Special Report By Dr. Vadivel
WHAT IS IV SEDATION FOR DENTISTRY? IS IT FOR ME?
“IV sedation is the best!! I would not hesitate to use it again if I needed to. They numb your hand first, they put the IV in, and before you know it you are off to sleepy land. I really don’t remember much, just bits and pieces of conversations.”
Are you amongst the 15 million people in the U.S. that avoid dentists totally – and several years have passed since your last dental visit? Or are you in the 50% of the population that has fear about dental procedures?
Or do you have medical conditions that make it necessary to reduce the stress level you feel during dental procedures?
Often the reason why people won’t go to the dentist is because they suffered pain in the dental chair. Maybe the pain occurred during dental procedures as simple as cleaning the teeth or in more advanced procedures.
Nevertheless whether it was a zinger type of pain that indicates the nerve root was affected, or it was pain because the tissues had to heal, it doesn’t matter. Your brain registered the pain as something associated with the dentist’s chair.
So the next time you have to sit in the dental chair, that memory comes back to you rapidly. It’s a method of protection for you, just like when you touched a hot stove and got burned; you remembered next time to not touch the hot stove!
Who I Am and How I Can Help You
I’m Dr. Kumar Vadivel, a highly regarded and popular dentist in your neighborhood. I’m not just an ordinary dentist – you know like one who just got out of dental school and hasn’t been practicing very long. Nope, that’s not me. I’ve been practicing for 24 years, and love every minute of it, especially now!
I’m also not like a small percentage of dentists that chose the profession to create fabulous smiles and long-lasting teeth that are still sound when people are in the grave. In fact, I can’t imagine why a dentist wouldn’t make this his or her goal!
I’m one of a selected number of dentists that consciously made the decision to go the distance for my patients. That means getting further education in specialty areas – such as IV Sedation Dentistry.
There’s so much to this subject of pain control at the dentist – and with all this training – and thousands of patient visits over the years, I am able to help patients with pain control that I never could before.
I Went Through Dental Fear, Too
If you have dental fears and phobias, I can feel for you.
I remember when I was a child and suddenly one day I had pain in my tooth. My mother said I had to go to the dentist – and my siblings and friends warned me about it. They said it would hurt.
While they were talking, I got a picture in my head of how I would be trapped in a dentist’s chair and my teeth and mouth would hurt so much…
And when I went to the dentist, that’s exactly what happened. I cried out so loud that the dentist had to stop a few times and leave the room. I was convinced that I had scared him away… but I was wrong. He kept coming back and told me he had to finish filling the cavity in my teeth.
And to tell you the truth, I had expended so much energy in fighting against the dentist for those first 45 minutes that I had no energy left to fight him the last 10 minutes. So I calmed down. And amazingly, I didn’t have any pain those last 10 minutes of the appointment.
What I learned from my own childhood experience is that it was how I felt about the dental appointment that made my pain worse or better.
And over the years, I started to realize that the longer I stayed away from the dentist, the worse the dental appointment was going to be when I had to return.
In dental school, I stopped fearing dental work.
Now fast forward 25 years, and I’m attending seminars that are brand new for the dental professionals on how to do dental procedures on patients without pain.
I was sitting there in those postgraduate classes thinking to myself, “Wow, we dentists have been causing pain for all these years and it’s no wonder that some people have dental anxiety. Yet now with advancements in dentistry, I don’t have to ever cause pain again to my patients. Count me in!”
And that’s when I started using several methods to deal with dental phobia.
To be frank about it, now my patients love me. They don’t avoid me in public anymore! They even invite me to their social gatherings.
My main point here is that if you have feared going to the dentist, you’re missing this information: There have been so many updates to the dental field that weren’t announced on television. Some of these advancements will totally eliminate your fear.
You just have to give them a try. And if your present dentist doesn’t use them, get one that does! You can’t afford not going to the dentist because of fear. Not anymore!
How Do You Know If You Have Dental Anxiety, Dental Fear of Dental Phobia?
7 Signs of Dental Phobia
Take a look at the list below of the signs of dental phobia and see if they apply to you. These signs are for those who have moderate to severe cases of dental anxiety.
1. You feel tense or have trouble sleeping the night before a dental examination.
2. You feel like crying when you think of going to the dentist. The sight of dental instruments — or of white-coated personnel in the dentist's office — increases your anxiety.
