Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.


When I was fifteen years old, I had eleven cavities. I went to a dentist, who extracted three of my teeth and would have taken out more if I was cooperative. He told me, “You will only feel a little pinch.” To him it was a pinch; to me it was a terrifying ordeal, and I vowed if I could ever improve the process, I would.

Since the late 1800s, dentists have always used various methods of pain control in order to allow their patients to relax and have their work done. Some patients could have an extraction with local anesthesia but needed additional levels of sedation for a root canal. Other patients could have a root canal with local but needed sedation for wisdom tooth extractions. It is all about perception. Some patients are scared when they hear the sound of a drill; others are bothered by the sight of a needle or the smell of medicine they associate with a dental office. Some people have a gag reflex — some so bad that they start to gag when a hand with a dental instrument approaches their face. Dental fear is an individual thing.

Based on a patient’s health and the dental procedures needed, we can propose different levels of sedation. A patient treated at one level for one procedure may be treated with less for a similar procedure at a different time. For purposes of discussion for general dentistry, we can call it “the five levels of sedation.”

The Five Levels of Sedation

Level One: Intro-sedation or techniques the doctor can use to make the patient feel more comfortable. This may include hypnosis; use of hard- and soft -tissue lasers, warming of the local anesthetics; or using small pediatric needles to start all injections; speaking to the patient in a low, calm voice.

Level Two: Adding nitrous oxide to decrease the patient’s apprehension along with local anesthesia as needed, and other techniques used in Level One.

Level Three: Anti-anxiety or relaxation medications are given to patients intra-orally (by mouth) prior to treatment. Patients go through treatment in a more relaxed state. Some amnesic properties are present in these medications. Patients pulse, heart rate, and blood pressure are monitored.

Level Four: Treatment is done with the addition of intravenous (by vein) sedation medication to produce a mild conscious sedation state. The patient can maintain his or her own airway and can respond to stimulus, thus minimizing the possibility of low oxygen levels and cardiac events. In addition to the patients pulse, heart rate, and blood pressure being monitored, a capnography machine is also used to monitor their oxygen and carbon dioxide levels.

Level Five: Treatment is done under general anesthesia in a hospital setting, monitored by an anesthesiologist. If you are hesitant to do dental treatment or even visit a dentist, try discussing these levels of sedation with your personal dentist. There is always an option that can help you.

Keeping Sedation Safe with Good Monitoring Equipment

Capnography allows us to see a graph of the patients’ carbon dioxide level as they breathe. This is one of the best additions to in-offi ce sedation dentistry that I have ever used. This device allows the doctor to monitor the sedated patients’ carbon dioxide levels to ensure that the right levels are maintained.

Another great device used in sedation dentistry is an EKG, which can give us a good idea of your basic heart rhythms during a moderate sedation session. EKG, blood oxygen level, blood pressure, pulse rate, carbon dioxide levels, and capnography (breathing chart) are parameters that quickly alert us to the level of sedation, as well as alertness, and provide us with a way of continually monitoring the patient through a dental visit.

One of the best safety measures in sedation dentistry is the accuracy of the patient’s medical history. Accurate history includes past use of drugs, including illicit drugs, operations, medications, history of illnesses, and recent medical checkups. Sedation dentistry involves a whole team, and the team consists of not only the people giving care but the patient and their full involvement with their treatment.

Undiagnosed or untold medical conditions are one of the greatest hindrances to proper treatment of a patient undergoing sedation dentistry. Do not keep parts of your medical history a secret from your sedation dentist!