistry.

How is conscious sedation administered?

It can be administered in various routes such as oral route, intravenous route, inhalational and intranasal to name a few. But the most common and reliable routes of administration pertaining to dentistry and pediatric dentistry are inhalational (nitrous oxide) and intravenous (use of midazolam).

What is NOIS?

Nitrous Oxide Inhalational Sedation, as the term implies, is used in both adults and children to make their dental treatment very pleasant and comfortable. This is administered using particular equipment with necessary safety protocols by mixing N2O-O2. When given a certain dose for a particular patient, it takes about 3-5 minutes to act on the body. Nitrous oxide, commonly called as laughing gas, triggers your happiness and smile stimulating hormones in the body. When these are stimulated, anxiety, fear and pain stimulation are inhibited, thereby increasing your tolerance level to a large extent. At this point when you communicate with the person he/she obeys your verbal commands more effectively and efficiently in a happy state of mind. At this relaxed state, a prick of the needle does not bother them, bitter substances really do not taste very yucky and vomiting sensations are subdued, resulting in the much enhanced cooperation ability of the person.

What is the age range at which NOIS can be administered?

People right from the age of five till the age of eighty or more can be given this form of sedation.

Is it not recommended for younger kids less than five years?

The procedure requires some amount of co-operation from the child to inhale and exhale continuously till the end of the procedure through a small mask kept on the nose. Children below five years are mostly lacking of co-operative ability. Their mental and physical developments are immature to handle such procedures without difficulty.

Then what is the alternative for such young children?

Either the problem can be addressed with Day Care General Anesthesia or with the use of intravenous sedation. It is generally left to the pediatric dentist to decide on what type of sedation is ideal for a kid.

Why is it that the focus is on children when you talk about sedation?

Every child who walks into the dental operatory will show signs of anxiety and fear towards dental treatment. When this anxiety and fear is not addressed comfortably for the children they tend to carry it till they become adults. Because of this, most of them happen to be poor dental patients with multiple problems at a later age.

“Adults do not show anxiety and fear unless elicited but children show it very openly”

That is the only difference. Hence sedation is more commonly used in children than in adults.

How do you decide whether an individual requires sedation or not?

A lot of factors come into play during this decision. A few factors among them are:-

• Intensity and invasiveness of the dental problem
• Age of the child or individual
• Less number of dental visits
• Addressing multiple problems in a single appointment
• Overseas patient (staying for a stipulated period)
• History of unpleasant dental experience previously
• To develop a positive attitude towards dental treatment

How frequently do you use it in your dental office?

For every 7 to 8 out of my 10 pediatric clients.

In adults, approximately 30-40% of the patients in my dental practice require some form of sedation for a comfortable treatment.

What are the advantages the seeker (patient) experiences?

• Reduced dental visits as multiple dental work is addressed
• Less intake of medications
• Time compression (though you stay in the dental chair for 4 to 5 hours continuously, you’ll feel like you have stayed for about 20 to 30minutes)
• Positive attitude towards dental treatment.
• Allay of anxiety and fear towards dentistry.

What are the advantages that the operator (dentist) experiences?

• More productivity for the operator
• Less strain in his/her posture
• Work can be done continuously without stopping
• Less salivary secretions – Enhanced quality of work
• Consistency in delivering good quality treatment.