Intravenous Sedation Dentistry
This is a transcript of an interview with Principal Dentist, Dr Chris Hardwicke about Intravenous Sedation Dentistry. The interview was recorded in 2015.
JK (Interviewer): We’re here today with Dr. Chris Hardwicke, who’s a dentist, the principal dentist of Corinna Dental Group, to discuss sedation dentistry which is also known as IV sedation dentistry, intravenous sedation dentistry, sleep dentistry and I think also, twilight dentistry. So Chris, first it’s probably a good idea just to establish those terms that you actually use within the practice to describe this type of dentistry.
Dr Chris Hardwicke: Sure. All of those terms are used quite interchangeable. But we like the term “intravenous sedation” which basically implies and suggests that we put drugs in through the vein in order to achieve our goal with what we’re looking for with intravenous sedation.
JK: Okay. So that’s given us a basic overview of what intravenous sedation is. So how does it work?
Dr Chris Hardwicke: Well, it’s an opportunity to introduce a variety of drugs into a patient so that basically they don’t know, care, or remember what’s going on during any dental procedure. It’s not like a general anaesthetic, but it often feels like this. It often feels as though the patient is asleep. But they are conscious and they’re able to speak. But when they do speak, it’s very slurred and very slow. They’re able to protect their own airway and they’re able to let the dentist know if there is any discomfort during the whole procedure. But the big advantage is that they won’t remember anything about it.
JK: So is intravenous sedation, is it a safe type of dentistry? You’ve spoken about general anaesthetics and we know that there are risks involved in having a general anaesthetic in hospital. What about intravenous sedation?
Dr Chris Hardwicke: Intravenous sedation is a safe means of having dentistry performed. But there is a risk associated with any anaesthetic agent, whether it’s an intravenous agent or whether it’s a procedure in a hospital where it’s a general anaesthetic. There is always a risk associated with it, but that’s clearly explained to the patient before we start any procedures.
JK: And so, along those same lines, is it something that’s suitable for everybody or are there medical conditions perhaps that might prevent a person from having intravenous sedation?
Dr Chris Hardwicke: Sure. I’d like to say it’s suitable for everyone but that’s not the reality. The two extremes of age, the very young and the very old, are more unpredictable in their response. So special need needs to be taken with these two groups of people.
Also, patients who have a complicated medical history might not be suitable for intravenous sedation and they might be best taken care of in a hospital environment, basically, because of their complex underlying medical conditions.
JK: You mentioned that under intravenous sedation people, whilst they’re conscious, they’re not as concerned about the dental care that they’re receiving during those appointments and they also have the added benefit of not remembering. So, this is a type of care that’s really suitable for people who are particularly nervous.
Dr Chris Hardwicke: Absolutely. Patients who are nervous and anxious about dental work. I know a lot of them have postponed dental work because of that, can often have their work carried out in a safe environment where they don’t remember any of the procedures. And hopefully we then get them to a point where their mouths are a lot healthier and then we help them maintain it thereafter.
So the fact that they come in and have intravenous sedation on one or two occasions initially doesn’t necessarily mean that they’re going to continue being intravenous cases for the rest of their lives. It just means that hopefully we can get them dentally fit so that we can then help them maintain that dental health.
JK: Can any type of treatment be done under intravenous sedation?
Dr Chris Hardwicke: The majority of treatment can be done under intravenous sedation. There are certain procedures that I think would be avoided and those might be orthodontic appliances where they’re applied to individual teeth. We don’t do any of that under intravenous sedation. But the vast majority of work can otherwise be done quite safely under intravenous for sure.
JK: So even with something that needs x-rays or impressions or those sorts of things, that can all be done?
Dr Chris Hardwicke: Of course it can. Yep. Everything can be done whilst the patient is in this relaxed state.
JK: What should somebody expect if they’re going to have intravenous sedation?
Dr Chris Hardwicke: The first appointment is basically a consultation appointment. So it’s an opportunity for the patient to come in, to meet me and meet the staff, to familiarise themselves with the environment. And we’ll assess their clinical needs and talk them through the whole process so that before they even arrive they have a clear understanding as to what’s gonna happen.
When they come in on the actual day of the procedure, they’ve fasted, they’ve had nothing to eat or drink for four hours beforehand, and they’re suitably attired and we place lots of monitors on them to make sure that everything stays nice and healthy during the procedure. We give them some happy gas, which helps them relax a little bit, and then we introduce a cannula into their arm or into their hand, into a vein, in one of those sites. And then we give them a combination of drugs.
