Contraindications
IV sedation is extremely safe when carried out under the supervision of a specially-trained dentist. Purely statistically speaking, it’s even safer than local anaesthetic on its own!
However, contraindications include
pregnancy
known allergy to benzodiazepines
alcohol intoxication
CNS depression, and
some instances of glaucoma.
Cautions (relative contraindications) include psychosis, impaired lung or kidney or liver function, advanced age, and sleep apnea. Many people who have sleep apnea haven’t been officially diagnosed – if you are overweight and you snore, do mention this.
Heart disease is generally not a contraindication.
If you have been taking benzodiazepines for many years, your tolerance may be very high – so let your dentist know that you’ve been taking them!
The Dental Sedation Teachers Group uses the following classification for making the decision if and where conscious sedation should be provided:
I – Normal, healthy patient
II – A Patient with mild systemic disease, e.g. well controlled diabetes or epilepsy, mild asthma
III – A patient with severe systemic disease limiting activity but not incapacitating, e. g. epilepsy with frequent fitting, uncontrolled high blood pressure, recent heart attack
IV – A patient (usually hospitalised or bedridden) with incapacitating disease that is a constant threat to life
V – A patient who is expected to die within 24 hours with or without treatment
source: American Society of Anaesthesiology Classification of Physical Status (ASA)
If you are in category I or II, then you can normally be treated in a general practice.
If you are in category III, it is best to be treated in an environment where more experienced support is available (a hospital-based clinic or a sedation clinic where medical support is available).
