Betül Ayaz

This is the question I am asked most often about sedation, and behind it there is always the same fear: losing control completely. Let me make one thing clear first: conscious sedation is not general anaesthesia. We take you into a state of deep relaxation and sleep, but your breathing stays under your own control; I adjust the depth of the sedation throughout the procedure.

Pain control is not the job of sedation; that is provided by the local anaesthesia your dentist administers. What sedation removes is the anxiety, the tension of waiting and the weight of the time spent in that chair. Most of my patients say they do not remember when the procedure began or ended.

And through all of it I am beside you; your heart rhythm, your blood pressure and the oxygen level in your blood are monitored without interruption. So I can answer the question like this: you will be comfortable enough not to notice the procedure, and safe enough for me to follow you at every moment.

I do not belittle this fear, because its source is usually a real story, but an old one. Most of the anaesthesia stories passed from ear to ear belong to times before today's monitoring technology and safety standards existed. Today, for every minute you are under anaesthesia, your heart rhythm, blood pressure, breathing and oxygen levels are followed without interruption, by machines and by a specialist's eye.

I never say the risk is zero for any medical procedure; be wary of anyone who does. The correct sentence is this: risk is managed with the right preparation. Before the procedure I ask about your illnesses, your medications, your allergies and your previous experiences of anaesthesia, one by one; where needed I order tests. The safety of anaesthesia is built not in that chair but at this assessment table.

Let me add one more thing: postponing treatment for years out of fear has its own price, and that price is usually heavier than the manageable risks of anaesthesia. Tell me your fear; together we will find the route that suits you.

Before one of our patients finally reached the clinic, they had made three appointments and come to none of them. On the fourth they came, but could not sit in the chair; we talked in the waiting room. They told me about a bad dental experience in childhood. Over the years the problems in their mouth had piled up; the more ashamed they felt, the longer they postponed, and the longer they postponed, the bigger the job grew.

That day we did not discuss treatment; I explained what sedation is, what they would and would not feel, and that I would be at their side throughout the procedure. I waited until their questions ran out. They asked for time to decide, and we gave it.

Some time later they came back, and we completed most of the accumulated treatment under sedation, in a few sessions. I have not forgotten the question they asked on waking at the end of the first session: 'have we started?' When I said it was finished, they did not believe me at first; then their eyes filled. That is the measure of success in my profession: years of fear fitting into one afternoon the patient does not remember.