And that’s when they start to drift off and feel very relaxed about life.
We always use local aesthetic around the teeth so that there is no discomfort to the patient because the drugs, whilst it makes them relax, doesn’t knock off the pain receptors. So we have to make sure that they’re comfortable throughout, and then the work is done. After the procedure is finished they have a period of recovery and sometimes that can be 60 minutes or so to make sure that they’re all feeling nice and healthy before we let them go.
And then we let them go with another adult that’s been organised beforehand to come in and pick them up and take them home and make sure that they get home safely.
JK: So are there any other staff in the room other than yourself and your chairside assistant?
Dr Chris Hardwicke: Sure. The legislation asks that there should be another suitably qualified person in the room at all times. In my situation, we have a registered nurse that’s present throughout and I have two dental assistants in the room. So there’s four of us in the room to take care of each patient as they come through the door.
With more complicated cases I also have a consultant anaesthetist that comes in and works with me. So in those cases, where there’s a higher level of need of care, we have five people in the room to take care of them.
JK: And if somebody’s particularly anxious can they also bring a loved one into the room…
Dr Chris Hardwicke: Absolutely. Yeah, absolutely. We often have supporters that come in, nearest and dearest, quite happy to hold hands whilst the line goes in and the drugs start to take effect. And that’s fine. I think it’s a nice thing to do. I think it’s both reassuring for the patient to have someone there and I think it’s really nice for their partner, their supporter to be able to see that everything’s nice and comfortable before they go across the road and do some shopping.
JK: I imagine that intravenous sedation dentistry comes with some additional costs…
Dr Chris Hardwicke: Yeah. Unfortunately there is an additional cost associated with it. And that’s to cover the additional staff, the additional equipment, and the materials and of course, the ongoing training to make sure that we can offer the best environment for this type of work to be done. The current fee is about the $560 mark, which covers a two-hour session, and in that two-hour session, we can achieve a lot of dentistry.
JK: You just mentioned that there’s ongoing study, and you’ve done a lot of additional study to be able to provide this service. So can you tell us something about that?
Dr Chris Hardwicke: Sure. There’s a requirement that in order to be able to deliver intravenous sedation as a dentist, you have to be endorsed by AHPRA, which is the governing body for dentistry in Australia, and they look to make sure that I’ve got a postgraduate qualification, which is currently being offered by the University of Sydney, and that’s a Diploma in Clinical Dentistry in Sedation and Pain Control. I continued on and did a little bit more study and I managed to obtain my Master’s in Pain Management from the University of Sydney. That was a Master’s of Science in Medicine. I became a member of the Royal Australian College of Dental Surgeons, which again, was part of that continuing education process, and I’ve also completed the Diploma in Clinical Dentistry and Sleep Medicine as well, and that fits in with a lot of the practice of sedation with maintenance of the airways.
JK: And I imagine that the support staff also have to keep their skills up-to-date?
Dr Chris Hardwicke: Sure. Absolutely. The staff here have regular updates as far as clinical management and emergency care, and that’s coordinated through external groups or with the input from the anaesthetist that we work with as well.
JK: If somebody was interested in making an appointment to go ahead and have that initial consultation with the view to having their dental treatment done under intravenous sedation, how would they go about that?
Dr Chris Hardwicke: They could ring any of the three surgeries and the staff there would be more than happy to organise a consultation appointment. That’s always with me so that I can have the opportunity to assess the patient. But the consultation can be organised at any of the rooms, that’s not a problem.
JK: I know that sometimes people who are nervous about dentistry and nervous about every aspect of dentistry, they don’t like the smells, they don’t like the look of the equipment, or anything like that. Do they have that initial consultation appointment in a treatment room, or is there opportunity to not be in that dental environment to begin with?
Dr Chris Hardwicke: There is the opportunity to have an initial discussion, not necessarily in the treatment room, but the reality is in order to decide what we need to do, we have to actually go into the treatment room just to have a look, but that’s just a matter of sitting in the chair and opening your mouth. For a lot of people, the use of any instruments in the mouth, that’s part of their anxiety, and so we can often just have a look and ascertain what’s going on without the need for anything like that.
JK: Thank you very much, Dr. Chris Hardwicke, for explaining sedation dentistry and how it can help very nervous people here in Canberra to receive the dental care that they really need.