July 5, 2020
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Conscious Sedation Dentistry– No fear!

By: George Malkemus
January 10, 2020

Dentistry has made great strides in creating a more relaxing atmosphere for patients.  Vast improvements in dental technology have made dental treatment much smoother, more effective and much more comfortable for patients.  In my office, patients have the option to listen to an I-pod with headphones or use their own cell phone to alleviate dental noise.  Many patients elect to use nitrous oxide for relaxation.  Fearful patients can have Conscious Sedation Dentistry, which safely allows them to sleep during dental treatment.

Dental materials and technology, as well as patient comfort, have advanced rapidly over the last 30 years.  When I began practicing, silver-mercury amalgam fillings were the norm.  Gloves where only used for surgery. Extractions and dentures were the common treatment.  All billing, appointment scheduling and treatment records were handwritten or typed.  Computers were unknown in the dental office.

It doesn’t seem possible, but things have changed so quickly.  Now dental implants have allowed teeth to reappear where they had been missing.  Computerized digital x-rays have revolutionized x-ray taking, improving performance, comfort and safety. Video viewing and digital photos of a patient’s mouth during a dental examination is an amazing advancement in communication and understanding of oral health. Computerized records storage has done away with paper charts and filing. 

With new bondable white materials, the ability to make beautiful tooth-like restorations is a reality. New high technology electric drills are quiet and more efficient than traditional air driven drills. Dyes can detect decay so it can be completely removed.  Sterilization of dental instruments used for each patient is total; everything is autoclaved or discarded.   Dental lasers allow fine precision surgeries. Isolite allows comfortable suction and opening for dental procedures. Painless, long-appointment dentistry is now possible with Conscious Sedation Dentistry.

Dental comfort needs 

Many people are relaxed in the dental office and only need dental anesthetic with an injection for treatment.   Many enjoy listening to music with headphones. Many others have a fear of dental treatment, usually from a terrible childhood experience.  Others have had difficulty with dental treatment, due to an extremely small mouth opening, a painful jaw joint from opening, or an awful gag reflex.  For these patients, either Nitrous Oxide [N2O] for mild cases or Conscious Sedation for advanced cases can be effective and comfortable for dental treatment.   

Nitrous oxide [N2O], also called “laughing gas,” has been available for many years. N2O is inhaled through a dental mask covering the nose and relaxes the patient. Nitrous oxide makes time go by without the patient being anxious and stressing about when the procedure will over.  Often times, the patient will say, “Are you already done?”  The level of gas can be adjusted to allow the patient to be in just the right relaxation state. One hundred percent oxygen is breathed at the end of the appointment to clear their head and avoid getting a headache.  The patient is clear headed when they leave, so they can drive themselves home.

Conscious Sedation dentistry

Conscious Sedation, often called Sleep Dentistry, is a procedure where sedative medications are taken orally at home the night before and the morning of the dental appointment.   During treatment in the dental office, additional sedative medications will be given, as needed. The medications make the patient groggy and sleepy, but able to easily respond to touch and voices.  Even though conscious, the patient is totally relaxed in a sleep state and has no memory of the visit. With Conscious Sedation, the medication does not immediately wear off like nitrous oxide, so someone is needed to give the patient a ride to and from the office.  Not all dentists offer N2O or Conscious Sedation, so you need to ask your dentist if either of these options is available to you.

One of the greatest improvements in my practice has been the use of Conscious Sedation Dentistry.  Before I was trained and certified in the use of Conscious Sedation Dentistry, I had many phobic patients who would call only for treatment when they had a terrible toothache.  Treatment usually involved either having an extraction or a root canal.   The patient underwent a fearful visit to relieve the immediate pain without the benefit of advanced planning.  I would explain the importance of regular, early preventive visits, having regular cleanings and less involved filling treatments to catch the decay while it was still small.  But their fear of going to the dentist was so strong, they would wait until they had a roaring tooth ache to return to the office for treatment, usually a number of years later.  Now conscious sedation allows that same patient to have years of dental neglect reversed in one appointment with no discomfort whatsoever during and after treatment and have little or no memory of the visit.

Last year I saw a fearful woman in her mid-40s who had not seen a dentist in over 25 years.  She had a terrible dental experience in her teenage years, when she was not completely numb, and the dentist continued drilling anyway.  She was traumatized.  This is so common, where a painful childhood experience has jaded a person and made them a dental phobic.  Her husband had to bring her to the office and hold her hand during her initial visit.  She had been living with dental pain for years, unable to chew on her right or left side without pain.  Her smile was unpleasant with dark, decay-ridden teeth.  After conscious sedation, she was happily smiling and chewing comfortably.  She is now ecstatic about her dental experience and her new smile.

Imagine not being afraid to go to the dentist.  Imagine being able to accomplish all your dental care in as little as one appointment.  This is what Conscious Sedation Dentistry can do for you.  You will be able to smile with confidence and chew your food without pain.  If you have been putting off years of dental work, Conscious Sedation Dentistry can change your life.

My best tip is to have regular dental checkups. Early detection and treatment can oftentimes prevent the need for extensive procedures later.



George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@  Visit Dr. Malkemus’ Web site at