3. You get increasingly nervous while you're in the waiting room.
4. The thought of a dental visit makes you feel physically ill.
5. You panic or have trouble breathing when objects are placed in your mouth during a dental appointment.
6. You’ll do anything to postpone the appointment. You would call in sick, say your car broke down, state you are out-of-town on a business trip; anything to prevent having the dental appointment.
7. You have had bad experiences at the dentist in the past.
“I had a major surgery done here and was a little scared at first. Dr. Vadivel and his nurses made sure I was comfy and ready. I had no issues with the surgery and almost no pain afterward. I've already handed out his card to multiple people and would recommend him to anyone. My surgery went great and in no time, I'm gonna have my smile back. Thank you Dr. Vadivel and thanks to all your nurses.” – John T.
Why You Can’t Eliminate Your Fear of Dentistry On Your Own
Once in a while, I get really smart patients that think they can beat their dental fear on their own. They believe that if they put their mind to it, they can stop the heart racing that occurs in the dental chair on their own. They think they can somehow command their mouth to open wide when the muscles are clamping down hard due to fear.
This doesn’t work in most cases unless the patient has an iron will. And even then, many patients will give in to the pain as soon as they start feeling it.
Others try teaching themselves biofeedback and a smaller percentage go to professionals that work with biofeedback so they can control their pain. It works to an extent, but what can they really do when they are in the dentist’s chair and a tooth nerve root cries out once, twice or three times? They may cave in to pain and the fear response is activated once again.
Your brain is great because it adapts to every new experience you have. Think about how you learned how to ride a bicycle as a child. You fell off the bike the first time you got on the bike. Then your brain took the circumstances surrounding the fall and put it into its master computer. The next time you got on your bike the same thing happened. Your master computer made adjustments. By the fifth or sixth time, your brain made your muscles work properly so you could stay on the bike longer. By about the 12th time, you mastered it.
Your brain adapts. With dental pain, it’s so rare to master it. Not very many people can experience tooth pain and say, “Okay, Dr., give me more – the pain stopped! I can handle it!”
Your brain doesn’t naturally remember mastering the dental experience. You only remember the pain.
Only Three Ways to Get Over Dental Phobia
To get over dental phobia, there are only a few ways to be successful:
1. Ascend to a Higher Spiritual Plane
Become a yogi master (before your teeth rot out) and you’ll rise above it, having control over your body’s muscles. When you’re in the dentist’s chair (as long as you’re not levitating!), you’ll feel your muscles clenching as a way to protect you and you’ll relax them… Good luck on this one!
2. Biofeedback Teaches You How to Deal with Unpleasant Situations
Learn several methods of biofeedback on your own – maybe including self-hypnosis, and hope that one of them will work once you get to the dentist for your next appointment.
If you use this method, don’t forget to pre-program yourself that you are going to love feeling how good your mouth feels after the appointment and concentrate on that picture.
The problem with this method is finding the time to create the neurological pathway in your brain that makes it happen. It’s similar to starting a new habit where you need at least 30 days of doing the habit daily to make it into a learned behavior.
All this is a lot of work for you to do, especially if you’re a parent, a student with upcoming papers due and finals, or a busy executive/employee on overtime many weeks of the year.
3. IV Sedation – Your Solution?
Try IV sedation and/or other methods of dental sedation that work really well on just about every patient. No training is required. No years of mastery is required either. With this option, you are using your fear as motivation to still progress in the journey of having good health.
Here’s how dentists explain the meaning of IV sedation: The use of medication through an IV to alleviate/eliminate dental anxiety and fear during a dental procedure.
IV Sedation sounds interesting, right? I think so, too! So I made a chart for you here so you can see
ALL the different types of sedation dentistry that we use in our office.
Table 1. Different Types of Sedation Dentistry, Level of Pain Control, Cost and Who It’s Ideal for
|Pain Control Method||Pain Control||Cost||Ideally For|
From this chart, if you read between the lines, you can see that IV sedation is the ideal solution for you if you have moderate to severe dental phobia.
And you may also be pleasantly surprised to find out that IV sedation is also perfect for those who can’t sit still for long periods of time. Many athletes fit into this category. They thrive on movement and sitting still is nearly impossible. Kids with ADHD also fit into this category.
