What is sleep dentistry?

In short: sleep dentistry means having dental treatment with the help of sedation or a general anaesthetic. Those are different things. With sedation you are calmer and drowsier but can usually still respond when spoken to. With a general anaesthetic you are unconscious. Which one is right for you, and where it happens, is a clinical decision made with your dentist and the practitioner giving the sedation or anaesthetic.

Why the name can mislead

The word “sleep” suggests you will be unconscious and remember nothing. For many people having dental sedation, neither is true. Australia’s anaesthesia college, ANZCA, describes sedation by how a person responds, not by how sleepy they look. At the lighter levels you are awake and can talk. At moderate levels you may drift off but still answer when someone speaks to you or touches your arm.

That matters, because people sometimes agree to “sleep dentistry” expecting one experience and receive another. The most useful question you can ask is a precise one: “What level of sedation will I have, and who will give it?” Our guide to the levels of sedation explains the four levels ANZCA uses.

The options, from lightest to deepest

Most dental treatment needs nothing more than local anaesthetic. When more is needed, the options form a ladder. Each step up has more effect on your awareness and breathing, and needs more preparation, monitoring and recovery time.

1. Local anaesthetic alone. The area is numbed with an injection and you are fully alert. It is usually still used underneath every other option, to control pain during and after treatment.
2. Non-medicine strategies. Breathing techniques, music, an agreed “stop” signal and, for longer-term anxiety, psychological therapy. The Better Health Channel notes that cognitive behaviour therapy can be very successful for dental anxiety.
3. Relative analgesia (“happy gas”). You breathe a gas mixture through a small nose mask. It takes effect within minutes and wears off quickly, and you stay awake.
4. An anti-anxiety tablet. A single dose of a short-acting medicine, prescribed after discussion with your dentist or doctor, taken before the appointment.
5. IV sedation. Medicines go through a fine plastic tube (a cannula) in your hand or arm. You become relaxed and drowsy and may drift into light sleep, but can still respond. This is often called “conscious” or “twilight” sedation.
6. Deeper sedation. You are hard to rouse and may respond only to strong stimulation. Your breathing can be affected, so this is managed by an anaesthetist.
7. General anaesthetic. You are unconscious for the whole treatment and an anaesthetist manages your breathing, usually with a breathing tube.

Why people have treatment this way

Sedation or a general anaesthetic may be considered when treatment would otherwise be impossible, unreasonably distressing or unsafe in the dental chair. Common reasons include:

• dental anxiety or phobia severe enough that treatment keeps being avoided
• long or complex treatment, such as removing impacted wisdom teeth
• a strong gag reflex
• a disability or medical condition that makes it very difficult to stay still with the mouth open
• a young child who needs a lot of treatment.

It is not a shortcut for routine care, and it is not a cure for dental anxiety. Sedation helps you through a particular appointment. If anxiety is stopping you from seeing a dentist at all, the Better Health Channel suggests talking with your dentist about a gradual approach and, if needed, a referral to a psychologist.

What sedation does, and what it does not do

Sedation can lower your anxiety, make a long appointment easier to tolerate and, for some people, leave only patchy memories of the treatment. It cannot promise that you will remember nothing, and it does not replace the local anaesthetic that numbs the tooth.

It also has costs beyond money. You will usually need to fast, have an adult take you home and stay with you, and keep the rest of the day free. The medicines can affect your breathing and blood pressure, which is why you are monitored throughout.

Where treatment takes place

Dental sedation and general anaesthesia can happen in three kinds of setting:

• a dental practice that has the room, equipment, monitoring, staff and emergency plans the level of sedation requires
• a day surgery
• a hospital, which may be the right place for people with significant medical conditions or for longer, more complex treatment.

The Better Health Channel describes dental treatment under general anaesthetic as taking place in hospital. In Victoria, an anaesthetist can also provide anaesthesia in some dental practices through a mobile anaesthetic service, which the Department of Health regulates. The Australian Dental Association’s policy on general anaesthesia in dentistry says the anaesthetic must be given by an appropriately qualified and registered practitioner, in line with ANZCA guidelines and state regulations.

How the decision is made

Before the day, the practitioner responsible for your sedation or anaesthetic should review your health. Expect questions about:

• heart and lung conditions, diabetes and other illnesses
• every medicine you take, including injections, inhalers and supplements
• snoring or sleep apnoea, and any previous problems with anaesthesia in you or your family
• allergies, loose teeth, crowns and bridges.

ANZCA’s position statement on consent says you should be told about the material risks, the alternatives and the financial implications, and that written information is not a substitute for that conversation. You are entitled to ask for a professional interpreter.

Risks in plain terms

Every level of sedation and anaesthesia carries some risk. Your own risks depend on your health, the treatment and the setting.

• Common and usually short-lived: drowsiness, feeling sick, a headache, bruising where the cannula was, and after a general anaesthetic a sore or dry throat.
• Less common: sedation becoming deeper than intended, slowed breathing, low blood pressure, damage to teeth from airway equipment.
• Rare but serious: a severe allergic reaction, or stomach contents entering the lungs (aspiration), which is one reason fasting matters.

Ask the person giving your sedation or anaesthetic which risks apply to you and how they are managed.

Questions worth asking before you book

Costs

This guide does not list fees. When an anaesthetist provides your sedation or anaesthetic, they usually bill separately from your dentist, and a hospital or day surgery may charge as well. Ask each provider for a written estimate before treatment. Dr Aly’s main website explains how anaesthetic accounts work without listing fees.

In an emergency, call 000. This information is general and does not replace advice from your treating practitioner.