What is transmucosal sedation?
The child or adult in your care may require dental treatment under sedation. Anxiety can be reduced by sedative drugs (medicines), which also make the patient drowsy. The dentist will be able to explain why the patient might benefit from having sedation.
Transmucosal sedation is generally given through a fine spray, which is squirted into the nose. The sedation drugs are absorbed through the lining of the nose and enter the bloodstream. It can take 5–10 minutes for the effects of the drug to work.
Once the sedation medicine has taken effect, for the patient’s safety, a needle is used to place a cannula (small plastic tube) in a vein in the back of the hand or in the arm. The dentist will use the cannula to reverse the effects of the sedation if necessary. A cream containing local anaesthetic may be used to make the injection site numb before the cannula is inserted.
Benefits and risks of transmucosal sedation
Transmucosal sedation reduces anxiety and fear of dental treatment. This is particularly helpful if the patient is having a long, uncomfortable or more complicated procedure.
The dentist and members of the dental team are trained to give sedation. They watch the patient closely and treat any problems that may develop.
An oxygen supply will be available and oxygen will be given by mask if necessary. They are also required to use appropriate monitoring equipment during sedation. There will be a recovery area where the patient will be observed until he or she has made a full recovery from the sedation.
It is a widely used technique but, as with the administration of any medicines, there are risks associated with intranasal sedation. These risks include:
- A reduction of oxygen in the blood stream due to poor breathing during sedation. The patient may be asked by the dentist/sedationist to take deep breaths to correct this. The dentist/sedationist will continually monitor the patient’s breathing and oxygen levels throughout the procedure.
- Bruising at the site of the cannula. This may take several days to fade completely.
Very rare risks are allergic reactions to the sedative drugs the patient has been given or vomiting during the procedure. The dentist/ sedationist will discuss any concerns that you may have about the patient prior to the procedure taking place.
What to expect
The method of dental treatment planned for the patient in your care will be discussed with you at a separate assessment appointment. The dental treatment will take place at second and subsequent appointments.
In exceptional circumstances, treatment may be carried out on the same day as assessment. It is important that the dentist knows of any recent changes in the patient’s medical history and of any medicines being taken.
If you think the patient may be pregnant or breastfeeding, you need to let the dentist know. The patient may need to come back to have the treatment at another time.
Before the treatment is started, the dentist will need to take a full medical history and, if necessary, contact the patient’s general medical practitioner or specialist. The patient will need to have their blood pressure taken with a cuff on their arm and the level of oxygen in their blood measured with a clip on their finger.
How to prepare the patient
The information provided here is to help parents or carers understand the process of sedation. It is a general guide. As part of the face-to-face discussions with the dentist, the patient in your care may be given specific advice that may differ from the general principles outlined here.
There are complicated rules regarding consent for patients with limited capacity. The dentist will explain to you and the patient what steps need to be taken to ensure that consent is properly obtained. No treatment can be started without consent.
The dentist will discuss with you and explain what the patient is able to eat and drink prior to the appointment. You will also be given this information in writing. It is important that these instructions are followed carefully.
If the patient is unwell on the day with cold/flu symptoms or any contagious illness, please contact the dentist for advice. The appointment may need to be rearranged.
What will happen during the sedation?
The patient will remain conscious during the sedation but may experience some temporary loss of memory during the time that he or she is sedated. Many patients have no memory of the procedure at all. Patients may feel unsteady on their feet for some hours after the procedure. They may be affected for the rest of the day. They may experience some forgetfulness.
The patient will be monitored by the dentist and the dental team during the procedure. This will include measurements of blood pressure, heart rate and oxygen levels at regular intervals.
Once the patient is sedated, and feels drowsy and relaxed, the dentist can use local analgesia (pain relief that numbs the site of the dental treatment).
Local anaesthetic as a paste is sometimes used to numb the site of the treatment. Any injections that the patient may need can then be given through this numbed area to reduce the chance of any discomfort.
The patient will spend some time in the recovery area following the treatment. He or she will be checked by the dentist or the person giving the sedation and will not be allowed to go home until alert and responsive. The patient will need to be accompanied home by an able-bodied adult who can take responsibility for him or her for the rest of the day. Escorts should not bring other children with them on the day of the treatment.
Children may not return to school and should not participate in active sports for the rest of the day. You may wish to make plans about how best to travel home with the patient following treatment.
All patients need to be supervised by a responsible adult for the remainder of the day. The parent/carer may need to make arrangements for the care of other children or elderly dependent relatives during this time.
Adult patients should be aware that their judgement may be affected and care should be taken for the next 24 hours if the patient is using the internet for personal communication. They are advised not to drive, ride a bicycle or operate machinery until the following day or, in some cases, for 24 hours.
You will be given information relating to any local anaesthetic or treatment that the patient has received. The dental team will give you advice about any medicines the patient will need while recovering from the treatment. You will be given a telephone number of who to contact if you have any concerns.
Reprinted and adapted from :
Standards for Conscious Sedation in the Provision of Dental Care
Report of the Intercollegiate Advisory Committee for Sedation in Dentistry 2015
The Dental Faculties of the Royal Colleges of surgeons and the Royal College of Anaesthetists