IV sedation is also great for those who don’t want to have a memory of what happened at the dentist yet are dead set against being unconscious during the procedure.
IV sedation is used for patients during dental procedures such as bone grafting, dental implants, and wisdom tooth extraction. These procedures take a long time and no one wants to suddenly end up having pain in the middle of them! It’s also quite effective for children, too. I wish I would have had it available to me when I was a child. And don’t worry about some types of dental treatment where it can’t be done. Even if you are scheduled for a routine cleaning, your dentist could still use IV Sedation dentistry.
There are Some Patients Who Can’t Have IV Sedation Dentistry
Now before you say you want IV Sedation dentistry no matter what, you should know that not everyone is suitable for it. For example, if you aren’t in good health, then IV sedation is not for you at this time. However, if you start reversing your health disorders, then you might become a candidate for it at a later date.
Your dentist will do a thorough health exam before the procedure to make sure you are right for it.
Dental Phobic Patient Success Story
“As I sat in the chair, I could feel my heart racing and remember telling the dentist that I needed to do this... I didn’t feel the IV being inserted, and as he was topping up the sedation level, he gave me the local injections.”
“By now, this should be freaking me out, but honestly, I only felt a scratch!! And I’m needle-phobic, too…! The infection I've had off and on for months came back with a vengeance last night, and I NEVER felt the tooth being extracted.”
“Basically, I felt a tiny pinch in the back of the hand and in goes the ‘stuff.' Nothing happens for several seconds, and then you begin to feel light-headed (a little drunk) for a few moments, which is not unpleasant. Then several hours have magically passed, and all the dental work has been done.”
What Happens During IV Sedation?
To alleviate your dental anxiety, it’s always a good idea to find out what exactly is going to happen during a scheduled dental appointment you will soon have. You will also benefit from knowing what happens during IV sedation.
Here are some highlights of the procedure:
- You may have been given a medication to take before arriving at the dentist’s office.
- You’ll be guided to the room where your dental procedure is placed.
- Blood pressure is taken before and after the procedure with a blood pressure cuff. Your pulse is also taken.
- Throughout the procedure, your pulse and oxygen levels are measured using a “pulse oximeter.” This gadget clips onto a finger or an earlobe and measures pulse and oxygen saturation. It gives a useful early warning sign if you’re getting too low on oxygen.
- The IV location will be decided and the Venflon will be placed in your arm.
- The medication will be administered through the port.
- After a while, you will feel tired. You are conscious and will hear everything the dentist says.
- At some point during the procedure, you may fall asleep. You’ll awaken when it’s over.
What Drugs are Used During IV Sedation?
There are a few categories of drugs that could be used during IV sedation:
- Anti-anxiety sedatives
1. Anti-Anxiety Sedatives (benzodiazepines): Midazolam and Diazepam
The drug used for IV sedation is a short-acting benzodiazepine or “benzo” for short. This is an anti-anxiety sedative.
IV administered benzos have three effects:
- they reduce anxiety/relax you
- they make you sleepy
- they produce partial or total amnesia (i.e. make you forget what happens during some or, less frequently, all of the procedure). Total amnesia is more common with midazolam than with diazepam.
By far the most commonly used drug for IV sedation is Midazolam, but occasionally Diazepam is used. Midazolam is the first choice because of its relatively short duration of action (meaning that it will be metabolized faster).
Valium is less expensive but longer acting and “harder” on the veins, so you may feel a burning sensation on your arm/hand when the drug first enters.
The local anesthetic solution can be mixed in with Diazepam to make things more comfortable. The latest IV Diazepam used by dentists is an emulsion that is believed to be easier on the veins.
The drug is put into the vein at the rate of 1mg/minute for Diazepam or 1 mg/2 minutes (followed by an extra 2 minutes to evaluate the effect) for Midazolam (because Midazolam is stronger regarding the dose needed to achieve sedation). Because there are differences between individuals in how much of the drug you need to be sedated, your response to the drug is monitored. Once the desired level of sedation is achieved, the drug is stopped.
The Venflon is left in place during the procedure so that the sedation can either be topped up or so that the reversal agent for benzos (Flumazenil) can be put in in the unlikely event of an emergency. The Venflon is a small plastic tube inserted through the skin into a vein.
