Dental anxiety is common and can range from mild uneasiness to intense fear that makes it difficult to attend appointments or complete treatment.
Sedation is one option that may help selected patients undergo dental care. It is not necessary or appropriate for everyone, and the type and depth of sedation must be based on the patient’s health, anxiety, proposed procedure and ability to cooperate.
Sedation involves medication and carries risks. An individual assessment, informed consent and appropriate clinical monitoring are required.
What is dental anxiety?
Dental anxiety can be associated with:
- A previous difficult dental experience
- Fear of pain, needles or loss of control
- Sensitivity to sounds, smells or sensations
- A strong gag reflex
- Difficulty becoming numb
- Embarrassment or fear of judgement
- Claustrophobia
- Medical or psychological conditions
- A history of trauma
- Uncertainty about what treatment will involve
Symptoms may include sweating, nausea, rapid breathing, a racing heartbeat, difficulty sleeping before an appointment or avoiding dental care.
People should not be blamed or judged for feeling anxious. Telling the dental team about your concerns allows time to discuss strategies that may make care more manageable.
Is sedation the only option?
No. Some patients can undergo treatment using non-drug anxiety-management measures alone or in combination with local anaesthetic.
Options may include:
- A preliminary appointment without treatment
- Shorter appointments
- Agreeing on a stop signal
- Step-by-step explanations
- Additional time for questions
- Gradual exposure to the dental environment
- Distraction using music or audiovisual material
- Topical anaesthetic before injections
- Local anaesthetic delivered slowly
- Breathing or grounding techniques
- Support from a psychologist or medical practitioner
- Referral to a practitioner experienced in managing complex dental anxiety
A history of trauma or abuse should be approached sensitively. Patients can ask the dental team to explain before touching them, minimise unexpected sensations and pause when requested.
What is sedation dentistry?
Sedation dentistry uses medication to reduce awareness, anxiety or distress during dental treatment.
Sedation exists on a continuum:
- Minimal sedation
- Moderate or conscious sedation
- Deep sedation
- General anaesthesia
A person can unintentionally move from a lighter to a deeper level of sedation. The practitioner and facility must therefore be able to monitor the patient and manage a deeper level if it occurs.
“Sleep dentistry” is an informal marketing term and can be misleading. Some patients remain awake and responsive during conscious sedation, even if they later remember little of the appointment.
Does sedation prevent pain?
Sedation and pain control are not the same.
Sedative medicines can reduce anxiety and awareness, but they do not always provide adequate local pain relief. Local anaesthetic is therefore commonly used to numb the treatment area, including when oral or IV sedation is provided.
No sedation method can guarantee that a patient will experience no discomfort, anxiety or memory of the procedure.
What types of dental sedation may be considered?
Nitrous oxide and oxygen
Nitrous oxide is inhaled through a small nasal mask together with oxygen. It may provide minimal or moderate sedation, depending on the concentration and individual response.
The patient usually remains awake and can communicate. The effects often reduce relatively quickly after the gas is stopped and oxygen is administered.
Possible side effects include nausea, dizziness, headache, tingling or an unpleasant sensation from the mask. Nitrous oxide is not suitable for every patient or procedure.
Oral sedation
Oral sedation involves taking prescribed medication before treatment. The medicine may reduce anxiety and cause drowsiness.
Response can vary between patients, and the depth of sedation may be less predictable than with medication delivered intravenously. Patients may remember parts of the procedure and may remain responsive.
Oral sedatives must only be taken in the prescribed dose and at the instructed time. Taking additional medication, alcohol, opioids, sleeping tablets or recreational drugs can increase the risk of excessive sedation and breathing problems.
A responsible adult may need to escort the patient home and remain with them afterwards.
Intravenous conscious sedation
IV sedation delivers medication through a small cannula placed in a vein. The dose can be adjusted during treatment.
During conscious sedation, the patient is generally very drowsy but remains able to respond to verbal instruction or light physical stimulation. Some people remember little or none of the procedure, but amnesia cannot be guaranteed.
IV conscious sedation is not general anaesthesia. A patient who is completely unconscious is no longer in a state of conscious sedation.
