Many people do not like visiting the dentist – who can blame them? Who wants to visit someone who is likely to give you an injection or hurt you in other ways? Although everyone needs regular dental treatment and maintenance, few visit the dentist gladly. Even a routine dental check-up produces fear in some people. But most realise that it is painless, unless you have not visited your dentist regularly. This is where sedation in dentistry (which I shall abbreviate as sedation dentistry) comes into sharp focus. Sedation dentistry allows a patient to receive otherwise unpleasant and/or painful dental procedures in comfort. When conscious sedation is used in sedation dentistry, dental treatment is almost a pleasure. The safest form of sedation dentistry is through the use of low doses of nitrous oxide plus high concentrations of oxygen. When nitrous oxide sedation dentistry is used, the patient is fully conscious throughout and can freely communicate with the dentist and his staff. As a result sedation dentistry with nitrous oxide/oxygen allows the dentist who administers the gas to also simultaneously do the dental treatment. Apart from nitrous oxide/oxygen, there are other forms of sedation dentistry, but these should not normally be undertaken by dentist who is doing the treatment himself. When using these other forms of sedation dentistry the patient’s level of consciousness sharply contrasts with those when using nitrous oxide/oxygen sedation dentistry. Although at very low concentrations the drugs used, apart from nitrous oxide/oxygen can produce an acceptable and manageable form of conscious sedation they are very much more potent than the gas. When these other more potent drugs are used there is always the danger of producing anaesthesia, with full unconsciousness. Because of the ever-present danger of the patient slipping almost unnoticed into full anaesthesia these more potent drugs must be used with additional sophisticated external monitoring systems to protect the patient. The minimum monitoring required with potent sedation dentistry drugs are oxymetry and electrocardiography. These external monitors are not needed for nitrous oxide/oxygen sedation dentistry and local anaesthesia.
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