A Brief History of Dental Sedation

For as long as there have been dentists, there have been people afraid of dental procedures. While medications, concoctions, and procedures have been around for a few thousand years to help reduce pain, it’s only been in the past two hundred years or so that medical science has developed options to help with fear and anxiety that people feel before a dental procedure or even during a basic cleaning.

In 2250 B.C. people were trying to handle pain from dental cavities and “sweet vitriol” was used in 1540. But it is in more recent years that what we recognize as the start of modern dental sedation began to be explored and used. Fearful patients weren’t able to take advantage of these advancements right away but today’s patients are grateful that options exist to help them get through their fear of the dentist and dental procedures.

Nitrous Oxide

While nitrous oxide was discovered in 1772 by Joseph Priestly, it wasn’t considered for use in dentistry for more than 20 years. Originally it was used for entertainment purposes because it made anyone breathing it quite silly, earning the name “laughing gas.” In 1978, Humphry Daly inhaled nitrous oxide while he suffered pain from a wisdom tooth that was partially erupted. It wasn’t until two years later in 1800 that he suggested it could possibly be used during surgical operations.

Nitrous oxide was brought front and center by Horace Wells, a dentist from Hartford, Connecticut, when he used it during his own tooth extraction in 1844. He noticed that it reduced pain and made the process easier. He met with problems later when he attempted to demonstrate it’s used at Massachusetts General Hospital. Too little was used and the patient screamed or indicated later that he still felt pain. (Accounts differ between sources.) It was another 20 years before anyone else was willing to try nitrous oxide on dental patients again.

Anesthesia

Localized anesthesia began to be used at the end of the 1800s. At the time, cocaine was a popular choice. Over time cocaine was rejected because it resulted in death for too many patients. This happened for a variety of reasons:

1. The dosages weren’t controlled, and it was easy to give too much to a patient.
2. The solutions used to administer the drug weren’t sterile.
3. Cocaine by itself is dangerous and toxic.

In 1943, two safer alternatives were made available: cinchocaine and lignocaine. Today’s popular option is novocaine for a local anesthesia. These were the only anesthesia methods being developed. William T.G. Morton gave a sulfur-ether concoction to his dental patient in 1946 and achieved a successful and painless oral surgery.

Between World War I and World War II, with so many soldiers injured and so many medical professionals needed, anaesthesiology developed quickly. Of course, over time these findings made their way into dental work, as well.

IV Sedation

Nitrous oxide, local anesthesia, and general anesthesia were first used in the late 1800s but it was in the 1900s when IV sedation began to be practiced by dentists. Finding that IV sedation had fewer risks than general anesthesia with better results than nitrous oxide spurred its development. In the 1930s, dentists in the United Kingdom used a barbiturate, hexobarbitone. Over time, more and better drugs were developed, and what dentists used changed.

• 1960s – methohexitone
• 1966 – diazepam known commercially as Valium
• 1970s – diazepam known commercially as Diazemuls
• 1983 – midazolam known commercially as Hypnovel
• 1988 – flumazenil known commercially as Anexate
• 1990s – propofol known commercially as Diprivan

Today, most American dentists use benzodiazepines likes Midazolam and Diazepam.

Conclusion

While some of the early methods of dental sedation and anesthesia might sound downright medieval, they were, in fact, a sign of medical progress. Dental health and hygiene are an indicator of overall health, and anything that makes it easier to receive is a step in the right direction. Finding ways to deal with fear, anxiety, and pain only help patients seek the dental care they need.

Early adopters of nitrous oxide, anesthesia, and IV sedation may not have had the advantages or knowledge we have today, but they were the pioneers of an important part of medicine. Just like cleanliness and sterilization helped improve medical outcomes for most patients, so too did the reduction of pain and fear. Even today, advancement in dental sedation continues. It is only due to the hard work and experimentation of early dentists that we’re able to offer today’s patients tools to alleviate their fear and pain.