Opioids are strong painkillers. They can be used as an add-on medication to either benzodiazepines or barbiturates.
Opioids are the best painkillers. When you take opioids, even terrible pain becomes tolerable.
In most cases, opioids are used only for pain after the dental treatment; local anesthesia takes care of pain during treatment. However, if the local anesthetic effect begins to wear off, an opioid will help. What is often done at dental offices is to give a long-acting local anesthetic when pain is expected after the procedure.
Also, where barbiturates are used, an opioid must be added to counteract their pain-threshold-lowering properties.
There’s another case where an opioid may be used: when a benzo has been given at maximum dosage and still the patient is not sedated. This usually only occurs in those who have been using benzodiazepines for years and have become tolerant to them. In this case, adding an opioid may provide the desired sedation. Alternatively, propofol, another medication, may be used.
Opioids that may be used for IV sedation include:
- Meperidine (Demerol)
- Butorphanol (Stadol)
- Nalbuphine (Nubain)
- Fentanyl (Sublimaze)
- Pentazocine (Talwin)
Barbiturates are sleep-inducing drugs. They are not ever used for conscious sedation in the U.K. and are not popular in U.S. dental offices. The only barbiturate still used occasionally is Pentobarbital Sodium (tradename: Nembutal).
Barbiturates need a trained anesthesiologist to administer them. Someone who isn’t trained could end up overlooking the heart rate and breathing rate fall into danger zones, and coma and death could follow. Another problem is that there’s no reversal agent that can be used if these occur.
Their only advantage over benzos is that they provide very extended periods of conscious sedation. If pentobarbital is used, it’s going to be used in combination with opioids because barbiturates have the effect of lowering a person’s pain threshold.
Some anesthetists use Propofol instead of benzodiazepines. You can expect a very fast recovery time with it – less than 5 minutes. The drug must be continuously administered, so the drug is pumped in using an electric infusion pump, the dose rate is set by the anesthetist.
Propofol is not a commonly used sedative agent because it’s very easy to end up going into a general anesthesia effect where the breathing reflex is lost. If you have a high tolerance to benzodiazepines, this medication could be useful. Propofol is classified as a general anesthesia drug.
“It's like the flick of a switch, which turns your brain off for an hour or two. You feel somewhat dopey and woozy afterward where you may want to go and sleep it off. Next thing I know is I am in the recovery room with my partner.”
Guidelines to Follow Before IV Sedation
At our dental clinic, we do things according to dental standard operating procedure and ensure that precautionary measures are taken for the sake of our patients’ well being. Below is a list of our guidelines to follow before IV Sedation.
1. Get a Driver/Escort
Arrange for a driver to take you home after your dental appointment. If no one is available for the job, try Uber.com or Lyft.com.
2. Your Companion Should Stay With You
Allow an adult to stay with you in your home until you’re fully alert.
3. Forget About Going Anywhere
Don’t perform any strenuous or hazardous activities. Don’t drive a motor vehicle – car, truck, motorcycle, or tractor. Anything on wheels means stay away from it. You need your total wits whenever you are driving. Rest for the remainder of the day after your procedure.
4. No Parties After the Dental Procedure
You may want to celebrate that your dental procedure is finished or you overcame your dental phobia with friends over a meal, but don’t do it. Eating a heavy meal after surgery is too much for your body to handle. If you’re hungry, eat something light. If you have nausea, lie down for a while or drink a cup of ginger tea.
5. Forget the Drinks
Do not consume any alcohol after your procedure.
6. Use Only Approved Medications
Do not take any medications for the rest of the day unless you’ve contacted your dentist first. Inform your dentist of any medications you are currently taking prior to the dental procedure. He will then advise you of any changes in your routine prior to the dental surgery. Take medications only as directed by your dentist.
7. Be Comfortable
To be comfortable during your dental procedure, wear comfortable clothes. Avoid the wearing of watches and jewelry on the day of your appointment.
8. Forget the Appliances and Eyewear
Skip the contact lenses and dentures/retainers on the day of your appointment.
