General Dentistry

Sedation Dentistry

Sedation options at our office 

If you find dental procedures unpleasant or challenging, we like to start by establishing a good relationship with you, to understand your needs. We make sure we always talk to you before even picking up an instrument; we ask you about your past experiences: what makes things better and perhaps what you don’t like about dental treatment. 

In this way we hope to gain an understanding how to create an environment where you are comfortable, and you can obtain the necessary treatment to keep you healthy. If we decide that sedation will assist you in achieving your dental goals there are different options. 

Sedation options will vary depending on your needs, and the complexity of the procedures we plan to do. Here are some common sedation options used in our office at Moss Vale: 

Computerised delivery of local anaesthetic 

We often hear stories of ‘horse needles’, which we guess is a description of the old-fashioned metal syringes dentists like to use. Patrick Meaney has been using a sophisticated computerised computerised instrument for delivering local anaesthetic for many years. This system was originally marketed as “the Wand”, we guess because it was a miraculous change to traditional anaesthetic delivery systems. The system evolved and is now called single-tooth or STA anaesthesia. 

Because it’s controlled by a computer designed specifically for dental injections this system allows virtually painless delivery of local anaesthetic in almost all situations. If you have found dental anaesthesia to be a problem in the past (because it’s a painful undertaking) you will be pleasantly surprised by the way we make people numb these days. 

Nitrous Oxide (‘Laughing Gas’) 

Nitrous oxide, often referred to as laughing gas, is a mild sedative administered through a mask placed over the nose. The gas and oxygen mixture creates a state of relaxation and in some cases euphoria, making our patients feel calm and comfortable during dental procedures. 

Nitrous oxide is suitable for patients of all ages and is quickly eliminated from the body after the procedure. This means you can safely drive home and there are no long-lasting effects at all. If you would like to see whether it can assist you, we can make an appointment solely for you to experience it without having any dental treatment at all. By the way, the laughing part is a hangover from when it was used last century for parties: it doesn’t actually induce laughing when we use it in our office! 

Oral Sedation 

Oral sedatives are medications you can take by mouth prior to any dental procedures to induce relaxation and reduce anxiety. Commonly used medications include benzodiazepines such as lorazepam, or oxazepam or temazepam. 

Oral sedation ranges from mild to moderate depending on the dosage and may cause drowsiness, making it necessary for patients to have someone accompany them to and from the dental appointment and for 24 hours following the appointment. If you would like to discuss oral sedation, please let us know and we can organise a consultation appointment. 

Intravenous (IV) Sedation

IV sedation involves the administration of sedative drugs directly into the bloodstream through a vein, allowing for precise control of the level of sedation. It induces a deep state of relaxation and may result in partial or full memory loss of the procedure. IV sedation is typically used for more complex or lengthy procedures and requires close monitoring of vital signs by a trained dental professional or anaesthetist. If you require IV sedation, we can discuss what needs to be done during the consultation — please let us know. 

General Anesthesia

We use general anesthesia by referral for more complex procedures better carried out while you are completely unconscious and unresponsive to pain during the dental procedure. It is administered by an anesthesiologist in a hospital setting, usually the private hospital in Bowral. Depending on the procedure you having done we will select the best specialist dentist to carry out the procedures while you have the general anaesthetic. Will work closely with them to make sure the treatment that you have is what we have planned here in the office beforehand. Once the procedure is complete if you need follow-up care it will be done here. 

General anesthesia is usually reserved for extensive oral surgeries, complex procedures, or patients with severe dental anxiety or special needs. We often refer young people with many procedures to be done at once to specialist paediatric surgeons where their treatment is carried out in a very comfortable manner. 

No matter what we do it's important that we conduct a thorough assessment of your medical history, anxiety levels, and the nature of the dental procedure before recommending a sedation option.  

Dental imaging 

We use different imaging systems to ensure we have a really good understanding of what is going on in your mouth at any point in time. 

The most common dental x-ray is called a bitewing. 

Bitewing x-rays are a type of dental radiograph used to capture images of the upper and lower back teeth (molars and premolars) in a single view. They are called "bitewing" x-rays because traditionally you bite down on a wing-shaped tab or holder to keep the digital sensor in place during the dental imaging process. Here's a breakdown of their use in dentistry: 

They are very useful for a variety of reasons. 

