Oral Conscious sedation provides a safe and effective option for patients undergoing dental procedures.  The number and type of procedures that can be performed using oral conscious sedation have increased significantly as a result of new technology and state of the art drugs.  Oral Conscious sedation allows patients to recover quickly and resume normal daily activities in a short period of time.



This type of sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives.  Patients who receive oral conscious sedation are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider. A brief period of amnesia may erase any memory of the procedure



Conscious sedation is extremely safe when administered by qualified providers. Innovative Periodontics & Dental Implants and team have been specially trained.



Because patients can slip into a deep sleep, proper monitoring of oral conscious sedation is necessary.  Innovative Periodontics & Dental Implants and team monitor the patient’s heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. There will be a qualified team member with the patient at all times.  In case of extreme emergency, all of our team members have been trained to perform advanced cardiac life support.



A brief period of amnesia after the procedure may follow the administration of oral conscious sedation.  Occasional side effects may include headache or hangover.  Rare cases of nausea and vomiting have been reported.



A qualified team member will monitor the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving oral conscious sedation. Wheel chair assistance is available if patients are not completely ambulatory at the end of the procedure.





As we have already discussed with the patient, it is important that he/she does not drive either to or from their dental appointment.  Thank you for helping keep them safe by committing to driving them to their appointment and directly home afterwards.  

The patient will be taking oral sedatives for their visit and will be in a drug-induced state of reduced awareness and decreased ability to respond.  The patient will need to be in an adult’s trusted care for the duration of 24 hours after the dental appointment.  The patient cannot drive or operate machinery or make important decisions while taking oral sedatives for 24 hours after the dental appointment.

Please review the post-operative instructions included with this form.  If you have any questions about these instructions, please ask a member of our dental team for further explanation. If you have any questions or concerns or know of some way we can make this experience even easier, please feel free to contact our office at (707) 525-0555.



  • Notify your dentist if there has been any change on your medical history since your sedation consultation.
  • Eat a light meal with water only no later than 60 minutes prior to your dental appointment.
  • Routine medications should also be taken with this method prior to appointment
  • No alcohol or narcotic drugs for 24 hours prior to and after your appointment. We cannot safely sedate you if you have consumed alcohol, narcotics of any type or any street or recreational drugs.
  • No caffeine for 12 hours prior to your appointment; may limit your level of sedation.
  • Do not drink grapefruit juice or eat any grapefruit products for 7 days prior to your appointment. The enzymes in grapefruit interfere with the systems that break down certain oral sedation medications.
  • If you are a smoker, nicotine may affect your sedation experience. Therefore, it is recommended that refrain from smoking for twelve hours prior to your sedation appointment.
  • There must be no chance of pregnancy.
  • Wear short-sleeved, comfortable clothing including shoes and socks. Slippers welcome!
  • Remove all nail polish before coming to appointment.
  • Remove contact lenses before coming to appointment.
  • Leave all valuables, purses or wallets and watches with your companion.
  • It is essential that you have a companion drive you to and from your appointment. If not, we will not be able to proceed with your sedation appointment and this will result in a forfeiting of your prepaid sedation fee (if applicable). It is also important that we provide your companion with instructions, so please make sure that they speak with a member of our dental team when you arrive for your appointment. Should your companion wish to remain at the office during your sedation appointment, a very comfortable lounge is available for their use.
  • For patients under 18-years-old, a companion is required to stay in our office for the duration of the sedation appointment.
  • You should have a responsible person stay with you for the duration of your recovery.




