Sleep dentistry – dental treatment and implantation in one’s sleep
Dental Implantation and treatment within a short time under sedation or general anesthesia in the “Smile Design” clinic in Israel will save you a huge amount of time that can be spent on more pleasant things. If your time is money, save it.
Not every dentist in Israel can work on a patient under general anesthesia or sedation, but only specialists who have a special permission.
What is sedation?
This is a proven method of dental treatment and implantation in Israel. This is a medication sleep, during which the anesthesiologist puts the patient in a state of maximum relaxation. The patient hears and does what the doctor asks him to do, but after waking up he does not remember going through the procedure. Sedation is a comfortable and restful sleep, after which the patient wakes up easily.
Modern sedatives that are used in Israel have no side effects and leave no painful sensation after the procedure. Dental teatment and implantation under sedation promote better healing after the procedure. With the help of a special mini-station the anesthesiologist controls the vital functions of the patient (blood pressure, pulse, heart rate, oxygen saturation in the blood), and an electrocardiogram is continuously registered on the monitor.
During 4 or 5 hours of sedation one can do a huge amount of work, both medical and surgical, or complete full mouth prosthetics. With the help of sedation one can get in Israel a full Hollywood smile in 2 weeks. During sedation one can carry out treatment and canal filling of the entire oral cavity, which is necessary for a full mouth prosthetics with the help of ceramic crowns. At one sitting it is possible to set implants on the entire jaw or perform a bilateral sinus lift.
Sedation is indispensable for patients with an increased gag reflex or with an acute fear of dentists. Besides, without sedation or general anesthesia the patient cannot sit in a chair with his mouth open for 4 or 5 hours. His muscles get tired and the patient ceases to control them and closes his mouth. This impedes the work of the dentist and considerably prolongs the duration of treatment.
The dental chair is stressful for most people, and in times of stress, as we know, the body releases a large amount of adrenaline. In any surgical procedure a person is under stress, and adrenaline increases bleeding. Sedation completely blocks the stress component during dental procedures, thereby significantly reducing the bleeding. The healing process of tunica mucosa of mouth goes much faster and better if the procedure was carried out in stress-free atmosphere.
Upon awakening the patient is in an easy relaxed state, feels complete absence of pain, since during sedation along with sedatives painkillers are administered (their effect lasts for 24 hours), as well as decongestants.
After 30 minutes the patient can go home.
1 sedation can replace 6 to 10 conventional visits to the dentist.
General anesthesia is used for more complex and lengthy procedures. For example, the bilateral sinus lift with simultaneous placement of 20 implants in both jaws cannot be carried out under sedation at a conventional dental clinic. This is a long and complicated procedure, hence general anesthesia is necessary. Such procedures as the displacement of the mandibular nerve or bone graft from the hip should be performed only under general anesthesia.
2 completely interchangeable dental specialists always take part in the procedures under general anesthesia. This ensures double quality control and maximum concentration of the dentists.
If necessary, during general anesthesia it is possible to combine the work of a dentist and an ENT surgeon, which is quite impossible in ordinary dental practice.
During general anesthesia full protection of the patient’s airway is ensured.
Since the patient lies still for a long time during the procedure, special massaging devices are used for the feet. This stimulates blood circulation, prevents the congestion of blood in the veins and the formation of blood clots.
During general anesthesia the vital functions are completely controlled by connecting the patient to a special anesthetic unit. The procedure is performed in a hospital. After the operation the patient remains under supervision for the night and is discharged home in the morning.
One procedure under general anesthesia can replace 10 to 15 ordinary visits to the dentist.
A little about general anesthesia
General anesthesia on an outpatient basis (in particular in dental implantology and stomatology) allows to expand the indications for medical care and diagnostic procedures on an outpatient basis, reduces psycho-emotional stress in the patient, reduces the risk of intraoperative and postoperative complications due to full anesthesia, monitoring of the state of vital bodily functions and the corresponding correction of their existing abnormalities, both as a result of the operation itself, and of concomitant diseases. General anesthesia involves a mandatory depression of the patient’s consciousness, who in this case remains in a state of drug-induced sleep during the entire operation, wakes up only after the end of surgery and does not remember anything of what happened to him during this period. Modern anesthesia that is carried out competently, professionally and without complications, has no harmful effect on the body.
Narcosis (Greek νάρκωσις – numbness, stupor) is an artificially induced state of reversible inhibition of the central nervous system, in which there is loss of consciousness, sleep, amnesia, analgesia, relaxation of skeletal muscles, and loss of control over certain reflexes.
All this occurs upon administration of one or more general anesthetics, the optimum dose and combination of which is chosen by the anesthesiologist based on individual characteristics of a particular patient and depending on the type of medical procedure. The term “narcosis” means genela anesthetization of the body. When they speak about the regional pain relief, the term “local anesthesia” is used. The cornerstone of this type of pain relief is namely switching off consciousness (narcosis — falling asleep), which is why the expression “narcosis” and “anesthesia” are completely different concepts.
The main objective of general anesthesia is to slow down reactions of the body to surgery, primarily to the sensation of pain.
Medication sleep, with which the term “anesthesia” is most often associated, is just one (and main) component of anesthesia. When administering general anesthesia it is also important to suppress or significantly reduce the manifestation of the vegetative (automatic) reactions to surgical trauma that are expressed as an increase in heart rate (tachycardia), rising of blood pressure (arterial hypertension), and other phenomena that can occur even with switched off consciousness. This suppression of vegetative reactions is called analgesia. The third component of anesthesia is muscle relaxation necessary to ensure normal work conditions for the surgeons.
