Intravenous and Oral Sedation

What Does “Sedation” Really Mean?

The term sedation is often misunderstood by the general public, even though it may seem straightforward at first glance. Sedation is one of those medical terms that is frequently mistaken for general anesthesia, which is incorrect. General anesthesia puts the patient into a state of full unconsciousness, whereas under sedation, the patient remains partially conscious.

On the opposite end of the spectrum, some patients believe that sedation is simply a mild dulling of the senses and a feeling of calmness while remaining fully aware, similar to the effect of sedatives. Intravenous sedation goes far beyond that. In this case, sedation is deep enough that the patient feels no pain and is not fully aware—rather, they are semi-conscious, in a state very similar to sleep. Just like in a dream, you might hear someone calling your name or an alarm going off, but you remain detached from the outside world. This level of awareness closely resembles the experience of intravenous sedation.

What Is Sedation in Dentistry?

Sedation refers to any intentional reduction of pain or discomfort during a medical procedure. It can be achieved in various ways, including inhalation, injection, or oral medication. Depending on the needs of the patient, anesthesia can be local (limited to a small area of the body), regional (such as an epidural during childbirth), or general, when the patient is completely asleep and feels no pain anywhere in the body. In terms of intensity, sedation can be minimal—when the patient is still fully responsive, moderate—when the patient gives brief answers to simple questions, deep—when the patient responds only to loud or repeated stimuli, and general anesthesia—when the patient is entirely unconscious.

	Local anesthesia (integral part of all dental treatments)	Regional anesthesia (used in minor surgeries)	Oral sedation (mildest form of sedation)	Intramuscular sedation (moderate sedation)	Intravenous sedation (strongest sedation)	General anesthesia (used in hospitals for surgery)
Scope	very localized	one part of the body	none	complete	complete	complete
Sedative effect	none	none	mild	almost complete	complete	complete
Pain response	reduced, localized	significantly reduced, regional	reduced	almost completely reduced, total	completely reduced, total	no response
Consciousness	fully conscious	fully conscious	slightly reduced	reduced	semi-conscious state	unconscious
Memory of procedure	full memory	full memory	partial memory	partial memory	no memory	no memory

Now that we’ve clarified the difference between sedation and anesthesia, let’s look at how intravenous sedation is administered in dentistry. This method, also known as short-term intravenous sedation, is commonly chosen by patients who come to our clinic for extensive implant procedures.

Short-term Intravenous Sedation

Patients often ask us whether they can receive “general anesthesia” in our clinic. Our answer is yes — but what they usually have in mind is not general anesthesia, but intravenous sedation. The term “intravenous anesthesia” is sometimes used, but the correct term for this procedure is intravenous sedation. As we previously explained, anesthesia refers to the elimination of pain response, while sedation is a broader concept that includes overall relaxation and may involve a reduced level of consciousness.

Intravenous sedation is administered by an anesthesiologist. This type of sedation is recommended for more complex surgical and implant procedures, as well as for the preparation of multiple teeth when placing veneers or fabricating bridges.
The process begins with the patient’s medical history — a detailed consultation between the anesthesiologist and the patient about their health status. Sedation is induced intravenously about 15 minutes before the procedure begins. The patient is then given local anesthesia, and the dental procedure starts. Throughout the procedure, the patient remains in a semi-conscious or semi-awake state.

A semi-conscious state is always a better choice than complete unconsciousness, as it allows for communication between the patient and the dentist/anesthesiologist. This is invaluable during implant procedures. Unlike surgery on, for example, the arm—where patient cooperation is unnecessary—dental procedures require us to instruct the patient when to open, slightly close, or fully close their mouth. This form of sedation also requires an experienced anesthesiologist, who can continuously adjust the sedation level to keep the patient in a stable semi-conscious state for the entire duration of the procedure (2–3 hours).

Short-term intravenous sedation is the best option for more extensive implant procedures, especially when multiple teeth need to be extracted at once. The most common major implant treatment in our clinic is the ALL ON 6 procedure, intended for partially edentulous patients whose remaining teeth are nearing the point of falling out. In a single session, the remaining teeth are extracted and implants are placed. This is a multi-hour procedure and ideally suited for intravenous sedation. Almost all patients receiving an ALL ON 6 procedure choose to pay extra for intravenous sedation, even though it is not mandatory. The procedure can also be performed under regional anesthesia, combined with mild oral sedation at no additional cost. The price of intravenous sedation is €700, and it is available only for treatments valued at €2,000 or more. Patients undergoing smaller procedures who request intravenous sedation will receive oral sedation instead, as intravenous sedation is entirely unnecessary for minor interventions.

Sedation as a Solution for Dental Anxiety

Over the past few years, sedation has become less of an exception and more of a standard when it comes to complex procedures in our clinic. This shift in practice has primarily been driven by patient demand, as patients prioritize being pain-free, while the dentist prioritizes the patient’s responsiveness. Although local anesthesia is often sufficient to eliminate pain, many patients prefer to simply “sleep through” the entire procedure, as sitting for hours—regardless of the absence of pain—is not a pleasant experience. The psychological aspect is also important; patients generally do not want to remember the moment all their teeth were extracted or the hours spent being toothless. Instead, they prefer to fall asleep with some remaining teeth and wake up with a brand new set.

Many patients also feel discomfort at the thought of major procedures, especially surgical ones, and some even experience severe dental anxiety before they even arrive at the clinic. These are patients who become distressed at the mere sight of dental instruments, and for them, intravenous sedation is the ideal solution. In such cases, sedation is administered before anything else is done—while we are still just talking—so that even the most fearful patients can relax. Naturally, patients with pronounced anxiety are advised to bring someone with them.

Waking Up from Sedation

After the procedure, which can last several hours, the patient will have little to no memory of the treatment, starting from the moment the sedative was administered. This is particularly important for anxious patients, as even a pain-free procedure under local anesthesia can leave a lasting impression. Since the anesthesiologist remains with the patient throughout the entire procedure, they can continuously adjust the level of sedation—putting the patient into a deeper sleep or returning them to a semi-conscious state as needed. During intravenous sedation, patients also receive strong medication for pain, swelling, and antibiotics, meaning no additional medication is required after the procedure.

In other words, the patient wakes up from sedation with no memory of the procedure and no pain. They may be slightly disoriented for the first minute, but almost immediately afterward, they want to see their new teeth and are fully aware—and in 99% of cases, thrilled! After 3–4 minutes, the patient is focused enough to talk to us for a social media post and can technically go home right after, although we usually stay to discuss care for the temporary restoration and other follow-up matters. The patient must not drive after sedation, and it is best if someone accompanies the patient home, as minor lapses in attention can occur during the first few hours.