Conscious Sedation for Dental Treatment

When it may be considered

• Fear of the dentist strong enough to make you put off treatment
• A gag reflex that makes treatment difficult
• A long surgical procedure is planned (for example full-mouth implant treatment)
• Treatment started under a local anaesthetic could not be completed because of anxiety

Ways it can be given

Conscious sedation is not a single method. A mixture of nitrous oxide and oxygen can be breathed in through the nose (inhalation sedation). A drug can also be given into a vein (intravenous, or IV, sedation) or taken by mouth. The UK standard uses a tablet only when a technique that can be given in small steps is not suitable. The tablet is then taken at the clinic, not at home. It is given only by a practitioner already competent in intravenous sedation. The team that will give the sedation decides which route is used. For adults, inhalation sedation with nitrous oxide is the only method outside the escort rule, and it disrupts your day less. Like every method, it is used only if the assessment shows that it suits you. Every other method requires the team to be competent in placing a cannula in a vein. Ask us which of these methods we offer before you plan around one.

When it is not suitable, or another step comes first

• No escort is available. For adults, an escort is required with every method except inhalation sedation with nitrous oxide; children need an escort with every method. The UK standard says treatment under sedation must not be provided¹ if an escort cannot be assured.
• A serious general illness. The American Dental Association guideline asks that, for patients with significant medical problems, the dentist first consults the patient's own doctor².
• Sleep apnoea or a high body mass index. The same guideline recommends checking body mass index as part of the assessment before sedation. A high index, especially together with sleep apnoea, can make airway problems more likely.
• A risky medication history. If an opioid has been given or taken shortly before, a benzodiazepine can be up to eight times more potent¹. Tell us the name and dose of every medicine you take and when you last took it. Tell us too about alcohol and any recreational drugs, and when you last had them.
• Pregnancy or breastfeeding. Tell us before the appointment. The team that will give the sedation decides whether it should wait.
• Children and young people. The UK care pathway refers 12- to 16-year-olds to community dental services or to hospital settings equipped for this work. For younger children the decision is made separately. Ask us whether we treat children under sedation at all.
• Expecting to be fully unconscious. In conscious sedation verbal contact continues. Being unconscious falls under deep sedation or general anaesthesia, which need a separate setting and a separate team. You may not remember part or all of the procedure, but that is a separate matter and no one can promise it.

What to consider instead

• A local anaesthetic, with the treatment split up. Short sessions, an agreed signal for a pause and a step-by-step explanation of the procedure are often enough.
• General anaesthesia. A separate decision that needs a separate team and an approved setting. It is not a stronger form of conscious sedation.

Suitability is decided by an examination, your medical history and a review of the medicines you take. The decision on sedation is made by the team that will give it.

The steps below are the ones two guidelines require, in the order an appointment runs. They are the UK national standard and the guideline of the American Dental Association, in the US. Which drug and which route are chosen depends on the patient; the team that gives the sedation decides. Ask us who will carry out these steps at your own appointment and with what equipment; we give you the answer in writing. This page describes what the guidelines require, not our own team or equipment. The questions to ask before you agree are under "What the GDC and the NHS suggest you ask" below.¹²

