Oral sedation is often used by dentists to help patients feel more relaxed and comfortable during dental procedures. It involves taking medication by mouth, usually in pill form, that has a sedating effect. Oral sedatives such as Valium, Halcion, Ativan, and Xanax are commonly prescribed. While oral sedation is effective at reducing anxiety, some patients wonder if they will still feel pain during their dental work if using this method. Understanding how oral sedation affects pain perception can help patients know what to expect.
How does oral sedation work?
Oral sedatives prescribed for dental sedation belong to the drug classes benzodiazepines or barbiturates. Benzodiazepines include medications like Valium, Ativan, and Halcion. Barbiturates used for sedation include phenobarbital and Amobarbital. These medications exert their effects by enhancing the activity of the inhibitory neurotransmitter GABA in the brain. GABA inhibits nerve impulses in the brain, which causes a calming effect. Benzodiazepines and barbiturates bind to GABA receptors and make the natural GABA released in the brain more potent. This results in sedation, relaxation, and often some short term memory loss.
The effects of oral sedatives depend on the dose taken. At moderate doses, they cause relaxation and anxiety relief. At higher doses, they can induce sleepiness and a decreased ability to focus or remember events. The medications typically take 30-60 minutes to take full effect when swallowed. Doses can be adjusted based on each patient’s age, health status, weight, and desired level of sedation.
Does oral sedation reduce pain?
While oral sedatives prescribed for dental procedures do help patients relax, they do not necessarily reduce or take away pain. Rather than acting directly on pain pathways like narcotic pain medications do, oral sedatives primarily affect anxiety levels and ability to focus on procedures. This results in the perception of less pain, even though the intensity of pain signaling may be unchanged.
Several factors influence whether oral sedation decreases perceived pain during dental work:
Level of sedation achieved
With moderate sedation, patients still feel pain but it bothers them less. At deeper levels of sedation approaching unconsciousness, pain perception is reduced more, but deep sedation comes with more risks of breathing and cardiac side effects. Most dentists use moderate levels of oral sedation that provide relaxation without heavily sedating patients.
Patient’s normal anxiety level
Oral sedation works best to reduce perceived pain in patients who normally suffer from higher dental anxiety. If a patient is not particularly anxious about dental work, the sedatives may not alter pain perception very much. However, they are still useful for making procedures more pleasant.
Type of dental work
Some dental procedures cause considerable discomfort, even with oral sedation on board. For example, patients may still experience significant pain during dental surgery or root planing and scaling. More invasive procedures are less likely to be perceived as painless, even if using sedation.
Advantages of oral sedation
While not as powerful as general anesthesia at reducing pain, oral sedation offers several advantages:
- Less risk – intravenous sedatives rarely used in dentistry have more risks like breathing difficulty or low blood pressure
- More gradual onset and recovery – no need to monitor patients as closely as with IV or general anesthesia
- Lower cost – less equipment and anesthesia professional involvement needed
- Medications are familiar and commonly used – benzodiazepines and barbiturates have decades of clinical experience behind their use
- Patients can take their medication at home before coming to the dental office – no need to lose time waiting in the office for it to kick in
For these reasons, oral sedation provides an appealing middle ground between unmedicated dental procedures and deep IV sedation or general anesthesia.
What to expect with oral sedation
If you opt for oral sedation for your dental work, here is how the process usually goes:
- Your dentist prescribes an oral sedative medication like Valium or Halcion. You fill the prescription and take it at home per their instructions (often 1 hour prior to your appointment).
- You arrive at the dental office already feeling relaxed. The medication peaks once you are in the dentist’s chair.
- As you undergo procedures, you likely feel pressure, rubbing, drilling sounds, etc. but the drug makes you care less about these stimuli.
- During longer or more stimulating procedures, the dentist may have you take more of the sedative to prolong the effects. This usually means taking additional pills.
- After your dental work is complete, you rest in the office while some of the sedation wears off. You may feel tired or foggy for several hours afterwards.
- You will need someone to drive you home since oral sedatives can make driving unsafe for the rest of the day.
While oral sedation is very helpful for anxiety, you may still require local numbing medication for cavity fillings or procedures involving significant manipulation of the teeth and gums. Don’t expect to be entirely pain-free, but the sedative will make you much calmer, relaxed, and detached from the procedures.
Who is a good candidate for oral sedation?
Oral sedation is appropriate for most adults and older teens undergoing dental procedures. Good candidates include:
- People with dental phobia or high anxiety about dental work
- Those with sensitive gag reflexes that are triggered by dental instruments and procedures
- Patients who have had bad experiences getting numb or with the noises/sensations of dental work
- People needing prolonged or invasive procedures like extractions, root canals, periodontal surgery, etc.
Oral sedation is not recommended for young children needing dental work or for patients with certain medical conditions:
- Children under 12 years old
- Pregnant women
- People with respiratory disorders like COPD or sleep apnea
- Those taking opioid pain medications susceptible to oversedation
- Patients with liver problems who may not metabolize sedatives normally
Thus, oral sedation is best suited for low-risk adolescents and adults undergoing uncomfortable dental procedures. It provides relaxation and anxiety relief more than true anesthesia.
Risks and side effects
When used properly, oral sedatives are quite safe. Potential side effects may include:
- Drowsiness – typically persists for hours after the appointment
- Lightheadedness
- Headache
- Upset stomach or nausea
- Trouble concentrating and short term memory impairment
- Lack of coordination for several hours – patients should not drive after oral sedation
More serious but rare risks include:
- Allergic reaction to the medication – likely to cause hives, itching, or swelling
- Oversedation – excessive sleepiness, trouble breathing, or unresponsiveness requiring emergency medical help
- Dangerous interactions with alcohol or opioids
To keep risks low, your dentist will screen you for allergies, interactions with other medicines, and health issues that may increase sensitivity to sedatives. Make sure to take the medication exactly as prescribed. Have someone accompany you to and from the dental appointment while under sedation. Stay with your escort for the remainder of the day until effects resolve. Avoid driving or making important decisions for the rest of the day after taking oral sedatives for dental procedures.
Conclusion
Oral sedation helps dental patients feel less anxiety, stress, and perceived discomfort during procedures. While it provides relaxation rather than true anesthesia, many patients report acceptable pain control when sedated for dental work this way. Sedatives by mouth have a slower onset and gentler effects than IV or general anesthesia. While not pain-free, oral sedation offers a favorable balance between patient comfort, safety, and convenience. Knowing what to expect and discussing all your options with your dentist allows finding your optimal solution to a comfortable dental visit.