In Australia, a dentist administering sedation by the intravenous route must hold the relevant endorsement from the Dental Board of Australia. IV sedation may also be provided by an appropriately qualified medical practitioner or anaesthetist, depending on the arrangement.
Deep sedation
During deep sedation, a patient is not easily awakened and may require assistance to maintain an open airway or adequate breathing.
Deep sedation carries greater risk than minimal or moderate sedation. It must be provided by appropriately qualified and credentialled practitioners in a facility equipped for the intended level of sedation and possible complications.
General anaesthesia
General anaesthesia produces unconsciousness. The patient is not responsive and generally requires support for breathing and other body functions.
General anaesthesia is not simply a deeper version of routine dental sedation. It is normally provided by a specialist anaesthetist in an appropriately equipped and accredited hospital or procedural facility.
It may be considered for selected patients or procedures after assessment. It carries different risks, costs and recovery requirements.
Are relaxation systems such as NuCalm sedation?
Non-drug relaxation systems may use music, sensory reduction, electrical stimulation or other techniques intended to promote relaxation.
These systems should not automatically be described as conscious sedation, anaesthesia or pain relief. Evidence, regulation and individual response can vary between products.
If such a system is offered, ask:
- What is the intended purpose?
- Is it a medical device?
- What evidence supports its use?
- Does it replace local anaesthetic or sedation medication?
- What are the risks and alternatives?
- What happens if it does not reduce anxiety sufficiently?
A relaxation aid should not be promoted as the “safest sedation” when it does not produce a medically recognised state of sedation.
Who may be considered for dental sedation?
Sedation may be discussed when a patient has:
- Significant dental anxiety or phobia
- A strong gag reflex
- Difficulty tolerating treatment while awake
- A physical or intellectual disability affecting cooperation
- A movement disorder
- A lengthy or complex procedure
- Previous difficulty completing necessary dental treatment
- A need for treatment that cannot reasonably be managed using simpler measures
Suitability depends on the person and the proposed procedure. Sedation should not be recommended solely because it is convenient for the practice.
Who may need additional assessment?
Extra precautions, medical consultation or a different treatment setting may be required for patients with:
- Obstructive sleep apnoea
- Significant heart or lung disease
- A difficult airway
- Severe obesity
- Liver or kidney disease
- Pregnancy
- Neurological conditions
- A history of adverse reactions to sedation or anaesthesia
- Multiple medications
- Opioid, alcohol or other substance use
- Frailty
- Acute illness or respiratory infection
- Poorly controlled medical conditions
Having one of these factors does not necessarily exclude sedation, but it may change whether, where and by whom it can be provided.
What happens during the pre-sedation assessment?
The treating team may ask about:
- Medical conditions
- Previous surgery, sedation and anaesthesia
- Allergies and adverse reactions
- Prescription and non-prescription medicines
- Vitamins and herbal supplements
- Alcohol, smoking and recreational drug use
- Pregnancy or breastfeeding
- Sleep apnoea and snoring
- Reflux
- Height and weight
- Recent illness
- Dental treatment needs
- Anxiety triggers and preferences
- Transport and aftercare arrangements
You may need a medical examination, additional investigations or advice from your general practitioner or specialist.
Consent should be obtained before sedative medication affects the patient’s ability to understand and make decisions.
What should informed consent cover?
Before proceeding, the patient should understand:
- Why sedation is being considered
- Who will provide it
- The intended level of sedation
- The proposed medicines or technique
- The dental treatment being performed
- The role of local anaesthetic
- Material risks and possible complications
- Reasonable alternatives
- Preparation and fasting instructions
- Recovery restrictions
- Costs
- What happens if the treatment cannot be completed
- Whether a responsible adult escort is required
Patients should have an opportunity to ask questions and, for elective treatment, time to consider their options.
Do I need to fast?
Fasting requirements depend on the sedation method, timing, medical history and practitioner’s protocol.
Do not assume that the same instructions apply to every form of sedation. Follow the written instructions supplied by the sedation provider.