9. Fast the Night Before the Procedure
Stop all food and water after midnight the night before your dental surgery. This is really important, as something as simple as water can be vomited during surgery. The official word for this is aspiration, as the water can end up in the lungs and cause pneumonia. When food or water goes down the wrong “pipe”, it’s called aspiration.
When you’re under the influence of anesthesia, the ability to cough may be suppressed, which can lead to aspiration especially if there is water in the stomach. Aspiration is more common under general anesthesia but there is still a risk that it could occur during IV sedation. Your dentist wants to avoid any and all risks for the sake of your well being. Follow his instructions!
10. Remember We are Here to Help
If you have any complications, call our office. We’re here for you and can give you additional post-op care after your IV sedation dental procedures.
You might already have a good idea that IV sedation is for you. Feel free to give us a call at our office at 214-304-7561 and we’ll schedule a consultation with Dr. Vadivel for you.
Some Last Things You Should Know
Our dental office at Implants and Gumcare is different from many other dental offices. First of all, we use the latest and most advanced dental equipment and procedures to serve you better. With all these new techniques, we can be sure we are offering the best dental care you will receive.
Secondly, we offer free CAT scan and consultation exams.
Thirdly, we have two convenient locations and won’t make you wait days or weeks for dental emergencies.
Fourth, my experience and training in all sorts of dental procedures allows me to give professional services in this area that exceed the minimal criteria and service others may be offering.
You will find my staff to quickly assist you in your needs, questions and concerns in a compassionate, caring manner.
And lastly, we will never give up on you! Our goal is for you to regain the most beautiful smile you can have – and keep it forever!
“The staff is awesome, everyone from the receptionist to the doctor. They make you really feel welcome and address all your issues and concerns. They offer advice on your best course of action and payment plans that work best for you. Great location and the place is absolutely spotless. Lydia is the dental assistant and a real sweetheart. If you have any type of surgical procedure done, Dr. V calls you personally the next day to check on you... I would recommend this place to anyone.” – Dennis E., Dallas
You can also expect the following when you become my patient:
1. No Reprimands in the Office
I do want you to know that when you make an appointment for your initial consultation with me, no matter how long it has been since you had dental work, I will not scold or embarrass you!
Why some dentists do that is beyond me… I see you as a person of how you are right now in time. There’s no need to dwell on the past, other than to find out what problems you had in the past that contributed to where you are now.
But after that, it’s time to jump onto the track where you get that great smile back that you have wanted for some time. You get the respect from others you deserve and there’s no more discrimination against you simply because you were in the dental hell time warp/black hole.
2. You Choose the Level of Pain You’ll Have in the Dental Chair
And if you have had far too much pain while sitting in other dentists’ chairs in the past, I want you to be comforted in knowing that I use some of the advanced methods of decreasing pain during a dental visit. It’s another of my specialties.
I take pride in this… and my patients have no qualms about booking regular check-ups or cleanings or even fillings because they know I will treat them right.
3. Other Specialized Services are Available
I do want you also to know that I don’t specialize in IV Sedation; it’s an extra certification I have so I can offer it to my patients. That means I’m qualified to use it here in this state. The dental procedures are what I specialize in. I’ve done hundreds of almost every type of dental procedure that patients need in my office is something. Most of your dental needs are ones I treat, and include the following:
• Gum Therapy - This includes using dental lasers, plastic surgery for your gums to make them look right, regenerative surgery using bone grafts to rebuild missing bone, and specialized antibiotics to treat resistant gum disease. All these methods are making huge strides in dentistry.
• Advanced 3-Dimensional X-Rays – These are definitely one of the advancements of modern dentistry. The ability to see your teeth in three dimensions is a way of insuring that nothing is missed.
• Wisdom Teeth Removal & Extractions – Impacted teeth cause a lot of pain and can get infected.
“I absolutely cannot express how awesome my dental visit was! The office staff was AMAZING! Dr. Vadivel was so patient and explained everything to me in full-detail! My extraction was done before I knew it! I couldn't believe it! I will forever be a patient to Dr. Vadivel and will refer all my family and friends!! Very affordable!! GET THERE FAST!!! “ – India S.
• Bone Grafting – In cases of bone loss, usually from periodontal disease, adding small pieces of bone stimulates the rest of the bone to remodel itself. As a result, the bone is built up. I have a special report on this topic.