The first means for analgesia were made from various plants (opium, hemp, henbane, hemlock, etc.) in the form of infusions or decoctions, as well as “sleep sponges.” The sponges were saturated with the plant sap and ignited. Inhalation of the vapours put patients to sleep.
In the 13th century the Spaniard R. Lullius discovered ether.
In 1540 Paracelsus described its analgesic properties.
On October 16, 1846 in a Boston clinic (USA) William Thomas Green Morton held the first public demonstration of ether anesthesia during the removal of the submandibular tumor.
In Russia the first ether anesthesia was applied on February 7, 1847 by F.I. Inozemtsev, and on February 14 the Russian scientist and physician Nikolay Pirogov for the first time applied it for anesthetizing during surgery.
In 1847 a Scottish obstetrician George Simpson first used chloroform for anesthesia while taking delivery.
At the end of the 20th century xenon was first used for anesthesia.
Types of anesthesia
Parenteral (intravenous, intravenous with ALV, intramuscular, rectal, etc.);
Combined (anesthesia is achieved by successive application of various narcotic drugs and methods of their administration).
Depending on what occurs with the patient’s breathing during general anesthesia, anesthesia with spontaneous (independent) breathing and artificial lung ventilation (ALV) are applied.
The second option generally requires intubation of trachea (a special tube is introduced into the airway after the patient falls asleep) or other methods, which allow blowing air, oxygen or gas mixtures into the lungs of the patient by means of an ALV device or a special Ambu bag.
Stages of general anesthesia
Each stage has its own characteristics and facilitates the inhibition of certain structures of the brain and spinal cord.
The first analgesic stage is characterized by external expression of stunned state. Breath is deep and rhythmic, pulse is rapid, the eyeball movement is arbitrary. Muscle tone remains the same or is slightly increased. The reflexes are intact. Sensation of pain becomes dull or disappears, while tactile and temperature reception is not impaired.
Analgesia develops in connection with the shutdown of pain sensitivity centers in the brain stem.
Continued intake of the agent entails deepening of its effect and the second stage – motor excitation – comes. It is manifested by increased tone of skeletal muscles, erratic contractions of limbs, attempts to get up or uncoordinated movements in space. Breathing and pulse are uneven. Blood pressure is increased. Eyeballs start “wandering”. Pupils are expanded. The secretion of salivary, lacrimal, bronchial and sweat glands increases. Swallowing becomes frequent. Against this background analgesia intensifies.
As the action of the anesthetic agent intensifies, the third stage begins – surgical anesthesia. In anesthesiology this stage is divided into 4 levels:
- Surface anesthesia. Pain and tactile sensitivity disappear completely. Swallowing stops. The corneal reflex (closing of the eyelids at the touch of a hair on the cornea) disappears. Eyeballs are deflected in an eccentric position, the pupils constrict. Breath is deep, rhythmic, and snoring due to the relaxation of the vocal cords. Blood pressure is stabilized, the pulse is rapid. Skeletal muscles are not relaxed. Anal sphincter and viscero-visceral (to stretching of the peritoneum and mesentery) reflexes are preserved.
- Light anesthesia. Eyeballs are set in a central position. Pupils are narrowed and slightly react to light. Skeletal muscles are relaxed, but not entirely. Loss of reflex to stretching of the peritoneum. Breathing and pulse are rhythmic. Surface operations may be carried out.
- Full anesthesia. Breathing is smooth, shallow, which quickens when C02 is added to the inhaled air. Rhythmic pulse, but its content is reduced, blood pressure is lowered. Reflexes from the surface and body cavities do not manifest, but are preserved in the aortic and sinocarotid zones, ensuring the functioning of the respiratory and circulatory centers. Weakened reflexes from the bladder and rectum can be induced. The pupils begin to widen. Skeletal muscles are relaxed.
- Ultra-deep anesthesia. Breathing is shallow, jerky, diaphragmatic. Pulse is weak, small filling, blood pressure is low. Cyanosis of the mucous membranes. Movement of the eyeballs does not show, and they are in the normal position, the cornea is dry, the pupils are enlarged.
Control of anesthesia
Control of the patient’s condition under anesthesia is performed by monitoring the pulse, blood pressure (measured manually or automatically, by direct and indirect methods), continuous registration of ECG, blood oxygen (by observing the color of the skin and mucous membranes with the help of a pulse oximeter or blood test), the temperature of the “core” and the body surface, the reaction of the pupils, a rate of urine output, blood tests for gases, electrolytes and the acid-base status.
Inhalation anesthesia is maintained with teh help of special devices (vaporizers, rotameters), which make it possible to accurately regulate the concentration of the liquid (vapor generating) or gaseous anesthetics in the breathing mix. Anesthetic and respiratory devices allow to control various parameters of ALV, and modern anesthetic monitors allow to control the concentration of gases (oxygen, nitrous oxide, carbon dioxide and anesthetic vapors) in the inhaled and exhaled gas.
Contraindications for anesthesia during routine operations
Presence of hormone-dependent diseases.
Decompensated pathology of the internal organs (cardiovascular system, parenchymal organs).
Decompensated pathology of the endocrine system.
Cardiac arrhythmias regardless of the cause.
Condition after myocardial infarction or acute stroke up to 6 months.
Acute alcohol or drug intoxication.