Tell the practice if you have not followed the fasting instructions. Do not hide this information, as it may affect the risk of vomiting and inhaling stomach contents into the lungs.
Unless instructed otherwise, take regular medicines only as directed by the treating team.
What happens on the day?
Depending on the sedation method, you may be asked to:
- Wear comfortable clothing
- Avoid jewellery or restrictive garments
- Remove contact lenses
- Avoid makeup or nail products that interfere with monitoring
- Bring an up-to-date medication list
- Arrive with a responsible adult
- Avoid alcohol and recreational drugs
- Confirm that fasting instructions were followed
The team should confirm your identity, treatment, consent, medical history and discharge arrangements before sedation begins.
How are patients monitored?
Monitoring requirements depend on the depth of sedation and the patient’s health.
They may include:
- Oxygen levels
- Breathing rate
- Heart rate
- Blood pressure
- Level of responsiveness
- Heart rhythm
- Exhaled carbon dioxide
Appropriate oxygen, suction, airway equipment, emergency medicines and resuscitation equipment should be available. Staff must be trained for their roles and able to recognise and manage complications.
Monitoring continues during the procedure and recovery until the patient meets the required discharge criteria.
What are the risks of sedation?
Possible side effects and complications include:
- Drowsiness
- Dizziness
- Nausea or vomiting
- Headache
- Disorientation
- Unexpected agitation
- Reduced blood pressure
- Slow or irregular heart rate
- Allergic reaction
- Excessive sedation
- Airway obstruction
- Reduced breathing
- Reduced oxygen levels
- Inhalation of stomach contents
- Delayed recovery
- Injury during recovery
- An incomplete dental procedure
Rare complications can be serious and may include severe breathing or cardiovascular problems, brain injury or death. Individual risk depends on the patient, medication, procedure, depth of sedation, practitioner and clinical setting.
“Natural” or non-IV options should not automatically be described as risk-free.
What should I expect after sedation?
Recovery varies according to the medication, dose, procedure and individual response.
You may experience:
- Sleepiness
- Reduced coordination
- Impaired judgement
- Temporary memory loss
- Nausea
- Dizziness
- Tenderness at an injection or IV site
Depending on the sedation used, you may need a responsible adult to take you home in a private vehicle and stay with you.
For the period specified by the sedation provider, you may be instructed not to:
- Drive
- Ride a bicycle
- Operate machinery
- Drink alcohol
- Take unapproved sedating medicines
- Sign legal documents
- Make important financial or personal decisions
- Care for children or dependent adults without assistance
Follow the written discharge instructions. Contact the supplied emergency number if you develop breathing difficulty, persistent vomiting, increasing confusion, severe pain or another concerning symptom.
Does sedation cure dental anxiety?
Sedation may help a person complete treatment, but it does not necessarily resolve the underlying fear.
For some patients, combining dental care with gradual exposure, communication strategies or psychological treatment may provide longer-term assistance. The appropriate approach depends on the causes and severity of the anxiety.
Questions to ask about dental sedation
Consider asking:
- What type and level of sedation are proposed?
- Why is it appropriate for me?
- Who will administer and monitor it?
- What qualifications, registration or endorsement do they hold?
- Where will the procedure take place?
- Will local anaesthetic still be used?
- What are my individual risks?
- What alternatives are available?
- What preparation and fasting instructions apply?
- Will I need an escort?
- How long should someone stay with me afterwards?
- When can I drive, work or exercise again?
- What is included in the quotation?
- What happens if the dental treatment cannot be completed?
Discuss dental anxiety and sedation options in Perth
If dental anxiety is making it difficult to attend appointments, you can discuss your concerns before agreeing to treatment. Options may include non-drug anxiety management, local anaesthetic, sedation or referral to another appropriately qualified practitioner or facility.
Availability and suitability of particular sedation techniques must be confirmed through an individual assessment.
Contact Smile Design Studio in Mosman Park, Perth, on (08) 9468 3322 or request an appointment online.
Sedation and anaesthesia carry risks and are not suitable for everyone. This information is general and does not replace assessment or advice from your dentist, medical practitioner, sedation provider or anaesthetist.
