Dental Sedation Options: Nitrous, Oral and IV Explained

If the thought of a dental visit makes your heart race, you are not alone, and you have options. Dentists can use several kinds of medicine to make treatment more comfortable, from numbing a single tooth to helping you relax deeply or, for some procedures, sleep through them. This guide explains the main types in plain language, what each one feels like, safety questions to ask, and non-medication strategies that help many anxious patients.

Key takeaways

• Local anesthesia numbs; sedation relaxes; general anesthesia causes temporary loss of consciousness.
• Nitrous oxide is breathed through a nose mask, keeps you awake and wears off soon after.
• Pills and IV sedation last longer and usually require a ride home.
• Share your full health history and ask who will monitor you.

Numbing vs sedation: two different jobs

The ADA explains that some drugs control pain, some help you relax, and others put you into a deep, sleep-like state (ADA MouthHealthy: Anesthesia and Sedation). It helps to separate them:

• Local anesthesia numbs a specific area by blocking the nerves that sense pain. It does not calm you; you are fully awake.
• Sedation helps you relax and can reduce anxiety. It is usually combined with local anesthesia, since sedation alone does not necessarily block pain in the tooth.
• General anesthesia causes a temporary loss of consciousness.

The ADA says you and your dentist can weigh the type of procedure, your overall health, your history of allergies and your anxiety level when choosing.

Local anesthesia

According to the ADA, a dentist may first apply a topical anesthetic to numb the surface, then inject a local anesthetic. Injectable anesthetics are used for procedures such as filling cavities, preparing teeth for crowns and treating gum disease. If you still feel pain after the numbing, the ADA’s advice on anxiety is clear: tell your dentist. Many people stay quiet out of embarrassment, but your dentist can often give more anesthetic or adjust the approach (ADA MouthHealthy: Anxiety).

Nitrous oxide (“laughing gas”)

The ADA describes nitrous oxide as a sedative mixed with oxygen and inhaled through a small mask over your nose (ADA MouthHealthy: Nitrous Oxide). Key points from the ADA:

• It is not intended to put you to sleep. You can hear and respond to the dentist.
• You breathe normally through your nose, and within a few minutes you should start to feel the effects.
• You may feel light-headed or tingling, or your arms and legs may feel heavy. The goal is to feel calm and comfortable.
• The effects wear off soon after the mask is removed.

Because it wears off quickly, nitrous oxide is often a good fit for people with mild to moderate anxiety. Ask your dentist whether you can drive afterward; policies vary.

Oral sedation (pills)

The ADA notes that sedation may involve pills that are taken by mouth. A dentist prescribes or gives the medicine before the appointment. You stay awake but feel drowsy and relaxed. Unlike nitrous oxide, the effects can last for hours, so you will typically need someone to drive you home and stay with you. Follow your dentist’s instructions exactly about when to take the medicine and whether to eat or drink beforehand.

IV sedation and deeper sedation

The ADA says sedation may also be medicine that is injected, and that more complex treatments may require deeper sedation to relieve both pain and anxiety. IV sedation delivers the medicine through a vein, which lets the provider adjust the level during treatment. Deeper levels mean you may remember little of the procedure. This type of sedation requires extra training and monitoring, and you will need a ride home.

General anesthesia

On occasion, the ADA notes, general anesthesia is used to cause a temporary loss of consciousness. It is more common for complex oral surgery, for some children, and for some people with special health care needs. It may be done in a dental office with appropriately trained staff or in a hospital or surgery center. An oral and maxillofacial surgeon often provides deeper sedation and anesthesia for procedures such as wisdom tooth removal.

Safety questions to ask

The ADA urges patients to take an active role and understand the risks and benefits of treatment. Before any sedation beyond local anesthesia, ask:

• What type and level of sedation do you recommend, and why?
• Who will give the medicine and monitor me, and what training do they have?
• How will my breathing, heart rate and oxygen be monitored?
• What should I do about eating, drinking and my regular medications beforehand?
• Will I need someone to drive me home and stay with me?

Give your dentist a complete list of your medicines, supplements and health conditions, including breathing problems such as sleep apnea, heart conditions and pregnancy. The ADA also offers a list of questions to ask before a child has anesthesia or sedation.

Non-medication strategies that help

Sedation is not the only tool. The ADA recommends several simple strategies for dental anxiety:

• Tell the office you are nervous when you book, and remind the team when you arrive.
• Ask questions; knowing what will happen can ease fear of the unknown.
• Agree on a signal, such as raising your hand, to take a break.
• Wear headphones with music or an audiobook, or squeeze a stress ball.
• Try slow breathing, counting your breaths, or relaxing one body part at a time.

Our article on dental anxiety tips has more ideas.

Cost and coverage

Sedation is often billed separately from the procedure, and coverage varies by plan. Ask for a written estimate that lists sedation as its own line. Our guide on how to read a dental treatment plan explains how to spot it. If you are looking for lower-cost care, see our article on dental school clinics. To find a dentist who offers sedation, start with our dentist directory and call ahead to ask.

Before and after your appointment

Before

• Follow any instructions about eating and drinking exactly. These matter more for oral, IV and general anesthesia.
• Ask whether to take your usual medicines that morning.
• Wear comfortable clothing with sleeves that roll up easily.
• Arrange a ride and, for deeper sedation, someone to stay with you afterward.

After

• Rest for the remainder of the day if you had oral, IV or general anesthesia.
• Avoid driving, operating machinery or making important decisions until the medicine has fully worn off.
• Take care not to bite your cheek, lip or tongue while they are still numb.
• Call the office if you have questions or symptoms that worry you.

Frequently asked questions

Will I be asleep with nitrous oxide?

No. The ADA says nitrous oxide is not intended to put you to sleep; you can still hear and respond to your dentist.

Can I drive after dental sedation?

It depends on the type. Nitrous oxide wears off soon after the mask is removed, but oral, IV and general anesthesia generally require someone to drive you. Ask your dentist.

Does sedation replace numbing?

Usually not. Sedation helps you relax; local anesthesia blocks pain in the area being treated. They are commonly used together.

Is dental sedation safe?

The ADA notes that dentists treat millions of patients safely every year. Safety depends on proper training, monitoring and an honest health history, so ask the questions above.

Sources

• ADA MouthHealthy – Anesthesia and Sedation
• ADA MouthHealthy – Nitrous Oxide
• ADA MouthHealthy – Anxiety

By the Dentist Review Editorial Team.

This article is for general information only and is not medical advice. Talk to a licensed dentist about your own situation. See our disclaimer.

Featured image: “Dental Chair” by Nizil Shah, via Wikimedia Commons, licensed CC BY-SA 3.0. Resized and compressed for the web.