What is conscious sedation, and what is it not?
Conscious sedation is a drug-induced lowering of consciousness used to reduce anxiety. It is not being put to sleep. The UK national standard requires verbal contact with the patient to be kept throughout the procedure. It treats loss of verbal contact as falling outside conscious sedation. Sedation does not remove pain on its own either; a local anaesthetic is still given to numb the area.
The decision rests on two questions. Is this method suitable for you, and do the setting and the team meet the conditions it requires? This page answers both openly, lists who it is not suitable for and explains the escort rule. We have no sourced figure for how often sedation-related adverse events occur, so we do not give a safety percentage.
- Conscious sedation is not sleep: the national standard requires verbal contact to be kept throughout the procedure.
- Sedation is not pain control; a local anaesthetic is still given to numb the area.
- For adults, every technique except inhaled sedation with nitrous oxide needs an escort; without one, treatment under sedation is not carried out.
- Safety depends on the setting, the team and the monitoring. The guidelines require consent, fasting instructions, vital signs, continuous pulse oximetry and discharge criteria.
- There is no sourced figure for how often sedation-related adverse events occur, so we do not give a safety rate.
Who it suits, and who it does not
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 uses 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. 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 asks that treatment under sedation is not carried out1 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. The standard asks for the drug to be given in small steps while its effect is watched. It also regards a single drug as safer than giving several different drugs one after another. 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. The UK care pathway refers 12- to 16-year-olds to community dental services or to hospital settings equipped for this work. For younger children the decision is made separately.
- 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.
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.
| Local anaesthetic | Conscious sedation | General anaesthesia | |
|---|---|---|---|
| Consciousness | Fully awake | Lowered, but verbal contact continues | Absent |
| Pain control | Provided by the local anaesthetic | Not provided by sedation; a local anaesthetic is still given | Provided by a combination of drugs |
| Breathing | You breathe for yourself | You breathe for yourself | Controlled by the team and equipment |
| Team and setting | Dentist and dental nurse | Trained team, monitoring equipment, resuscitation competence | Anaesthetic team and an approved setting |
| Escort | Not needed | Needed for adults except with inhaled sedation; for children with every method | Needed |
| Driving afterwards | No restriction | Not for the period the team specifies | Not allowed |
| Remembering the procedure | You remember it | You may not remember part of it; this cannot be promised | Recall is not expected, but cannot be guaranteed |
How a sedation appointment runs
The steps below are the ones the two national guidelines require, in the order an appointment runs. 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. We do not describe our own team or equipment on this page until we can support it with a document.
Before you agree, we suggest you also ask these questions. We have drawn them from the sedation standards:
- Who will give the sedation, and what are their qualifications?
- What monitoring will be used during the procedure?
- If a problem arises, which team and which equipment will be ready?
- What are the discharge criteria, and will the instructions be given in writing?
- Whom can I contact afterwards, including outside working hours?12
Assessment and consent
Your medical history, the medicines you take and when you last ate and drank are reviewed. Informed consent specific to sedation is taken. Baseline vital signs are measured and recorded: blood pressure, pulse, breathing rate, weight, height and oxygen saturation by pulse oximetry. The American guideline makes all of these mandatory. Before the appointment, tell us if you might be pregnant or are breastfeeding. Also tell us about any earlier problem with sedation or anaesthesia, and about a recent respiratory infection.
Choosing the method
The UK standard asks for the simplest technique that will work. Every technique other than inhaled sedation with nitrous oxide requires competence in placing a cannula in a vein.
Preparation and equipment check
The equipment is checked before every administration. A system for giving oxygen under positive pressure must be immediately available. At least one person trained in basic life support is present with the dentist.
Giving the sedation and monitoring
Where the route allows, the drug is given in small steps while its effect is watched. The next dose is given only after the previous one has taken full effect. The American guideline requires continuous pulse oximetry, continuous watching of chest movements and assessment of the level of sedation. It also requires equipment that measures exhaled carbon dioxide, and the means to listen to breath sounds, to be immediately available. The UK standard sets monitoring by technique, including pulse oximetry and blood pressure. It does not recommend routine measurement of exhaled carbon dioxide for dental patients who are healthy or whose illness is mild. The treatment is carried out under a local anaesthetic; sedation does not replace numbing.
Recovery and discharge
The dentist does not leave the treatment room until the patient meets the recovery criteria. The patient does not leave the premises until the discharge criteria are met. Post-operative instructions are given to both the patient and the escort, verbally and in writing. You are also told where and how to get advice outside working hours.
Going home
When your sedation method requires an escort, you go home with your escort. For the period the team specifies you do not drive or operate machinery, make important decisions or sign documents.
