Sedation Options

Dr. Ruben Cohen, DDS is Board Certified in Oral & Maxillofacial Surgery to provide various types of pain-free dental procedures (“sedation dentistry“) to allow patients the most comfortable experience, no matter what services are needed. If elected, nitrous oxide (commonly known as “laughing gas”), intravenous sedation, or general anesthesia are offered with all procedures.

What is Laughing Gas?

Nitrous Oxide, N2O, also called laughing gas, is a colorless gas with pleasant, sweetish odor and taste, which when inhaled produces insensibility to pain preceded by mild hysteria or laughter.

The principal use of nitrous oxide is as an anesthetic in surgical operations of short duration.

Nitrous oxide has very distinct characteristics and when inhaled, nitrous produces a variety of physical effects including:

• Disorientation
• Fixated vision
• Throbbing or pulsating auditory hallucinations
• Similarly pulsating visual hallucinations
• Increased pain threshold
• Deeper mental connections

The physiological effects of using nitrous oxide last approximately a minute for a lungful of nitrous and then mainly dissipate. Some residual effects may last up to several minutes later. Nitrous gas works by infusing into the membranes of the body and produces an anesthetic effect.

What are the Benefits of Nitrous Oxide?

The benefits of nitrous oxide are many, and the risks are few. The gas is administered with a comfortable mask placed over the nose, and the patient is instructed to breathe in through the nose and out through their mouth. As a precaution, patients should not eat anything for about two hours prior to use of the gas. The patient begins to feel a pleasant level of sedation in anywhere from 30 seconds to three or four minutes. The cheeks and gums will also begin to feel numb in about a third of the patients.

After the gas is adjusted to the appropriate dose, and the patient is relaxed and sedated, the dentist can comfortably give the anesthetic injection (if needed) to the patient, and then proceed with dental treatment. After the treatment is completed, the patient is given pure oxygen to breathe for about five minutes, and all the effects of sedation are usually reversed. Unlike IV sedation or general anesthesia, the patient can almost always leave the office by themselves, without an escort.

What are the Side Effects of Nitrous Oxide?

Nitrous oxide has few side effects although high doses can cause nausea in some patients, and about 10% of patients do not benefit from it. Patients that are claustrophobic or have blocked nasal passages cannot use nitrous oxide effectively. Nitrous oxide is one of the safest anesthetics available.

What are Anti-Anxiety Medications?

The most commonly prescribed dental related drugs that treat anxiety belong to the “benzodiazepine” family, drugs such as Valium, Halcion, Xanax, or Ativan. These drugs decrease anxiety by binding and toning down activity within “fear” receptors in the brain.

There are two different types of Benzodiazepines:

Sedative-Hypnotics: These drugs induce calm, including drowsiness and even sleep. This sleep state is actually a form of hypnosis, which is a form of physiological sleep.

Anti-Anxiety Drugs: These are drugs which relieve anxiety and induce a state of calm and relaxation.

Benzodiazepines are also Central Nervous System (CNS) depressants (i.e. there can be a decline in blood pressure and breathing). It is important to note that they shouldn’t be mixed with other CNS depressants such as alcohol. Its important that you utilize the dose your dentist or doctor recommends. It is possible to overdose, and overdoses could lower your breathing to dangerously low levels, which could result in coma or death.

Please note that you shouldn’t travel on your own after you’ve taken any of these drugs. Make sure you have an escort, even if you traveled by bus or foot! It’s easy to become disorientated

When Should You Not Take Benzodiazepines?

Some of these drugs can affect your liver and heart. It’s important to check with your practitioner and/or pharmacist.  You should be sure to inform your doctor or dentist if any of the following apply: known allergy to the drug, narrow-angle glaucoma, pregnancy, severe respiratory disease (COPD), congestive heart failure (CHF), impaired kidney or liver function, depression/bipolar disorder/psychoses, chronic bronchitis and some other conditions. It’s also important to let us know if you are taking other medications. There could be possible drug interactions.