Here are the top six reasons why bitewing x-rays are an absolute necessity for our patients: 

1. Finding cavities (or ‘Dental Caries’
   
   Bitewing X-rays are primarily used to detect dental caries (cavities) between the teeth. Inspired of magnification and excellent modern lighting systems it still impossible to see some cavities without x-rays. Bitewing x-rays are particularly useful for detecting ‘flossing cavities’— where dental floss should go between teeth is a commonplace the decay to develop. There are also useful for detecting cavities in the biting surfaces of back teeth.

   Bitewing X-rays can reveal early signs of decay that may not be visible to the naked eye.

2. Assessment of Existing Restorations
   
   We also use bitewing x-rays to help assess the integrity of existing dental restorations such as fillings, crowns, and bridges. Bitewing x-rays are really useful for checking signs of decay that has formed around existing restorations and they help detect any other problems that may cause your existing fillings to fail.

3. Evaluation of Periodontal Health

   Bitewing x-rays can provide valuable information about the health of the supporting structures of the teeth, including the bone level and presence of periodontal (gum) disease.

   Changes in bone density and height can be observed on these X-rays, aiding in the diagnosis and monitoring of periodontal conditions.

4. Orthodontic Treatment PlanningBitewing X-rays may be used as part of the diagnostic process for orthodontic treatment planning. These X-rays help orthodontists assess the alignment and position of teeth, as well as the relationship between the upper and lower jaws. 
5. Monitoring Dental Development

   In paediatric dentistry, bitewing x-rays are used to monitor the development of permanent teeth and assess eruption patterns. These x-rays can help identify potential issues early on, allowing for timely intervention if necessary.  

6. Screening for Other Dental Conditions

   Bitewing x-rays can also aid in the detection of other dental conditions such as impacted teeth, dental infections, and abnormalities in tooth structure or anatomy. 

   Overall, bitewing X-rays play a crucial role in comprehensive dental examinations, allowing us to diagnose dental problems accurately and develop appropriate treatment plans tailored to the individual needs of each patient.  

   We take bitewing x-rays only when necessary; this varies depending on your risk of developing decay which we assess during your initial examination and in an ongoing basis during your hygiene maintenance appointments. 

Other types of x-rays that we take 

When we perform root canal therapy, and some other procedures we might take single x-rays that show the roots of teeth. Dentists call these views ‘periapical’ — ‘peri’ comes from the Greek meaning around, and apical comes from Latin meaning ‘the tip; so these x-rays are taken around the tip of the root. 

Oral surgeons prefer the orthopantomogram to assess third molar impaction. We also use a really modern imaging modality called cone beam computed tomography (‘CBCT’). 

These 3D x-rays help us to detect hidden abscesses, assess bone levels in disease and health and give us a whole new way of looking at our patients. 

Radiation Dose 

We are often asked whether x-rays are safe. We think they are, but let’s look into it in a bit more detail: 

The dose of radiation from a bitewing x-ray is typically measured in millisieverts (mSv). 

It represents one thousandth of a sievert, which is the unit of measurement for the effective dose of ionizing radiation received by the human body. We are all exposed to background radiation every day, typically about 4 microsieverts. 

The symbol for microsievert is µSv. It represents one millionth of a sievert. 

A single bitewing X-ray exposes the patient to a very low dose of radiation, typically ranging from about 5 to 10 mSv per image. Therefore, the radiation dose from a single bitewing X-ray is significantly lower than the background radiation dose received over the course of a year. 

Here are some comparisons with other activities: 

• Eating a banana: about 0.1 microsieverts 
• Dental x-rays: about 10 or less microsieverts 
• Flying from Darwin to Perth: 16 microsieverts 
• Medical chest x-ray: 20 microsieverts 
• A flight from London to Melbourne: 42 microsieverts 
• A cone beam 3D x-ray: less than 80 microsieverts 
• Average annual background radiation in Australia: 1500 microsieverts 
• Medical chest x-ray: 7000 microsieverts 

It's important to note that the actual radiation dose can vary based on factors such as the type of X-ray machine used, the settings we select, and the size and composition of the your body. However, dental x-rays, including bitewing X-rays, are considered to be safe and effective diagnostic tools when used appropriately and in accordance with recommended guidelines for radiation exposure in dentistry.