Risks and benefits
Risks and limits
- A deeper effect than expected. The 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 make airway problems more likely; in these patients the assessment is made separately.
- Sedation does not remove pain. A local anaesthetic is still given to numb the area. A patient who expects sedation to control pain will be disappointed.
- 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 treat fear. Whether it makes the next treatment easier cannot be answered from the sources on this page.
- A lost day, and the load on your escort. For adults an escort is required except with inhaled sedation. For the period the team specifies you do not drive or go back to work. When your sedation method requires an escort, follow the team's supervision instructions. 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.
- No safety rate can be given. Both national documents cited on this page are standards documents. Neither contains a figure for how often sedation-related adverse events occur1. So you will not find a sentence on this page saying "sedation is this safe".
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.
After the procedure
Discharge
You are discharged when the criteria are met. Under the UK standard, instructions given verbally and in writing to both the patient and the escort are a condition of discharge1. So is an explanation of where to get advice outside working hours.
The same day
- When your sedation method requires an escort, go home with a responsible adult and follow the team's supervision instructions.
- Do not drive or operate machinery for the period the team specifies.
- 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.
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.
When to get help
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
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. Show these lines to your escort beforehand.
What determines the cost?
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.
Talk to us about your fear before the appointment
Write to us about what you are afraid of and what you have been through before. Together we will work out whether sedation is needed, which method could be considered and how the escort arrangement will work. The decision is made after an examination and a review of your medical history.
Frequently Asked Questions
Will it hurt?
Sedation does not remove pain on its own; it reduces anxiety. A local anaesthetic is still given to numb the area. If you feel pain during the procedure you can say so, because verbal contact continues. Afterwards some pain can be expected, depending on the procedure, and it is managed with medicines. We do not tell you that you will feel nothing at all.
Is sedation a general anaesthetic? Will I be asleep?
No. Conscious sedation is not being put to sleep. The UK national standard requires verbal contact with the patient to be kept throughout the procedure. It treats loss of verbal contact as falling outside conscious sedation. The American Dental Association's definition of moderate sedation also requires the patient to respond purposefully to spoken instructions.12
Will I remember the procedure?
It varies. Some patients do not remember part of the procedure; others do. It depends on the drug, the dose and the person. No one can promise that you will remember nothing; if that is what you expect, let us talk about it before the appointment.
Can I come without an escort?
Not for adults with any technique other than inhaled sedation with nitrous oxide; children need an escort with every method. The UK standard makes an escort mandatory and asks that treatment under sedation is not carried out if an escort cannot be assured. If you have no one to come with you, tell us before the appointment. Sedation that needs an escort is not given without one. We will discuss the options that do not need an escort, such as a local anaesthetic alone.1
How many hours do I need to fast?
The team that will give the sedation tells you how long to fast. The guidelines ask for this to be given verbally and in writing, and recorded. We do not give a number of hours on this page, because the time depends on the method and the patient. A figure remembered wrongly could lead to your appointment being cancelled.2
Is sedation safe?
We do not answer this with a percentage. The two national documents cited on this page are standards, not studies of how often things happen. Neither contains a figure for how often adverse events occur. What determines safety is the setting, the team, the monitoring and the discharge rules. Ask how these are met at your own appointment.12
I have heart disease or high blood pressure. Can I have sedation?
It needs an assessment. The American Dental Association guideline asks the dentist to consult the patient's own doctor or the relevant medical specialist first. This applies to patients with significant medical problems. Bring a list of the medicines you take and any recent reports. The decision is made once this information has been seen.2
Can my child be treated under sedation?
For children the decision is made separately. The UK care pathway refers 12- to 16-year-olds to community dental services or to hospital settings equipped for this work. For younger children the method and setting are also assessed separately. Write to us beforehand with your child's age, health and previous experience.1
When can I drive after sedation?
Do not drive or operate machinery until the period given by the team that sedated you has passed. When your sedation method requires an escort, go home with a responsible adult and follow the team's supervision instructions. The period depends on the method and on you; it is given in writing at discharge.1
Dt. Dilek AKSU GÜLER
Dentist · Founder
She has completed advanced training in implantology and works in aesthetic restorations and smile design.
Sources
- Standards for Conscious Sedation in the Provision of Dental Care (V1.1). Intercollegiate Advisory Committee for Sedation in Dentistry, Dental Faculties of the Royal Colleges of Surgeons and the Royal College of Anaesthetists, 2020. 2020.↩saad.org.uk
- Guidelines for the Use of Sedation and General Anesthesia by Dentists (moderate sedation section). American Dental Association, adopted by the House of Delegates, October 2016. 2016.↩ada.org