What is Intravenous Sedation (“Twilight Sedation”)?

Our office offers our patients the option of Intravenous Sedation, also referred to as Dental Intravenous Anesthesia, or “Twilight Sedation,” for their dental treatment. This is what sets our office apart from other dental practices; it is our niche, if you will.

Intravenous Sedation or “twilight sleep” helps you to be comfortable and calm when undergoing dental procedures. Your treatment can be completed for you under intravenous sedation, if you so desire. Intravenous sedation or “IV sedation” (twilight sedation) is designed to enable you to undergo your dental procedure while you are very relaxed. It will enable you to tolerate the procedure and help you to not remember those procedures that may be uncomfortable for you. IV sedation will essentially help alleviate the anxiety associated with your treatment. You may not always be asleep but you will be comfortable, calm and relaxed, drifting in and out of sleep – a “twilight sleep”.

If you choose the option of intravenous sedation your IV sedation/anesthesia is administered and monitored by Dr. Cohen, therefore eliminating the costly expense of having your treatment carried out in an operating room or same-day surgical facility.

How is the IV Sedation Administered?

A thin needle will be introduced into a vein in your arm or hand. The needle will be attached to an intravenous tube through which medication will be given to help you relax and feel comfortable. At times a patient’s vein may not be able to sustain a needle for the length of the procedure. In this case, the medications will be administered and the needle retrieved. Both scenarios will achieve the same desired level of conscious sedation. Once again some patients may be asleep while others will slip in and out of sleep. Some patients with medical conditions and/or on specific drug regimens may only be lightly sedated and may not sleep at all.

The goal of IV sedation is to use as little medication as possible to get the treatment completed. With IV sedation, a constant “drip” is maintained via the intravenous tube. At any time an antidote can be administered to reverse the effects of the medications if necessary.

What is Sedation Dentistry for the Elderly?

As we age, our oral health becomes more important than ever. Periodontal disease can lead to bone and tooth loss, which affects nearly every part of our daily lives. To lead full and active lives, we need our teeth and gums. They allow us enjoy food, support speech and good conversation, and facilitate digestion. Dr. Cohen is dedicated to treating elderly patients with care and commitment to comfort and health.

Elderly patients as a group tend to avoid dental visits for a variety of reasons, including: more pressing medical concerns, anxiety about treatment, the hardship of transportation, or fixed incomes. Once their oral health has reached an unmanageable point, fear and embarrassment further keep these patients away from the dentist.

For elderly patients embarrassed or fearful of their current oral state, sedation dentistry provides the opportunity for Dr. Cohen to treat these conditions while the patient remains relaxed and unaware until “awaking” to an improved oral state!

What is Sedation Dentistry for the Disabled?

It may be especially difficult for people with disabilities to obtain access to proper dental care. They must find a dentist who is skilled and compassionate, and who can provide services for which some dentists may not be qualified. At Park Avenue Oral & Facial Surgery, we provide the expertise, state-of-the-art-equipment, and dedication to assisting special-needs patients necessary to ensuring great oral care for our patients.

Disabled patients may face added challenges in maintaining their oral health. Their disability may make it difficult to brush or floss regularly; they may also suffer a severe gag reflux, or dry mouth as a result of medication. Dr. Cohen meets these challenges with sedation dentistry for the disabled. He is skilled in anesthesia for special-needs patients, and can ease the fear associated with out-of-control oral hygiene with one visit.

What is Sedation Dentistry for the Fearful?

Dental phobia is a real, often overwhelming reality for thousands of people. Negative previous dental experiences, fear of needles or drills, and a severe gag reflux are just some of the reasons people feel extreme anxiety when thinking about visiting the dentist.

If you suffer from dental phobia- fear no more! At Park Avenue Oral & Facial Surgery , we are committed to understanding the very real nature of your fears. Not only will our staff treat you with delicacy and care, but IV sedation will allow you to experience dentistry in a whole new way. While engaging in a pleasant sleeplike experience, Dr. Cohen will be hard at work making sure you “wake up” with the results you desire.