Risks and limits

• A deeper effect than expected. The American guideline judges the level of sedation by how you respond, not by how the drug is given. A deeper effect than expected is possible by any route. The same drug can also act more deeply in one patient than in another. As sedation deepens, breathing can slow and the oxygen level in the blood can fall. That is why the guidelines require continuous pulse oximetry² and, depending on the technique, resuscitation competence¹. If this happens, the procedure is stopped, oxygen is given and the airway is supported.
• Drug interactions. If an opioid has been given or taken shortly before, a benzodiazepine can be up to eight times more potent. Tell us about every medicine and herbal product you take, and about alcohol and any recreational drugs.
• Drug allergy and the cannula site. An allergic reaction to the drugs used can occur, though rarely. The place where the cannula went in may bruise, hurt or turn red.
• Airway risk. Sleep apnoea and a high body mass index can make airway problems more likely. In these patients the airway risk is assessed before sedation is decided.
• Sedation does not remove pain. The local anaesthetic does that, and it is still given to numb the area.
• You may still remember the procedure. Some patients do not remember part of the procedure; others do. This varies with the drug and the patient.
• Sedation does not cure dental fear. It reduces anxiety during the treatment. We have found no source that says whether it makes later treatment easier.
• A lost day, and the demands on your escort. For adults an escort is required except with inhalation sedation. For the period the team specifies you do not drive, do not go back to work and are not left alone. This period does not end at midnight; after intravenous sedation it can run into the next day. During the same period, do not take sole charge of a child or of someone who depends on your care. On a trip, that day is not a travel day.
• No safety rate can be given. Both guidelines cited on this page are standards documents. Neither contains a figure for how often sedation-related adverse events occur¹.

Benefits

• It can make it possible to carry out treatment that has been put off for years because of anxiety.
• It can help a long procedure feel less demanding.
• It can make treatment easier for patients with a strong gag reflex.
• Because verbal contact continues throughout, you can say "stop"; under general anaesthesia you cannot.

None of these benefits is the same for everyone. The same drug at the same dose does not give two patients the same experience.

Discharge

You are discharged when the criteria are met. Under the UK standard, instructions given verbally and in writing to both the patient and the escort are a condition of discharge¹. So is an explanation of where to get advice outside working hours.

The same day

• Go back to where you are staying with a responsible adult, and do not stay alone that day. This does not apply to adults after inhalation sedation with nitrous oxide alone.
• Do not drive or operate machinery for the period the team specifies. That includes a hire car.
• Do not make important decisions or sign contracts or consent forms.
• Do not drink alcohol. Ask the team how to take your regular medicines that day.
• In the first hours, choose light, lukewarm food.
• Do not plan a flight for the day of a sedation appointment, or before the period the team specifies has passed. The dental treatment itself also has a wait before flying; see below.

Flying

Two waits apply, and whichever ends later sets your flight date. One is the period the sedation team gives you; after intravenous sedation it can run into the next day. The other is the wait after the dental treatment itself, which still applies once the sedation has worn off. A 2023 review in the British Dental Journal suggests waiting about a week³ before flying after most dental procedures. After an implant is placed it suggests at least 72 hours. After a sinus lift it suggests at least two, and ideally six, weeks. Its shortest suggested wait, after restorative treatment such as a filling, is 24 hours. These times assume there is no pain, swelling or bleeding where you were treated. The authors say the research is limited and comes mostly from military aviation. Treat these intervals as a starting point for a conversation with the dentist who treated you, not as clearance. Your written plan gives your flight date, set with that dentist.

The next day and after

The dental treatment itself comes with its own care instructions, given separately; sedation does not replace them. After implant surgery or a bone graft, the rules for that surgery apply; they are explained on the dental implants and bone grafting pages.

Contact the clinic if any of the following happens after sedation.

• Excessive sleepiness that continues into the next day
• Dizziness, unsteadiness or nausea that does not pass
• Vomiting that continues, and fluids cannot be kept down
• Unusual restlessness or agitation
• Pain, swelling or redness where the cannula went in

Before you fly home. If any of these signs starts while you are still in Turkey, tell us before you travel.

Once you are home. Contact us through the route written in your plan. If a sign above does not settle, also see your GP or a dentist near you without waiting for our reply. For an urgent problem with your teeth or mouth, call your dentist. In England, if you have no dentist or cannot get an emergency appointment, the NHS says to call 111 or get help from 111 online⁴. They can tell you where to get help, and you may have to pay for the appointment. Elsewhere in the UK, check the local arrangements.

