Conscious Sedation for Dental Treatment

When it may be considered

• Fear of the dentist strong enough to make you put off treatment
• A gag reflex that makes treatment difficult
• A long surgical procedure is planned (for example full-mouth implant treatment)
• Treatment started under a local anaesthetic could not be completed because of anxiety

Ways it can be given

Conscious sedation is not a single method. A mixture of nitrous oxide and oxygen can be breathed in through the nose. A drug can also be given into a vein or taken by mouth. The UK standard allows a tablet only when a technique that can be given in small steps is not suitable. The tablet is then taken at the clinic, not at home. It is given only by a practitioner already competent in intravenous sedation. The team that will give the sedation decides which route is used. For adults, inhaled sedation with nitrous oxide is the only method outside the escort rule, and it disrupts your day less. Like every method, it is used only if the assessment shows that it suits you. Every other method requires the team to be competent in placing a cannula in a vein.

When it is not suitable, or another step comes first

• No escort is available. For adults, an escort is required with every method except inhaled sedation with nitrous oxide; children need an escort with every method. The UK standard says treatment under sedation must not be provided¹ if an escort cannot be assured.
• A serious general illness. The American Dental Association guideline asks that, for patients with significant medical problems, the dentist first consults the patient's own doctor².
• Sleep apnoea or a high body mass index. The same guideline recommends checking body mass index as part of the assessment before sedation. A high index, especially together with sleep apnoea, can make airway problems more likely.
• A risky medication history. If an opioid has been given or taken shortly before, a benzodiazepine can be up to eight times more potent¹. Tell us the name and dose of every medicine you take and when you last took it.
• Children and young people. For children the decision is made separately; the method and the setting are assessed for each child. Ask us whether we treat children under sedation at all.
• Expecting to be fully unconscious. In conscious sedation verbal contact continues. Being unconscious falls under deep sedation or general anaesthesia, which need a separate setting and a separate team. You may not remember part or all of the procedure, but that is a separate matter and no one can promise it.

What to consider instead

• A local anaesthetic, with the treatment split up. Short sessions, an agreed signal for a pause and a step-by-step explanation of the procedure are often enough.
• General anaesthesia. A separate decision that needs a separate team and an approved setting. It is not a stronger form of conscious sedation.
• Saying no. You can decline sedation, or the treatment itself, at any point before it starts, including after you have arrived. Once it has started, verbal contact continues, so you can still say "stop". Having the treatment with your dentist at home remains an option.

Suitability is decided by an examination, your medical history and a review of the medicines you take. The decision on sedation is made by the team that will give it.

The steps below are the ones two guidelines require, in the order an appointment runs. They are the UK national standard and the guideline of the American Dental Association, in the US. Which drug and which route are chosen depends on the patient; the team that gives the sedation decides. Ask us who will carry out these steps at your own appointment and with what equipment; we give you the answer in writing. This page describes what the guidelines require, not our own team or equipment. The questions to ask before you agree are listed under 'If you are coming from abroad' below.¹²

Risks and limits

• A deeper effect than expected. The American guideline judges the level of sedation by how you respond, not by how the drug is given. A deeper effect than expected is possible by any route. The same drug can also act more deeply in one patient than in another. As sedation deepens, breathing can slow and the oxygen level in the blood can fall. That is why the guidelines require continuous pulse oximetry² and, depending on the technique, resuscitation competence¹. If this happens, the procedure is stopped, oxygen is given and the airway is supported.
• Drug interactions. If an opioid has been given or taken shortly before, a benzodiazepine can be up to eight times more potent. Tell us about every medicine and herbal product you take.
• Drug allergy and the cannula site. An allergic reaction to the drugs used can occur, though rarely. The place where the cannula went in may bruise, hurt or turn red.
• Airway risk. Sleep apnoea and a high body mass index can make airway problems more likely. In these patients the airway risk is assessed before sedation is decided.
• Sedation does not remove pain. The local anaesthetic does that, and it is still given to numb the area.
• You may still remember the procedure. Some patients do not remember part of the procedure; others do. This varies with the drug and the patient.
• Sedation does not cure dental fear. It reduces anxiety during the treatment. We have found no source that says whether it makes later treatment easier.
• A lost day, and the demands on your escort. For adults an escort is required except with inhaled sedation. For the period the team specifies you do not drive, do not go back to work and are not left alone. This period does not end at midnight; after intravenous sedation it can run into the next day. During the same period, do not take sole charge of a child or of someone who depends on your care. On a trip, that day is not a travel day.
• No safety rate can be given. Both guidelines cited on this page are standards documents. Neither contains a figure for how often sedation-related adverse events occur¹.

Benefits

• It can make it possible to carry out treatment that has been put off for years because of anxiety.
• It can help a long procedure feel less demanding.
• It can make treatment easier for patients with a strong gag reflex.
• Because verbal contact continues throughout, you can say "stop"; under general anaesthesia you cannot.

None of these benefits is the same for everyone. The same drug at the same dose does not give two patients the same experience.