• Cosmetic Dentistry – Teeth whitening, correcting crowding or alignment problems, applying veneers or crowns to craft a more uniform-looking, bright smile. Achieving your best possible smile
• Same Day Dentures for Missing Teeth Replacement
• Emergency Dental Treatment
“Same day emergency service folks. Great experience and healed up quickly.” – Alicia W.
• Laser Gum Treatment – Laser gum treatment gives results that are similar, if not better than root planning and scaling according to medical studies. It’s used to treat periodontal disease (gum disease).
• Oral Cancer Screening – Your medical doctor generally won’t check your mouth for mysterious sores, spots, lumps or bumps that could be cancer. Finding cancer early on is much better than finding it in the later stages. We screen for oral cancer.
• All-on-Four Dental Implants – This has been explained in this special report. You don’t always need bone grafting with dental implants. With this technique, you won’t. The benefits of these are decreased cost, same day teeth, ease of maintenance, drastically improved aesthetics, potential for eating steak and other difficult foods after the procedure, and great clinical results.
• Pin Hole Surgery – This type of surgical treatment is done without scalpels, stitches and grafting. You have less discomfort during the procedure, and can expect faster healing time.
You are the only one that can make the decision that your dental fear is not going to possess your life.
Don’t label yourself as incurable when it comes to dental fear.
When you choose IV Sedation, the day is coming where you will see that your dental fear is a thing of the past.
But it’s all up to you. You are the only one who can take the first step and ask for IV sedation from your dentist.
Q: How is the IV sedation done?
A: The doctor will tell you when the sedation medication is administered. You will then be unconscious for a while, and the dental procedures will be performed. You will wake up after the dental procedures are finished. You will have absolutely no perception of time, or anything while you are under the anesthesia. IV sedation is not similar to sleeping; you will not dream.
Q: What should I expect when being sedated?
A: An IV feels really gentle on the body; you just get drowsy and drift off to sleep. IV sedation works quickly, and although you are conscious and capable of responding to your dentist's visual signals, you won't remember much about your appointment. Because IV sedation does not provide pain relief, it is used in combination with local anesthesia. You'll be groggy and need a ride home after the appointment.
Nitrous Gas is a little different because you are a lot more aware that you're getting 'dosed,' so usually they will talk to you. The staff will try to converse with you to distract your mind, and at some point, you'll drift off just like what happens with IV sedation.
Q: How does dental phobia affect my life?
A: Dental anxiety and phobia can have adverse impacts on your quality of life. If you’re so afraid of going to the dentist because of pain in the past, the bad experience(s) you had will stand in the way of you getting any further dental care.
Your fear becomes a significant obstacle to oral health and overall well being. Scientists have already proven links between periodontal disease and heart disease, as the bacteria in the mouth don’t simply stay in the mouth. They end up traveling throughout the entire body and lodge in the heart and blood vessels.
Q: How can Dr. Vadivel help me overcome my dental phobia?
A: During Dr. Vadivel’s 24 years of experience with patients, he has mastered what it takes to not only provide excellent dental care but also provide it without pain.
Q: Can IV Sedation be used with my special needs child?
A: IV sedation may be used with patients with special needs as well. Therapy is customized to each individual following proper evaluation and based on the dentist’s experience, expertise, the degree of anxiety, patient intellect, age, cooperation, and clinical situation.
Q: What’s the difference between IV sedation and general anesthesia?
A: After an extended period of IV sedation, patients are able to come out of anesthesia rapidly. With general anesthesia, patients emerge slowly after an extended period of anesthesia. General anesthesia is a combination of oral and IV medications that sedate you to a level where you are placed in a level of unconsciousness. Those who are heavily sedated may reach stages of complete unconsciousness. The best part is, once you're fully awake, you won't remember anything about the procedure.
Q: What happens if I don't take IV Sedation?
A: Everyone copes with fear in different ways. However, the prospect of dental work does not need to fill you with terror. If it does, then you may need some help overcoming the fears, and IV sedation could be your solution. Once you choose IV sedation, it doesn’t mean you have to choose it for every dental procedure afterwards for the rest of your life. You can make the decision yourself for each and every dental procedure you have.
If you don’t take IV Sedation, you may choose another method of sedation. Gone are the days where you would have to put up with dental pain because no anesthetic was available.