Contributed by Michael Kirk, DDS
On September 30, 1846, a man in Boston named William T.G. Morton single-handedly changed the course of medical and dental history. Dr. Morton was a dentist and laid the groundwork for sedation and anesthesia by performing a painless tooth extraction on a patient. Using a chemical known as “ether,” Dr. Morton sedated his patient and performed a tooth extraction while in a surgical theater. Word spread quickly around Boston, the United States, and the world. The rest is history.
I wish that I could say that dentistry embraced Dr. Morton’s foundational work and implemented sedation dentistry from that very day. Sadly, that is not the case. Dentistry found its way using early local anesthetics and, hopefully, a warm bedside manner. Very often this did not suffice and dentistry wound up with a large part of our patient population dreading the dentist. Recently, general dentistry has answered the call and is more commonly offering this service to patients who either want or require sedation.
“Do I need to be sedated, doc?” This question can be answered by dividing patients into two categories: patients who should be sedated due to their anxiety level, and patients who need a procedure that the dentist deems invasive or ideally done with sedation. For the first category, the better question would be, “Do YOU need to be sedated?” Due to a severe dental phobia, some patients may themselves admit they require sedation for even minor procedures. The second category of patients is often undergoing surgery that is either invasive or is long in duration.
While Dr. Morton in 1846 would have provided his ether anesthesia with a mask, today the most common delivery method for sedation is through an IV. An IV is started and then medications can be given in titrated doses to deliver the desired effect. If we think about anesthesia as a continuum, the desired effect may be mild, moderate, deep, or general anesthesia. With sedation dentistry, we typically only require a patient to be mild to moderately sedated to accomplish the procedure. It is often more invasive and major surgeries that require patients to be deeply sedated or under general anesthesia.
The ability to have a better smile and better health is not limited by our fears and anxieties that have hung over the profession like a dark cloud. Through better chairside manner, better local anesthetics, and now the use of sedation, dentistry is at a point where patients can feel, dare I say, excited about going to the dentist.
