Scared of the Dentist? Sedation and Dental Anxiety Options in Ontario

How common is dental anxiety?

The best Canadian numbers come from a national survey of 1,101 adults published in the journal Anesthesia Progress. It found that 5.5% of Canadians had high dental fear and another 9.8% were somewhat afraid, roughly one person in seven. Fear had caused 7.6% to miss, cancel or avoid a dental appointment at some point. The survey dates from 2005, but it remains the standard Canadian reference, and newer international reviews land in the same range, around 15% of adults. If you've been putting a visit off for years, you have plenty of company.

Demand for sedation is just as real. In the same survey, 12.4% of Canadians said they definitely wanted sedation or general anaesthesia for dental work, and another 42.3% wanted it if the price was right. Among people with high fear, nearly a third definitely wanted it. For surgical procedures the numbers climb higher still: 46.5% of respondents preferred sedation or general anaesthesia for an extraction.

Dental anxiety usually has a reason: a rough childhood visit, a dentist who didn't stop when it hurt, or a specific dread of needles, gagging or feeling trapped in the chair. Many people also feel embarrassed about their teeth after years away, and dread the lecture more than the drill. Dentists see this every day; a good one won't judge you for any of it.

The real damage is the avoidance cycle. The longer you stay away, the more work your mouth needs, and the scarier the next visit looks. Problems a filling would have fixed become root canals and extractions. Breaking that cycle is the entire point of the options below.

What helps before you try sedation?

Start with one sentence when you book: "I'm anxious about dental visits." It changes how the whole appointment is run. Ask for a short first visit with no treatment at all: you meet the dentist, talk about your history and what went wrong before, and leave. For many anxious patients, that single visit lowers the temperature more than any drug.

In the chair, control beats fear. Agree on a stop signal, usually a raised left hand, before anything starts, and test it once so you trust it. Bring headphones and your own playlist. Book a morning slot so you don't spend the whole day dreading it. Ask for topical numbing gel and extra freezing time before the needle. Some people want every step narrated; others want silence and speed. Tell the dentist which one you are.

For severe phobia, cognitive behavioural therapy (CBT) with a psychologist has the strongest evidence of any approach. Sedation gets you through one appointment; CBT shrinks the fear itself, and the effect lasts. Ask your family doctor for a referral or look for a psychologist who treats specific phobias. These strategies cost little or nothing, which matters, because sedation fees add up fast.

What are the four levels of sedation, and what does each feel like?

Nitrous oxide (laughing gas) is the lightest level. You breathe it through a small mask over your nose, always mixed with at least 30% oxygen; Ontario requires a fail-safe in the delivery system to guarantee that. Within a few minutes you feel warm, floaty and pleasantly unbothered, but you stay awake and can answer questions. It clears within minutes of breathing straight oxygen, which is why it's the only option after which a dentist may let you drive yourself home.

Oral sedation is a prescription benzodiazepine, such as triazolam or lorazepam, usually taken at the office so the dentist can watch it take effect. Ontario doesn't permit oral opioids for dental sedation. You'll feel drowsy, heavy and calm, and many people remember little of the visit afterward, but you remain awake and responsive throughout. You'll need someone to take you home.

IV sedation, often marketed as sleep dentistry, runs a drug such as midazolam through a vein and adjusts the dose minute by minute. Most patients settle into a deeply relaxed fog and remember almost nothing, yet can still respond to a voice or a tap on the shoulder. Your heart rate, blood pressure and oxygen are monitored the whole time. Plan for an escort and a full day off.

Deep sedation and general anaesthesia put you fully under, the way hospital surgery does. In a dental office this is the most tightly restricted level: a permitted facility, a qualified provider and a team of at least three people in the room for the entire case. It's typically used for wisdom teeth and other oral surgery, severe phobia, strong gag reflexes, some special-needs patients and very young children.

What does sedation cost in Ontario?

