Toronto Sleep Dentistry Logo

About Sleep Dentistry

What is Sleep Dentistry?

Many patients are either unable to tolerate dental treatment without being sedated or asleep, or they would prefer to be sedated or completely asleep when having their dental treatment. Our dentist anaesthesiologist specialists are able to provide dental care to you while you are either sedated and relaxed, or completely asleep and unaware that you are in a dental office having dental treatment!

The different Levels of Sedation

Sedation is a spectrum, which means there are different levels of sedation. Patients can choose from being sedated and very relaxed, or they may prefer (or require) to be completely asleep and unaware when having dental care completed. The different levels of sedation are:

  • Minimal sedation
  • Moderate sedation
  • Deep sedation
  • General anaesthesia

Deep sedation and general anaesthesia involve the patient being completely asleep, and we specialise in offering this service to our patients for their dental treatment.

Patients who may need sleep dentistry

There are many patients who either require to be sedated, or they prefer to be sedated or asleep for their dental treatment. These patients include:

  • Patients with dental anxiety and dental fear
  • Pediatric patients who may not cooperate for dental treatment
  • Patients with intellectual disabilities who may not cooperate for dental treatment
  • Patients with physical disabilities
  • Patients with a severe gag reflex
  • Medically compromised patients
  • Patients in whom local anaesthesia (dental freezing) is not effective
  • Patients who are unable to have local anaesthesia (Dental freezing)

If you fall into one of the above groups, then sleep dentistry may be the answer for you. Call our office for a consultation to discuss your sleep dentistry appointment.

Dental procedures which patients may request sleep dentistry for

Sleep dentistry is completely dependent on the patient. Some patients may prefer or require sleep dentistry for procedures that they feel are invasive, such as root canals, extractions, or gum surgery. Some patients may not like the sound of the drill, and may require sleep dentistry for a filling. Another patient may really dislike the feeling of having a tooth cleaning instrument, such as a scaler, scraping against their teeth – so they may prefer sleep dentistry for a cleaning as well. And many children who require treatment on multiple teeth also require sleep dentistry to have a positive experience at the dentist. This is especially important, because traumatic dental experiences in children can lead to dental anxiety and poor oral health, even when that child becomes an adult.

In order to allow the most relaxing and positive dental experience, we offer the following procedures while the patient is sedated or completely asleep:

  • Restorations (fillings)
  • Pediatric dentistry (fillings, stainless steel crowns, extractions, space maintainers, “baby root canals”, and other pediatric dental procedures)
  • Root canals
  • Extractions
  • Crown and bridge dentistry
  • Implants to replace missing teeth
  • Cosmetic Dentistry
  • Cleanings
  • Exams and Radiographs
  • Nightguard/Mouthguard
  • Dentures

Safety of Sleep Dentistry

Is Sleep Dentistry Safe?Some people fear that “going to sleep” for a procedure can be very risky and unsafe. While going to sleep for some medical procedures and operations can carry higher levels of risk, going to sleep for dental treatment is extremely safe and carries a very low risk level. Over the past few years, there have been two high quality studies conducted at the University of Toronto, which looked at the safety profile of sleep dentistry in Ontario. These studies were conducted by Dr. El-Mowafy in 2018 and Dr. Nkansah in 1997. Both studies found that the risk of having a serious event (such as brain injury or death) while having sleep dentistry in a dental office in Ontario is extremely low. For example, the risk of sleep dentistry is significantly lower than the risk of you suffering a serious event while you are commuting to work every day. Statistically speaking, you also have a much higher risk of getting struck by lightning than by having a serious event while having sleep dentistry!

In summary, there are risks associated with everything in life, including going for a walk, crossing the street at a crosswalk, and going to the grocery store – and sleep dentistry is no different. However, thankfully the risks associated with sleep dentistry are extremely low, and we hope the examples provided help put the risk in context for you.

For the full article on the safety of Sleep Dentistry conducted by Dr. El-Mowafy, please click here.

What are the common side effects of Sleep Dentistry?Although side effects are not common, some patients may experience some of the following symptoms after their sedation/anaesthetic:

  • nausea and vomiting
  • shivering or feeling cold
  • bruising around the IV site
  • dry mouth or throat
  • dizziness
  • temporary confusion or memory loss (in the elderly)

Is Sleep Dentistry harmful for my child’s brain?The effect of anaesthesia on the developing brain is one of the most widely discussed topics in paediatric anaesthesia. There is some controversy surrounding whether anaesthesia can affect the developing brain in children under three years of age, but it is generally accepted that after age three, anaesthesia exposure is very unlikely to affect the brain.

Regarding children under three years of age, there have been three landmark studies conducted in the past five years, and all three suggest that a single, brief exposure to general anaesthesia in children is likely safe. These studies are the Paediatric Anaesthesia Neurodevelopment Assessment (PANDA) study, the Mayo Anaesthesia Safety in Kids (MASK) study, and the General Anaesthesia or Awake-Regional Anaesthesia in Infancy (GAS) study.

The PANDA study compared IQ scores of patients who had general anaesthesia before age three to their siblings who did not have general anaesthesia, and their IQ scores were compared when they were 8-15 years of age. The study found no significant difference in the IQ scores of the patients who had general anaesthesia, to their siblings who did not have general anaesthesia. There was also no significant difference in their cognitive function, such as memory/learning, motor/processing speed, visuospatial function, attention, executive function language, and behaviour.
Full PANDA study article

The MASK study compared three different patient groups: those never exposed to general anaesthesia, those exposed to anaesthesia once before age three, and those exposed to anaesthesia multiple times before age three. They compared general intelligence and neurodevelopment in these three groups. They concluded that exposure to general anaesthesia, either once or multiple times before age three, was not associated with any deficits in general intelligence. However, they stated that multiple exposures to anaesthesia before age three was associated with a modest decrease in fine motor abilities and processing speeds, and the parents of the patients in the multiple exposure group also reported some difficulties with reading and behaviour.
Full MASK study article

The GAS study is the only randomized controlled trial to date (one of the most reliable form of scientific evidence) on the topic of general anaesthesia and the developing brain. This study compared infants (patients under one year of age) who had inguinal hernia repair surgery either under general anaesthesia, or under awake regional anaesthesia (the patients in this group were not under general anaesthesia, they just had “freezing” of their nerves so they could have the surgery without feeling pain.) The study compared the IQ of the patients at age 5, as well as their cognitive scores at age 2. The study concluded that at age 2, there was no difference in the risk of neurodevelopmental outcomes between the patients who had general anaesthesia and those who did not. They also concluded that at age 5, there was no difference in the IQ of the patient group who had general anaesthesia and the patient group who did not.
GAS study article - part 1
GAS study article - part 2

The PANDA, MASK, and GAS studies are three of the best designed studies to examine the topic of general anaesthesia and the developing brain. As the information above outlines, all three studies provide reassuring evidence that a single, brief general anaesthetic in children under the age of three are unlikely to affect their neurodevelopment.