Routes of Administration
Sedation is sometimes necessary in some patients, particularly those with disabilities. Sedation may be necessary for individuals with extreme phobia concerning dental treatment; those with involuntary movements - such as tics or other neuromotor symptoms; and patients whose cognitive disability is such that they cannot comprehend the need for dental care, nor understand the intent of the dental provider, despite attempts to explain procedures and gain compliance. Sometimes children are able to tolerate minor procedures fairly well; while more involved procedures may require sedation. Types of sedation range from light, or conscious, sedation, to general anesthesia.
Some oral sedatives commonly used in dentistry are midazolam, chloral hydrate, hydroxyzine, and diazepam. These agents typically induce conscious sedation. Oral sedatives are easy to administer. They may be used alone or in combination to enhance their effect. The use of oral agents typically allows the patient to remain awake - and thus able to assist with positioning, answer questions, etc.
Administration by entering a mucous membrane. These drugs are water soluble, or have high water solubility, and they can be absorbed through mucous membranes.
Administration within the nasal or periorbital sinuses. Intranasal drug delivery is a non-invasive, first line method which results in therapeutic drug levels and effective treatment of pain and anxiety without the need to give a shot or a pill.
Intramuscular (IM) sedative administration may be used occasionally within the dental operatory setting. IM sedation is typically used for procedures of short duration. IM may be used with clients who don't want to swallow oral medications or are unable to do so. The IM route of administration usually offers more effective absorption, and is faster-acting than medications given orally.
The advantages of IV sedation include its rapid onset of action, effectiveness, and the dentist's ability to carefully control the level of sedation by adjusting the rate or dose of medication administration continually. Should an adverse reaction occur, emergency medications may be administered through the IV access. IV sedation is especially useful for the completion of lengthy dental procedures. Sedation administered in the dental office is much more cost effective than that performed in a hospital setting.
A combination of oxygen and nitrous oxide ("laughing gas") is the most commonly used agent for sedation in dentistry. Nitrous oxide is considered safe and can be effective in relieving anxiety. Nitrous oxide is very short-acting; patients typically recover 3-5 minutes after pure oxygen inhalation. Patients are able to follow instructions and cooperate.