Q: Dr. Crapo: I have a terrible gag reflex – so bad that I can barely get my tooth brush in my mouth. When I go to the dentist or hygienist it’s embarrassing because I almost throw up when they try to take x-rays. When the hygienist tries to clean my teeth it’s impossible – any picking farther back than my upper front teeth and I’m gagging so badly I have to move her hands away and sit up or I throw up. Several weeks ago my dentist said he could give me something to help my gagging. He said it was a pill that would make me drowsy and that would take away my gagging reflex. He called it sedation dentistry. He said it was new and really worked so I gave it a shot. Well it did make me drowsy but boy I almost threw up a lung when he got into the back of my mouth. I was drowsy no more! I was throwing things out of my mouth, sitting up and violently gagging like I’d swallowed a bag of maggots. What am I to do? He said he’d refer me to someone who did hospital dentistry where I’d go under general anesthetic but that takes months to get in and I’ve got a bad tooth now. He said he could also refer me to someone who does I.V. sedation but he doubted that would do the job any better than the pill he gave me. I need help now; can you give me some direction?
A: In the past ten or so years oral sedation for dental procedures has been monikered (named) “Sedation Dentistry” and been advertised under that name. Though a bit misleading in its claims it does help a reasonable number of people. It requires certification by the dentist administering it and done properly requires monitoring with a pulse oximeter (measuring of oxygen content in the blood, heart rate and blood pressure). A fee is attached to this service as extra monitoring by dental personnel and continual training of the dentist is required.
The problems associated with oral sedatives are induction time – the degree of sedation control by the dentist, depth of sedation and duration of the sedation. This article can’t deal with these issues in any depth, only to say that I.V. sedation acts almost instantly, can be titrated (measured) to the appropriate depth of sedation necessary for each individual and maintained at that level for the entire procedure. Broader and longer dental procedures can be performed for almost 100% of patients requiring this service, (including gagging of your type).
The certification necessary for this service is more rigorous and requires constant certification of the dentist and staff to deliver these services. Requirements to make this a safe modality of treatment are constantly under review by the profession’s licencing authority. A few dental offices offer this service as part of their dental care.