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.
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.
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.
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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