Dental Sedation

The following definitions, cited in the American Dental Association's (ADA) Guidelines for the Use of Conscious Sedation, give some consumer-friendly definitions for the different types of analgesia and sedation.

Analgesia is the reduction or elimination of pain in the conscious patient, such as novocaine injections.

Conscious Sedation is a minimally depressed level of consciousness during which the patient is able to breathe independently and/or respond purposely to verbal command.

Deep Sedation is a controlled state of depressed consciousness accompanied by a partial loss of protective reflexes, including the ability to breathe independently and/or respond purposely to verbal command.

General Anesthesia is a controlled state of unconsciousness accompanied by partial or complete loss of protective reflexes, including the ability of breathe independently and/or respond purposely to verbal command.

Most in-office dental procedures involve the use of the lowest level of analgesia - what is commonly referred to as the novocaine injection, although the anesthetic most commonly used is actually xylocaine. This provides anesthesia directly to the area in which the dental procedure occurs. This type of anesthesia generally wears off within a short period of time. Your CDA member dentist will advise you to be cautious of eating until all sensation returns, as you can burn your tissue with hot liquids or bite your cheek, lip or tongue without realizing it.

Conscious sedation, deep sedation and general anesthesia, while not used routinely in most dental procedures, are a necessity for some. They provide effective pain and anxiety control, without which it would be virtually impossible for many patients to receive the care they need. Some of these pain control techniques help bring care to many vulnerable patients including children, the elderly and disabled patients

When discussing the use of dental anesthesia, the patient should disclose information about any illnesses, allergies, other health conditions or concerns with their dentist. In the case of a child, any medications that a child is taking should be discussed. The parents should ask if the dentist follows ADA guidelines for anesthesia and sedation. The patient or parent should always keep asking questions until the procedures are fully understood and, if there are concerns, it is always appropriate to seek a second opinion.

Are anesthesia and sedation safe?

Dentists in California have a long and enviable history of the safe utilization of general anesthesia in their practices.

1999 marked the 20th year since the enactment of SB 389 (Keene), a measure sponsored by the CDA to establish the general anesthesia permit requirement. The bill was modeled after ADA guidelines and an already existing assessment process used by the California Society of Oral and Maxillofacial Surgeons (as oral surgeons perform most of the total general anesthesia procedures in the state).

CDA sponsored legislative efforts to add a similar permitting requirement for dentists utilizing conscious sedation, as well as a certification process for general dentists using oral conscious sedation for pediatric patients.

In order to strengthen safety measures for children under the age of 13 receiving oral sedation, CDA sponsored AB 2006 (Keeley) in 1998, to set up a Dental Board of California certification process for dentists who do not have a general anesthesia or conscious sedation permit. In mid-August of 1999, the Board passed regulations which include specified education, training and continuing education requirements (as well as a grandfather clause for those now performing oral conscious sedation).

Currently, dentists are required to receive extensive training and review to obtain a general anesthesia permit. Requirements include:

  • A one-year or equivalent advanced anesthesiology training course approved by the Dental Board of California.
  • A comprehensive onsite inspection by a team of at least two dentists (selected by the Board) who themselves have extensive general anesthesia experience. Evaluators must observe an anesthesia procedure and determine that the applicant, and the office in which the inspection is conducted, have the proper equipment, lighting, drugs, records, etc.
  • Permit holders must undergo a reevaluation every six years, and must complete at least 15 hours of continuing education courses in general anesthesia every two years in order to renew the permit.

Dentistry has an excellent safety record. Dentists and the CDA are committed to advancing the safety of all dental procedures and reducing risk, although we can never completely eliminate all risk to health care procedures.

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