There's no public provincial price list for sedation, and most offices don't post fees. The ranges below are compiled from Ontario clinics that publish theirs (Toronto, Markham and Kitchener-Waterloo pages, 2025–2026), so treat them as a starting point, not a quote. For comparison, one Toronto clinic prices nitrous at about $85 per 15-minute unit, while a Kitchener-Waterloo practice reports an average nitrous fee of just over $200 a visit. One rule holds everywhere: the sedation fee sits on top of the dental work itself. A sedated filling costs the filling plus the sedation.

Two habits keep the bill down. Match the sedation to the job: nitrous is usually plenty for a filling or a deep cleaning, and it costs a fraction of an IV session. And group your treatment: one longer IV appointment covering four fillings costs far less than four separately sedated visits. Ask the office to price it both ways.

If your surgery is happening in a hospital because it's medically necessary, the anaesthesia side may be handled differently than in a dental office. Ask the oral surgeon's office to spell out, before booking, exactly which parts you'd pay for.

Who is allowed to sedate you in Ontario?

The Royal College of Dental Surgeons of Ontario (RCDSO) sets the rules, and they tightened sharply in 2020. Since April 1, 2020, a dentist needs RCDSO authorization to administer even nitrous oxide, and any facility using it can be inspected without notice. Dental hygienists and dental assistants aren't permitted to administer laughing gas at all; it's a controlled act.

Moderate sedation, which covers higher-dose oral sedation and IV sedation, requires both dentist authorization and a facility permit. A dentist doing IV sedation needs specific training (a minimum of 40 hours of instruction plus at least 20 supervised patient cases) and current advanced cardiac life support certification.

Deep sedation and general anaesthesia are the most restricted. Only four groups can provide them in a dental office: dental anaesthesiologists, dentists with at least 24 consecutive months of hospital anaesthesia training, oral and maxillofacial surgeons, and physicians qualified in anaesthesia. The facility needs its own permit, and the standard requires at least three trained people in the operatory for the whole case, two of them certified in advanced life support.

You're allowed to ask about all of this. A practice offering sedation should tell you plainly which authorization the dentist holds, and you can check any Ontario dentist's status on the RCDSO public register.

Will insurance, the CDCP or OHIP pay for sedation?

OHIP doesn't pay for dental care in dental offices, and that includes the sedation. Workplace dental plans vary widely: some pay part of the cost when sedation is medically justified, others exclude it as a comfort service. Look for "conscious sedation" or "general anaesthesia" in your benefits booklet, and have the office send a pre-determination so you know the number before you're in the chair.

The Canadian Dental Care Plan is more specific. The CDCP covers nitrous oxide and oral sedation without preauthorization, up to 4 sedation sessions in 12 months. IV sedation, deep sedation and general anaesthesia are covered only with preauthorization, meaning your dentist submits the case for approval before treatment.

Two cautions. The CDCP pays its own fee schedule, which runs below what most Ontario practices charge, so you can owe the difference even with full coverage. And your income tier sets a co-pay: adjusted family net income under $70,000 means no co-pay on CDCP fees, $70,000–$79,999 pays 40%, and $80,000–$89,999 pays 60%.

Are you a candidate, and what should you ask first?

Most healthy adults can have some form of sedation, but the medical review comes first. Heart and lung disease, sleep apnea, pregnancy, alcohol use and several common medications all change what's safe, and elderly patients need lower doses. Answer the health history completely; sedative drugs interact with more things than people expect.

Sedation also comes with logistics. Before deep sedation or general anaesthesia, Ontario's fasting standard applies: no solid food for roughly 8 hours, clear fluids allowed until 2 hours before. After oral or IV sedation you must be released to a responsible adult, and you shouldn't drive, work or sign anything important for the rest of the day. Nitrous oxide is the lone exception, at the dentist's discretion.

Before you book, ask the office these questions:

• Which RCDSO sedation authorization does the dentist hold, and does this facility have a permit?
• Who monitors me during treatment, and with what equipment?
• What will I feel, and how much will I remember?
• What's the all-in price, in writing, with sedation shown as its own line?
• What are my fasting and escort rules?
• Can we agree on a stop signal before anything starts?

Common questions