Discharge

You are discharged when the criteria are met. The UK standard makes instructions, given verbally and in writing to both the patient and the escort, a condition of discharge¹. So is an explanation of where to get advice outside working hours.

The same day

• Go back to your home or hotel with a responsible adult, and do not stay alone that day. This does not apply to adults after inhaled sedation with nitrous oxide alone.
• Do not drive or operate machinery for the period the team specifies. That includes a hire car.
• Do not make important decisions or sign contracts or consent forms.
• Do not drink alcohol. Ask the team how to take your regular medicines that day.
• In the first hours, choose light, lukewarm food.
• Do not plan a flight for the day of a sedation appointment, or before the period the team specifies has passed. The dental treatment itself also has a wait before flying; see below.

Flying

Two waits apply, and whichever ends later sets your flight date. One is the period the sedation team gives you; after intravenous sedation it can run into the next day. The other is the wait after the dental treatment itself, which still applies once the sedation has worn off. A 2023 review suggests waiting about a week³ before flying after most dental procedures. After an implant is placed it suggests at least 72 hours. After a sinus lift it suggests at least two, and ideally six, weeks. Its shortest suggested wait, after restorative treatment such as a filling, is 24 hours. These times assume there is no pain, swelling or bleeding where you were treated. The authors say the research is limited and comes mostly from military aviation. Treat these intervals as a starting point for a conversation with the dentist who treated you, not as clearance. Your written plan proposes a flight date on this basis. Confirm it with that dentist after the treatment.

The next day and after

The dental treatment itself comes with its own care instructions, given separately; sedation does not replace them. After implant surgery or a bone graft, the rules for that surgery apply; they are explained on the bone grafting page.

The escort rule changes your travel plan. For adults it applies to every method except inhaled sedation with nitrous oxide. After such an appointment, going back to a hotel on your own is not appropriate; a responsible adult must be with you. If you are travelling alone, raise this before you book. Sedation that needs an escort is not given without one¹. We will then discuss the options that do not need one, such as a local anaesthetic alone.

The day of sedation is not a travel day, and the rest of that day is not for sightseeing or other appointments. Your written plan states on which day of your stay sedation is planned, and when you can fly. Ask for it before you book travel.

Language during the procedure

Conscious sedation relies on the team being able to talk with you throughout. Ask in advance which language the team will use with you during the procedure. Does the dentist speak your language, or will a translator be there?

The record to take home

Before you fly home, ask for your record. Ask that it states the sedation method and the drugs given, as well as the dental treatment. If you have treatment under sedation again, the next team will want to know what was given and how you responded. The Dutch dental association suggests asking for your patient record⁴ after treatment and checking what it describes. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging⁵.

Your dentist at home

The Dutch dental association also advises you to discuss your plan with your own dentist⁴ before treatment abroad. Check, too, whether you can see that dentist if you need care afterwards. Take your record to your dentist at home after you return. Ask the health service or your insurer in the country where you live what they cover for treatment abroad, for follow-up care and for complications.

Questions to ask before you commit

We suggest you ask these questions before you agree to treatment under sedation:

1. Who will give the sedation, and what are their qualifications?
2. Will they speak my language, or will a translator be there?
3. Does the method planned for me need an escort?
4. What monitoring will be used during the procedure?
5. If a problem arises, which team and which equipment will be ready?
6. If I needed hospital care, where would I be taken, and who pays for extra nights or a changed flight?
7. What are the discharge criteria, and will the instructions and my plan be given in writing?
8. Whom can I contact after the treatment?

The questions on monitoring, emergency readiness and discharge come from the sedation standards cited on this page. Ask us all of them. We give you, in writing, who gives the sedation, where, and with what equipment. The full list of questions to ask before treatment abroad is on our page about dental treatment abroad.

Contact the clinic if any of the following happens after sedation.

• Excessive sleepiness that continues into the next day
• Dizziness, unsteadiness or nausea that does not pass
• Vomiting that continues, and fluids cannot be kept down
• Unusual restlessness or agitation
• Pain, swelling or redness where the cannula went in

Before you fly home. If any of these signs starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. If a sign above does not settle, also see a doctor or dentist locally without waiting for our reply.

Emergencies. If your escort cannot wake you easily, that is an emergency. So are difficulty breathing, blue lips or skin, a seizure or chest pain. Do not wait for the clinic's reply. Sudden confusion, slurred speech, a drooping face or weakness in an arm are also emergencies. Do not put these down to sedation and wait, even if the symptoms pass. Call 112 in Turkey, or the local emergency number wherever you are. Show these lines to your escort beforehand.

This page does not quote fees. The aspects of sedation that affect a plan are the method, the length of the procedure, and the monitoring and team it needs. An additional assessment, if one is needed, and the length of the appointment also count. Ask in writing whether sedation is included in the treatment fee and, if it is charged separately, what it covers.

If your sedation needs an escort, their travel and stay are part of the cost of your trip. The Dutch dental association advises counting all the costs, travel and accommodation included⁴.