North Carolina Faqs - Sedation Dental Care

Why are there new sedation dental care guidelines?



The North Carolina State Board of Dental Examiners has the mission and responsibility to help patients in North Carolina get safe and effective dental treatment. They set the standards for delivery of care in the state. Sedation dentistry is growing in popularity across the nation as well as the state of North Carolina, which means that there will likely be new providers emerging. The state is wisely implementing guidelines that give consumers the confidence that any dentist offering sedation dental care has received specialized training for administering sedation.



How does dental sedation compare to other sedation?



First of all, just as with sedation and anesthesia used by medical physicians and anesthesiologists, there are different approaches used to achieve progressive levels of sedation. The North Carolina Dental Board guidelines enacted in July 2009 address the different levels of sedation.



One conundrum about sedation dental care that you may not have stopped to think about is why people are routinely provided sedation and anesthesia by medical doctors for procedures that are perhaps even less painful than some dental procedures. That lack of availability of sedation services in dentistry likely accounts for at least some number of people who aren't getting the dental care that they need. With its new guidelines, the North Carolina Dental Board is allowing a pent-up patient need to be safely satisfied by dentists across the state who are willing to get the appropriate training and certification.



What are the different levels of sedation dentistry?



Certification is required for the type of sedation dentistry that lets you have more invasive or lengthy procedures performed comfortably. Some patients also need this level of sedation to be comfortable with lesser procedures. This level of accreditation is referred to as limited moderate conscious sedation dentistry, or oral conscious sedation dentistry. More details on this level - the one you are likely to be most interested in - are as follows:



- In June 2009, only 96 of the general dentists in North Carolina had been accredited to perform this level of sedation dentistry. (There were only 6 in the capital city - Raleigh, which has one of the highest dentist to patient ratios in the state.



- This form of sedation dentistry permits the administration of multiple doses of sedatives, either alone or in conjunction with inhaled sedation techniques (e.g., nitrous oxide).



- This type of sedation dental care can be used along with "traditional" non-sedating anesthetics that create numbness, as may be appropriate for a specific procedure.



- Your dentist must have many hours of specialized training and experience in this technique before he or she can be certified to practice sedation dentistry.



- In addition, dental staff members also receive special sedation dentistry training that helps them know what to do in the rare event of emergency.



- There is less risk with this limited, certified form of sedation dentistry because you remain conscious and able to respond to commands, even though you're unaware of what is happening or how much time has elapsed.



- The dentist uses equipment designed to evaluate the patient's blood pressure, pulse rate, levels of oxygen saturation in the blood, and other important information - in many ways similar to the monitoring that would occur in a hospital setting.



Other levels of sedation dental care require the use of a back-up ventilators and artificial airways. The equipment is needed because deeper levels of sedation also carry with them an increased risk of needing to be resuscitated. There is another level of conscious sedation dentistry - beyond limited moderate conscious sedation dentistry - that permits the administration of sedation intravenously (with an IV needle). Oral surgeons, for example, may offer this added level of sedation dentistry although a more limited means of sedation (i.e., oral conscious sedation dentistry) makes most patients completely comfortable for procedures such as wisdom teeth extractions. The North Carolina Dental Board refers to the level of sedation dentistry involving the use of IVs as moderate conscious sedation dentistry, because it is not "limited" to oral administration of sedation.



There is also a general anesthesia option, which renders the patient unconscious and is typically only performed in a hospital setting. It is performed in that setting because of expensive equipment that is needed to provide an artificial airway by insertion of a tube, so that artificial resuscitation can occur instantly in the event of an overdose.



How do I know what level I need?



Just because a dentist is accredited to perform a higher level of sedation dentistry doesn't mean that they always administer the higher level. For your convenience, especially if you are looking for a dentist who provides cosmetic dentistry or comprehensive dentistry, you may want to search out a dentist who is certified to provide limited moderate conscious sedation dentistry. That will give you the flexibility to have the sedation options - from mild to moderate - that may be most appropriate for both your dental care needs and possible level of anxiety. That range of service does not require the use of needles, which in themselves create anxiety for some patients.



Providers of this level of sedation dentistry may be especially attuned to patients needs for comfort and to their potential anxiety levels. If they feel that a procedure that you need might suggest a higher level of sedation, they will probably be more likely to refer you to someone who provides that higher level of sedation service, rather than risk losing you as a patient because you experience either pain or anxiety. Sometimes, the mere availability of this level of sedation dental care can provide patients the assurance that they can get the treatment they need without experiencing pain - even if they elect not to use it all the time.



Can dentists practice sedation dentistry in North Carolina without being accredited?



Without a special accreditation by the Board, a dentist in North Carolina can only administer a single dose of an oral sedative prior to beginning a treatment - possibly in combination with nitrous oxide.



- This single-dose practice is consistent with the new guidelines for North Carolina, but does not require special certification and the associated specialized training.



- This practice may be sufficient to manage the anxiety that some patients experience about minor, fairly routine procedures (fillings, teeth-cleaning).



- This is not actually a form of sedation dentistry per se, although providers of sedation dental care will usually make this option available to you as well for lesser procedures.