  1. Patient may seem alert when he/she leaves the appointment. This may be misleading so do not leave the patient alone.
  2. A responsible adult should be with the patient until he/she has fully recovered from the effects of the sedation.
  3. Always hold patient’s arm when walking; A patients balance and equilibrium may be negatively affected; companion should assist in all ambulatory movements for 12 hours following the procedure.
  4. Drive directly home and make sure the patient is comfortable and safe.
  5. Patient should not go up and down stairs unattended. Let the patient stay on the ground floor until recovered. Having nutrition after sedation is important. The patient should begin eating soft foods as soon as possible. Do not delay.
  6. The patient needs to drink plenty of fluids (water, decaf juice or sports drinks) as soon as possible and stay hydrated.
  7. No sedatives or stimulants should be taken for 24 hours after the appointment including alcohol, caffeine, cola, nicotine or recreational drugs.
  8. Patient should not be caring for infants or young children until the next day after the sedation appointment.
  9. Patient cannot drive for 24 hours after taking sedation medication.
  10. Patient cannot make any important decisions for 24 hours after taking sedation medication.
  11. Patient cannot operate any hazardous devices or do any heavy lifting for 24 hours.
  12. Please follow all post-op instructions and take medication as prescribed by your dentist/periodontist.


  1. I understand that Anxiolysis, defined as the diminution of anxiety, will be achieved by the administration of oral medications and possibly nitrous oxide/oxygen. I have been instructed to take 1 pill approximately 60 minutes before my dental appointment and bring the 2nd pill with me to my dental appointment.
  2. A pharmaceutical consulation is REQUIRED if you take prescription or non-prescription medications for sleep aid.
  3. I understand that the purpose of Anxiolysis is to more comfortably receive dental/periodontal care.
  4. I understand that Anxiolysis is not required to provide the necessary dental/periodontal care.
  5. I understand that Anxiolysis has limitations and risks and success cannot be guaranteed.
  6. I understand that Anxiolysis is a drug-induced state of consciousness to reduce fear and anxiety. I will be able to respond during the procedure. My ability to act and function normally will return when the effects of the sedation wear off.
  7. I understand and have been informed that the alternatives to Anxiolysis are: No sedation; the necessary procedure is performed under local anesthetic only, Nitrous oxide/oxygen (N20) inhalation sedation only, commonly called laughing gas, Intravenous (I.V.) Sedation.
  8. I understand that there are risks and limitations to all procedures. For Anxiolysis these may include: Inadequate initial dosage. This may result in a sub-optimal level of Anxiolysis.  Atypical reaction to the sedative medications. In unusual circumstances this may require emergency medical attention and/or hospitalization. Other atypical reactions may include; altered mental states (e.g. over sedation or hyper-response to the sedative medication), allergic reactions, nausea, and/or vomiting.
  9. I understand that if, during the Anxiolysis procedure, a change in treatment plan may be required. In that instance, I authorize the dentist/periodontist to make whatever change they deem in their professional judgment is necessary. I understand that I have the right to designate the individual who will make such a decision if I so desire.
  10. I have had the opportunity to discuss Anxiolysis and had my questions answered by qualified personnel, including the dentist/periodontist. I also understand that I must follow all the recommended treatments and instructions of my dentist/periodontist.
  11. I understand that I must notify the dentist/periodontist if I am pregnant, or if I am lactating. I must notify the dentist/periodontist if I have sensitivity, intolerance, or allergies to any medication. I have informed the dentist/periodontist of my past and present medical history, if I have recently consumed alcohol or other recreational drugs, and if I am presently on any prescription or non-prescription medications
  12. I understand that after taking oral sedatives I am not permitted to drive or operate hazardous machinery from the moment I take the medication and for 24 hours after my procedure. I understand and acknowledge that I will have a responsible adult drive me to and from my dental/periodontal appointment on the day of the Anxiolysis procedure. I understand that public transportation (taxi, bus, other) is not an acceptable form of transportation.
  13. By signing below I acknowledge that I understand the benefits, risks and alternatives to Anxiolysis and hereby consent to Anxiolysis in conjunction with my dental/periodontal treatment and I have or I will comply by the requirements and recommendations listed in this form.
Do not hesitate to call our office at (707) 525-0555 if there are any questions or concerns. If you are calling after hours, please contact the doctor directly by calling our office for a list of directories.  If you feel that your symptoms warrant a physician and you are unable to reach us, go to the closest emergency room immediately.
J. Jay Uemura, D.D.S.
Philip Vassilopoulos, D.D.S., D.M.D.