Sleeping woman getting dental work done

A lot of people get pretty freaked out about seeing the dentist, and it’s not hard to understand why, especially if they only come see us when something is wrong. By the time most dental symptoms become a burden, what’s needed to fix the problem is usually far more intensive than had the problem been caught early, during a regular exam and cleaning appointment. 

But even just sitting back in the dental chair, letting others look in your mouth, can make you feel pretty darn vulnerable and stir up a lot of worry. 

Nick Koogler DDSWhile we do our utmost to create a comfortable, relaxed, and caring environment for our patients, a bit of sedation can make things go a whole lot easier. 

As a holistic and biological dental office, we prefer non-narcotic sedation for our patients who need a little extra help relaxing for long appointments or intensive procedures. Our patients prefer it, too. 

“Narcotic medication is typically fentanyl,” explains Dr. Nick Koogler, an associate dentist here at Green City Dental in Edmonds. He oversees all sedation choices in our office along with his brother, physician Dr. Andrew Koogler, who is board certified in anesthesia and pain management.

“Fentanyl,” says Dr. Nick, 

Is not great from a patient perspective. We understand people not wanting opioids in their system, and using non-narcotic sedation helps decrease any associated complications or risks.

Those risks, of course, include the opioid abuse and addiction that continues to run rampant in this country, despite early warning signs of the emerging problem

For procedures that last an hour or less, we offer IV sedation, where Dr. Andrew will administer the sedative Versed (midazolam), monitoring vital signs closely in order to ensure each patient gets the appropriate dose. Dr. Nick says this is preferable to the usual “oral conscious sedation” that many dentists offer. 

One of the biggest drawbacks to giving patients a pill is that it’s one size fits all. Everyone gets the same dosage, but it doesn’t work the same on everyone. Some patients are totally asleep, but for others, there’s no effect. It’s just trickier.

If there’s an IV, it can be tailored to that specific person, and we can continually adjust. It gives us better control.

For longer procedures, though, anesthesia is recommended. In this case, Dr. Andrew will administer propofol, a non-narcotic medication that slows down brain and central nervous system activity. Here, too, each patient is carefully monitored, and dosages are adjusted as necessary. 

Another option [for anesthesia] is gas, but we don’t prefer gases because they can 

increase postoperative nausea and vomiting, plus it takes longer to wake up.

In an office-based setting, we want patients to wake up more quickly. With propofol, the average wake-up time, even when a procedure might last 2-3 hours, is about 30 minutes. And there isn’t really toxicity that’s associated with the drugs we use, because propofol is out of your system fairly quickly.

Once you schedule a procedure during which you’ll be sedated, Dr. Andrew will call you to go over your medical history, noting any red flags or determining whether you might need to consult with your primary physician before dental treatment. 

After you and the friend or family member who will be driving you home check in on the day of your procedure, Dr. Andrew will review your medical history again to make sure nothing has changed. Only then will the sedation protocol begin. 

Once Dr. Taylor or Dr. Koogler complete their work and you’ve fully awakened, Dr. Andrew will discharge you and you’ll check-out along with your driver, ensuring that you can safely make your way home to complete your recovery. 

But what about if just the thought of a regular exam or cleaning gets you anxious? 

Though sedation would be way too much for such non-invasive treatment, we have an excellent drug-free option for you called NuCalm. This all-natural  relaxation system uses electromagnetic frequencies to biochemically help your brain interrupt adrenaline and cortisol release by mimicking what naturally occurs in your brain right before you fall asleep. 

Initially developed for people suffering from PTSD, the benefits and effectiveness of NuCalm are now widely accepted in many healthcare and therapeutic settings. 

Just as we practice minimally invasive dentistry, we at Green City want your sedation options to be effective but also safe and conservative, leading to a recovery that is as quick and comfortable as possible. 

For additional information about dental sedation or anesthesia, patients are welcome to go to

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