Sedation dentistry may seem fairly
straightforward at first but it actually has quite the history. To understand
its complex history it helps to first understand what sedation dentistry is in
the first place. The purpose of sedation dentistry is to treat people with
anxiety and/or to reduce pain and discomfort during certain dental procedures.Often
the procedures vary depending on the patient’s behavior and how they react to
certain medicines. Until the development of modern medicine and sedation
techniques, patients have been forced to undergo these painful procedures fully
awake and without much aid to relieve them of stress and pain.From the
prehistoric times all the way up until the modern day, many lives have been
lost and many great minds have contributed to the development of dental
practices. Fortunately for us these technological
advancements and discoveries over the centuries have allowed for us to develop
very effective methods of dental work with very little pain and discomfort.
Ancient Dentistry
Most people aren’t aware that
dentistry and oral surgical procedures have actually been around for thousands
and thousands of years. The earliest complex dental procedures we know of have
occurred as early as 3500 B.C.in prehistoric Middle East. After the discovery
of several ancient burial sites in Mehrgarh, Pakistan researchers were able to
find Neolithic skeletons that contained molars with drill holes in them. There
was little evidence to suggest the Neolithic patients were sedated in any way
but the wear of the teeth did suggest that the patients lived on well after the
procedures were made. In addition to that, the teeth that were drilled were
mainly molars located in the back of the mouth, which would suggest that these
procedures were not done for decorative purposes. The sites were located along
a trading route in the Indus Valley and the dental procedures required flint
drill bits that were adopted from bead-making techniques being used at the
time. Flint drill bits were found to actually be quite effective. A flint drill
bit attached to a bow-drill can actually produce a hole in human enamel in well
under a minute. These ancient techniques were actually quite impressive for
their time and there have been no discoveries of any dental procedures like
this any earlier then 4500 B.C.
Nitrous Oxide
Even though dentistry practices have
dated back to the Pre-historic days, experimentation with sedation dentistry is
still relatively new. The technology to intentionally put someone to sleep
and/or sedate them under controlled circumstances to the point where they feel
little to no pain has been a quite complex and lengthy developmental process. That
being said, the beginning of sedative dentistry begins with the discovery of
Nitrous Oxide in 1772. At the time it was marketed more recreationally as it
went by the name “Laughing Gas” for it’s sedative properties and it’s
tendencies to make people feel loopy and laugh excessively. It wasn’t for a few
more decades until it began to be taken more seriously and viewed as a
potential breakthrough for medical procedures. The key moment when Nitrous
Oxide really started to gain momentum was when Horace Wells, a dentist from
Connecticut, used it on his own tooth extraction. At this point people were
just starting to see the potentials of this new substance but it still took a
couple years of trial and error before dentists got used to using Nitrous Oxide
in moderation and in controlled, safe, environments.
Anesthesia
For almost a century, Nitrous Oxide
remained the primary substance used in most complex dental procedures before
being replaced by many different anesthetics.Towards the end of the 19th
century Cocaine was making a huge debut in the world of dentistry and was
actually the preferred drug of choice fordentists. Obviously being that cocaine
often wasn’t administered under controlled dosages and was extremely addictive
and unpredictable it didn’t take long for alternative methods to surface. As cocaine
started to become more and more unmanageable, powerful anesthetics such as
lignocaine and cinchocaine slowly began to take its place. After a few more
decades upon the arrival of World War I and World War II, the demand for
anesthetics skyrocketed and the world quickly saw an increase in the
development and quality of most anesthetic drugs administered in the medicinal
field.
IV Sedatives
As the 19th century came
to a close, IV administered sedatives became more and more popular not just
because they were extremely effective, but also because they were easily
controlled and had very few risks compared to previous methods of sedation. IV
sedation involves administering sedative drugs into a patient directly into
their bloodstream through an IV tube typically in the patient’s arm. The
emergence of IV sedation started with drugs like hexobarbitone being used by
dentists in the UK, before evolving into the extensive list of benzodiazepines
that we know today. Drugs like Midazolam and Diazepam remain the most popular
choice for most modern dentists.
Without a doubt, the history and
development of sedatives over the years has proven to be quite the journey.
Dating back to Neolithic eras, dentistry is clearly not a new process but still
has come quite far. From simple stone and flint tools, to machine powered
chairs and IV induced sedatives, the world of dentistry will never be the same.
So the next time you find yourself counting backwards from 10 just remember how
lucky you are to be sitting in that chair and what a privilege it is to live in
a time where crucial procedures are quick and painless.
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