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Who Needs Dental Sedation?

Dentists employ two methods of dental sedation. The first is oral, where dentists provide pills (or syrups for children) for patients to intake one hour before the procedure. The dosage depends on the level of sedation required, but it doesn’t usually exceed moderate sedation.

When dentists need a patient to be perfectly still during a procedure, they administer the sedative through the bloodstream. This is known as intravenous (IV) sedation and is reserved for patients with certain conditions or special needs.

IV sedation for dental work is the middle ground between oral sedation and general anaesthesia. Dentists typically undergo special training to practice sedative dentistry or hire sedationists with said certifications, as a tiny mistake can put a life in danger. This blog post will closely examine the nuts and bolts of IV sedation.

Conscious Sedation

The goal of IV sedation is conscious sedation, meaning the patient is relaxed enough to be still able to respond when prompted but unable to make erratic movements. Oral sedatives are too weak to fulfil the latter, and general anaesthesia is too risky to use regularly. In most clinics, IV sedation is as deep as dental sedation can go.

We briefly discussed the drugs used for this procedure in a previous blog post. But as this post is about IV sedation, we can discuss each in more depth. Dentists or sedationists will determine the most suitable sedative based on the patient’s health profile.


The most common sedative used in dentistry is midazolam, a variant of benzodiazepine, a type of drug used in treating anxiety-related disorders. It triggers a neurotransmitter that reduces nervous activity between nerve cells, reducing anxiety. It doesn’t affect breathing and heartbeat much, making it a safe sedative for children and adults.

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Midazolam takes effect within three minutes of entering the body and takes 15 minutes for half of the drug to wear off, known as the half-life. However, possible side effects like self-harm, restlessness, and agitation can kick in five minutes after being administered. Dentists or sedationists must quickly pacify the patient in such a situation.


Until recently, it was believed propofol works like a sleeping pill. However, researchers at the Queensland Brain Institute discovered that it works by hampering the movement of a protein necessary for communicating between neurons.

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Propofol’s effects don’t last as long as those of midazolam, roughly within 100 seconds and with a half-life of up to 8 minutes. That’s why dentists maintain a steady supply of propofol for as long as necessary, though they also need to watch out for a dip in the patient’s blood pressure, which is one of its side effects.

There’s some debate about whether propofol is safe for patients allergic to soy and poultry, as it’s mixed into a solution consisting of egg lecithin and soybean oil. For safety, patients should ask their doctor if propofol is ideal for them.


Ketamine is derived from phencyclidine. It’s the primary drug used in dissociative sedation, where the patient enters a trance-like state where they can’t feel pain but will barely recall anything about the procedure once the drug’s effects wear off.

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Ketamine kicks in faster than other sedatives because of its lipid solubility. It can take effect one minute after being administered, with a maximum half-life of 15 minutes. Side effects include increased heart rate and blood pressure, so it isn’t ideal for people with hypertension.


This drug also nulls pain by preventing the release of norepinephrine, a hormone known for its role in inducing pain. However, dentists or sedationists use little of it, as its side effects include a moderate decline in blood pressure and heart rate. Experts say adequate sedation using dexmedetomidine can be achieved with less than 1 µg/kg/hour of the drug.

In some cases, these drugs don’t work alone. For example, a patient suffering from a side effect of midazolam may receive ketamine to calm them down.

Always Have Company

While not at the level of general anaesthesia, IV sedation dentistry will render a patient unable to act independently for at least 24 hours. The more sedative pumped into the patient’s body during the procedure, the longer the recovery time.

Before any procedure involving IV sedation, dentists always advise patients to have someone bring them to and from the clinic. This individual will be responsible for everything the patient usually does until the sedative’s effects disappear, including reporting any adverse side effects. They can be a close relative or a trusted friend.

As much as dental sedation is generally safe, there are also risks. Make sure to engage the services of a qualified dentist to perform mild to moderate sedation. Regular dentists can do minimal to moderate sedation. However, higher qualifications are required for deep sedation. After carefully evaluating your health, the dentist will choose age-appropriate and FDA-approved dental sedation.


Not all dental cases warrant IV sedation. In those that do, dentists exercise caution in preparing the necessary tools and, more importantly, dosages of the sedative. If done correctly, IV sedation can be indispensable in getting even the most fearful of tending to their dental health.

With this in mind, are you ready to go to your dentist? If you need more details, head to this page to learn more about pain-free dentistry.