Emergencies. If your escort cannot wake you easily, that is an emergency. So are difficulty breathing, blue lips or skin, a seizure or chest pain. Do not wait for the clinic's reply. Sudden confusion, slurred speech, a drooping face or weakness in an arm are also emergencies. Do not put these down to sedation and wait, even if the symptoms pass. In Turkey call 112. In the UK call 999. The NHS lists severe difficulty breathing, blue or grey lips or skin, tight chest pain and passing out⁵ among its reasons to call 999. Show these lines to your escort beforehand.

The escort rule changes your travel plan. For adults it applies to every method except inhalation sedation with nitrous oxide. After such an appointment, going back to a hotel on your own is not appropriate; a responsible adult must be with you. If you are travelling alone, raise this before you book. Sedation that needs an escort is not given without one¹. We will then discuss the options that do not need one, such as a local anaesthetic alone.

The day of sedation is not a travel day, and the rest of that day is not for sightseeing or other appointments. Your written plan states on which day of your stay sedation is planned, and when you can fly. Ask for it before you book travel.

Before you go

The NHS website for England advises you to discuss your plans with a GP⁶ before making any final decisions about travel or medical arrangements. For sedation this matters: the medicines you take and any long-term condition are part of the decision. Take an up-to-date list of your medicines, with doses, to the assessment. The GDC says it is always a good idea to speak to your own dentist⁷ before treatment abroad. If you do not have a regular dentist, find one, NHS or private, before you travel. You can also ask a dentist in the UK for an independent opinion, including whether the treatment could be done in the UK instead. Until the sedation is given, you can still decide against it.

Back in the UK

The effects of the sedation should have passed before you fly; you do not fly before the period the sedation team gives you. Once you are home, the aftercare you follow is mostly for the dental treatment itself. Soreness or bruising where the cannula went in can also take time to settle. A problem after you return is usually seen first by your GP or a dentist near you, so take your records with you. The NHS states that it is not liable for negligence or failure of treatment⁶ you receive abroad. It also warns that most travel insurance policies will not cover you for planned treatment abroad⁶, so you may need specialist cover. Ask your insurer, in writing, before you book. The NHS guidance quoted on this page is from the NHS website for England. Scotland, Wales and Northern Ireland have their own NHS services, which this page does not cover.

The UK General Dental Council lists thirteen questions⁷ to ask before dental treatment abroad, and the NHS has its own checklist. Below are the ones that matter most for sedation, each with our answer. Where our answer is a commitment rather than something you can check today, it says so. Ask us the full list, and ask for the answers in writing.

Who will give the sedation, and what are their qualifications?

The GDC's first question is who will treat you and what qualifications they have. For sedation, ask it about the person who gives the sedation as well as the dentist who treats you. Before you commit, we name both in writing, with their titles as registered in Turkey and where they qualified. A dentist in private practice in Turkey must register with the provincial or regional dental chamber⁸ within a month of starting. Without it, they cannot practise privately. The Turkish Dental Association's website offers a search of registered dentists by name and province⁹. Registration in Turkey is separate from the UK register: the GDC states that only people registered with it can legally practise dentistry in the UK¹⁰. This page does not set out the Turkish rules on who may give sedation in a dental clinic. Ask us which rules apply and how the sedation team meets them.

How often do you do this, and what are your complication rates?

The GDC suggests asking how many times the procedure has been carried out, and the success, complication and infection rates⁷. For sedation this page has no figure to offer, because the two standards it cites contain no adverse-event rates. We publish no sedation figures of our own yet. Ask us how many patients we treat under sedation, how adverse events are recorded and over what period.

Is the clinic licensed and regulated?

In Turkey a dental clinic cannot open without a licence or treat patients without an operating permit. It is inspected at least once a year¹¹. To treat international patients, a facility also needs an authorisation certificate from the Ministry of Health¹². The Ministry publishes a register of authorised facilities¹³ that you can check yourself. We give you our authorisation details before you commit. A licence or authorisation is a legal minimum, not a statement about the result of your treatment. The GDC itself cannot guarantee that a regulator like it exists in another country⁷.

Will I get the plan in writing?

