In general, patients are apprehensive about dental procedures mainly due to the fear of the unknown. Therefore, adequate anxiety control is an integral part of patient management.

Most patients respond well to counselling and explanation of procedures. Some of them may refuse treatment outright due to fear, and a few agree to undergo procedures out of necessity but with great anxiety nevertheless. This could be an unpleasant experience for the patient and a trying time for the dental surgeon. These patients will be immensely benefited by "conscious sedation" or ‘sleep dentistry’ (Twilight Sleep), which is a technique in which the use of a drug or drugs produces a state of depression of the Central Nervous System, enabling treatment to be carried out on a less anxious patient, with whom verbal contact can be maintained throughout the period of sedation.

• In most people, IV Sedation induces a state of deep relaxation and a feeling of not being bothered by what is going on
• The patient is aware of his/her surroundings and communicates with the doctor and attendees, but may not be able to recall much about the procedure later (antero grade amnesia)

Candidates ideal for intravenous (IV) sedation are,

• People with dental anxiety or phobia
• People who need prolonged or difficult procedures
• Medical conditions potentially aggravated by stress (e.g.) bronchial asthma / hypertension / ischemic heart disease
• Patients with special needs

Sedation is commonly achieved by injection of Midazolam, a short duration benzodiazepine. Because there are differences between individuals in how much of the drug is needed to make them comfortable and relaxed, small doses of the drug are given at increments and once the desired level is achieved, (according to the judgement of the anaesthetist), the drug is stopped. Throughout the procedure oxygen saturation, blood pressure and heart rate are monitored. Intravenous Sedation with Midazolam is extremely safe when carried out by trained personnel. It is documented to be much safer than local anaesthesia alone.

All equipment and drugs recommended for treating medical emergencies and sedation related complication should be easily accessible and should be available at the chair side.

Information to be communicated to the patient

• Abstain from alcoholic drinks for 24 hours before the procedure
• Do not eat solids for 6 hours, and liquids for 4 hours before the procedure
• Bring along a responsible adult who can stay through the day
• Take your other routine medications unless advised otherwise
• Avoid tight clothes and high heeled or slippery footwear
• After the procedure, for 24 hours do NOT
  • Drive a car
  • Consume alcohol
  • Operate machinery (including kitchen equipments)
  • Climb ladders
  • Take important decisions or sign documents

Patients who are trying to conceive, who are pregnant and mothers who are breast-feeding must inform the dentist in advance.

Patients on anti-psychotic medication, who are mentally sub-normal, COPD patients, the very young and the elderly are not suitable for conscious sedation.

IV sedation produces only relaxation and is not a painkiller. Hence effective local anaesthetic techniques should be used to relieve pain during the procedure.

Facilities needed during the postoperative recovery period are

• Availability of skilled personnel and supplemental treatment
• Equipment to give supplemental oxygen
• Calibrated pulse oximetrey and blood pressure monitor