Nervous patients & sedation in Rugby · the honest guide
Is dental sedation safe? Who can have it, who can't, and what we check
Written by Dr Savan Zala, implant and sedation dentist at Rugby Smiles (BDS, MFGDP RCSEng, MSc Implants) · Reviewed September 2026
The short answer: yes, for the right patient, IV sedation with midazolam is one of the safest and best-studied techniques in dentistry, with a very wide safety margin and a reversal drug on hand if it is ever needed. Its safety depends on assessing you properly first, giving the drug slowly, and monitoring you throughout, and we do all three to the UK national standards.
Fear of the dentist and fear of the sedation itself often arrive together. If you are the kind of person who reads the leaflet in the medicine box, this page is for you: what the drug does, what could go wrong and how we guard against it, which medical conditions rule sedation out, and the questions we will ask you at your consultation.
Not ready to speak to anyone yet? Tell us what worries you first, it takes two minutes and Georgia reads every one.
Why midazolam is the drug of choice
Midazolam is a short-acting benzodiazepine that has been the standard for intravenous dental sedation in the UK for decades. It works within minutes, wears off within a couple of hours, calms anxiety rather than switching off consciousness, and has a specific antidote, flumazenil, which we keep in the surgery and which reverses its effects in under a minute. Very few drugs offer that combination.
We give it slowly through a cannula, a small amount at a time, watching how you respond. This is called titration, and it is the reason the dose is right for you rather than an average for your weight. A large person who is very anxious and a small person who is calm may need surprisingly similar amounts; titration finds the right point for each.
How you are monitored
- A pulse oximeter on your finger measuring oxygen levels and heart rate continuously
- Blood pressure taken before, during and after
- A second trained person, a sedation nurse, watching you and the monitors while I treat
- Oxygen, emergency drugs and the reversal agent in the room, checked before every session
- A recovery period in the practice until you meet the criteria to go home, then release to your escort
These are the requirements of the Intercollegiate Advisory Committee for Sedation in Dentistry, the body that sets the UK standards, and they are the same whether the treatment is a single filling or a morning of surgery.
Who is a good candidate
Healthy adults, and adults with mild, well-controlled medical conditions such as treated high blood pressure, well-managed asthma or diet-controlled diabetes. In the fitness grading the guidelines use, these are ASA 1 and ASA 2 patients, and they can be safely sedated in a dental practice. You should be over 16, have someone who can bring you and stay with you afterwards, and be able to follow the instructions for the day.
Who we would not sedate here
Significant medical conditions
Severe or unstable heart disease, serious lung disease such as COPD, significant liver or kidney problems, or severe obstructive sleep apnoea. Sedation may still be possible, but in a hospital setting with anaesthetic support, and we would refer you.
Pregnancy
Midazolam is avoided in pregnancy unless there is a compelling reason. Treatment can usually wait, or be done with local anaesthetic and a lot of reassurance, and we are good at reassurance.
Allergy or interactions
A known allergy to benzodiazepines rules it out. Some medicines, alcohol and recreational drugs interact with midazolam, which is why we ask about all of them and why the 24-hour no-alcohol rule matters.
We also ask about previous problems with sedation or anaesthetics, whether you have ever been told you have a difficult airway, and your weight, because very high BMI can make sedation less predictable and may mean a hospital setting is safer. None of these questions are there to catch you out. They are how we decide whether to say yes.
The honest risks
The main risk of any sedative is breathing more slowly or shallowly than normal. This is why oxygen levels are measured continuously, why the dose is given gradually, and why the reversal drug is to hand. In a properly assessed patient, monitored by trained staff, serious problems are very rare. Minor effects are more common and short-lived: a drowsy afternoon, a bit of forgetfulness, occasionally a headache or mild nausea, and a small bruise where the cannula was.
“The most dangerous thing I see is not sedation. It is the abscess that was ignored for six years because the dentist was too frightening.”
Dr Savan Zala, sedation dentist at Rugby Smiles
What we check at your consultation
A full medical history, your medicines, your alcohol intake, previous experiences with sedation or anaesthetics, and a look at your mouth so we know what treatment we are planning. You leave with a written plan, a written price, and written instructions for the day. If we think you would be safer elsewhere, we tell you and help arrange it. Read how the day itself runs on our IV sedation page, or start with a free, no-chair chat with Georgia if even that feels like too much.
Questions people ask
Can sedation go wrong?
Any drug carries some risk, and the specific one with sedation is breathing that becomes too shallow. Continuous oxygen monitoring, gradual dosing, a trained second person and an immediate reversal drug are the safeguards, and with them serious events are very rare in properly assessed patients.
Is there a reversal drug?
Yes. Flumazenil reverses midazolam within about a minute and is kept in the surgery for every sedation session. We very rarely need it, but it is part of why the technique is so safe.
Can I have sedation if I have high blood pressure or diabetes?
Usually yes, if the condition is well controlled. Poorly controlled blood pressure or diabetes would need sorting with your GP first.
What about sleep apnoea?
Mild sleep apnoea is often fine with extra care. Severe sleep apnoea, particularly if you use a CPAP machine, may mean sedation is safer in hospital, and we would say so.
Is it safe for older patients?
Often yes, with smaller doses given even more gradually. Age alone is not a barrier; overall health and medicines are what matter.
Who regulates dental sedation in the UK?
Dentists providing sedation must be trained to the Intercollegiate Advisory Committee for Sedation in Dentistry standards, keep that training up to date, and work with a trained second person. The General Dental Council and the Care Quality Commission oversee compliance.
Tell us your medical history. We will tell you honestly whether sedation is right for you.
The free consultation is a conversation, not a treatment: your medical history, what you need done, whether sedation is right for you, and a written price before anything is booked. Or start with a free, no-chair chat with Georgia, our treatment co-ordinator.
Read next: what sedation feels like · how long it lasts · what it costs · IV sedation in Rugby · Rugby Smiles Dental Clinic · 3 Newbold Road, Rugby CV21 2LQ · 01788 579 577