Yes. The GDC says you should be assessed by a qualified dentist before being given a treatment plan and cost estimate⁷. For sedation, your written plan states the method proposed and why, who gives it, and on which day of your stay it is planned. It also states whether you need to fast and the earliest day you can fly. A plan made from photographs, X-rays or a medical history you send is preliminary. The decision on sedation is made after the assessment in Antalya.

What if sedation proves unsuitable once you are assessed?

The assessment in Antalya may show that sedation does not suit you, or your escort may not be able to come. Ask before you book what happens then: whether the treatment goes ahead under a local anaesthetic alone, is postponed or is not done. Ask, too, what you pay in each case.

Will the team speak English during the procedure?

The GDC suggests asking whether the team speaks your language and, if not, whether a translator is provided⁷. Under sedation this is a safety question, not a courtesy: conscious sedation relies on the team being able to talk with you throughout. Before you commit, we confirm in writing which language the sedation team will use with you. We also confirm who will explain the consent form and the aftercare instructions to you in English.

Who do I contact after the appointment?

The UK standard makes written and verbal instructions, and an explanation of where to get advice outside working hours, a condition of discharge¹. Ask us for both in English. Your written plan also names the contact route once you are home. For urgent symptoms, get emergency care where you are first (see "When to get help" above).

If there are complications, who pays?

The GDC suggests asking whether further treatment is included if there are complications, and who pays for extra flights, hotel and remedial work⁷. For sedation, ask too where you would be taken if you needed hospital care, and who pays for extra nights or a changed flight. Ask for the answers in writing before you commit.

Is there insurance if something goes wrong?

The GDC list also asks about insurance⁷. In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre¹². That does not by itself tell you whether your treatment, or the sedation given with it, is covered. Ask which procedures in your plan fall under it. Ask us too, in writing, whether the clinic, the treating dentist or the person giving the sedation is insured for complications or errors. Ask what that cover includes. Travel insurance is covered under "Back in the UK" above.

What records will I take home?

The NHS lists exchanging medical records and arranging aftercare back home⁶ among the things to consider. In Turkey you are entitled to an itemised bill, and on request to free copies of the records of materials, tests and imaging¹². You may also examine your file and take a copy¹⁴. Ask that your record states the sedation method, the drugs and doses given and how you responded, as well as the dental treatment. If you have sedation again, in the UK or elsewhere, the next team will want to know.

What if I am unhappy, and where can I complain?

We give you our written complaints procedure before treatment. A complaint goes to the clinic first; private dental polyclinics, centres and hospitals in Turkey must have a patient rights unit¹¹. If the clinic does not resolve it, you can apply in writing to the provincial health directorate's Patient Rights Board¹⁴. The Board decides within thirty days, but it does not assess allegations of medical error. The dental chamber can also open disciplinary proceedings⁸ against a dentist. Do not expect the UK regulator to settle it. The GDC states that it cannot resolve complaints or help with refunds¹⁰; its investigations are about whether dental professionals are fit to practise.

Questions from the sedation standards

The next three are not on the regulator's list. We have drawn them from the sedation standards, and we suggest you ask them too:

1. What monitoring will be used during the procedure?
2. If a problem arises, which team and which equipment will be ready?
3. What are the discharge criteria, and will the instructions be given in writing?

Warning signs, including for us

The NHS checklist names five signs to think twice about before booking. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare¹⁵. Apply them to us too. If you feel pushed to decide quickly, wait.

This page does not quote fees. The aspects of sedation that affect a plan are the method, the length of the procedure, and the monitoring and team it needs. An additional assessment, if one is needed, and the length of the appointment also count. Ask in writing whether sedation is included in the treatment fee and, if it is charged separately, what it covers. What you pay if sedation proves unsuitable is covered under "What the GDC and the NHS suggest you ask" above.

If your sedation needs an escort, their travel and stay are part of the cost of your trip. The Dutch dental association advises counting all the costs, travel and accommodation included¹⁶.