Moderate Sedation Overview

Sometimes nitrous and local anesthetic just doesn’t cut it for dental procedures either due to patient anxiety or the type of procedure.

In our office we will offer sedation services for a wide range of procedures including – surgical extractions, wisdom teeth removal, root canals, crowns, and implants.  

The drugs used during the procedure include:

• Fentanyl – Narcotic, helps with pain and a feeling of euphoria
• Versed/Midazolam – benzodiazepine, makes sleepy, helps with amnesia, can slow breathing
• Ketamine – hallucinogen which causes patient to disassociate from what is happening

**The half-life of these drugs is very fast.  Most of the IV drugs are metabolized before the patient leaves the office.

The patients will feel very drowsy and lose their ability to feel pain as well as care what is going on.   Most people are very loopy but still respond to basic commands – sit up, open your mouth, etc.

At the end of the procedure, the patient must meet basic criteria to leave the office.  This includes breathing on your own without oxygen supplementation, ability to respond to basic commands, and swallowing as well as able to freely move all extremities.  The patient will NOT be able to drive themselves for their appointments. Additionally, we cannot let them take an Uber home. They must have a responsible driver prepared to take them home.

For post care, we recommend patients take it easy for the next few hours – a patient will not be able to return to work/school the day of their surgery and should monitor themselves for the next several days. 

We typically do not send patients home with a prescription for drugs, instead we recommend 650mg Tylenol and 600mg Advil. Take at the pills together, every 6 hours. This will be a super important conversation with parents as statistics show the most common time to become addicted to narcotics is when you have your widsom teeth removed.

Key Points:

• Patients may not eat or drink ANYTHING (water included) 6 hours before their appointment. This is imperative! If the patient were to get sick during surgery, this becomes a choking hazard. They can also aspirate (get fluid in their lungs) which can lead to serious infections.
• Patients much have a driver and we ask that person to stay in the office throughout the entire procedure.

Procedure Codes:

Procedure we will charge out D9239 – intravenous moderate (conscious) sedation/analgesia – first 15 minutes. Then D9243 – intravenous moderate (conscious) sedation analgesia – each subsequent 15-minute increment.  For any additional amount of time needed the patient will be charged another D9243. It’s a slightly different code if our CRNA is doing the procedure.