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Conscious Sedation Dentistry: Managing Dental Anxiety

All too frequently, a planned visit to the dentist is looked on with a degree of dread and foreboding. This is referred to as dental anxiety.

Dental anxiety is not unusual, for it is quite natural for a person to be uncomfortable when placed in a position in which they feel that they are vulnerable, as occurs in the dental chair.

It is important that a patient tell the doctor if they have any dental anxiety related to their planned dental treatment. Keeping their fears hidden can only lead to a much more unpleasant experience for the patient and, in more extreme circumstances, may even increase the likelihood of certain emergencies occurring, such as fainting.

Once the sedation dentist is aware of the patient's dental anxiety and fears, there are many ways in which they may be addressed. In some cases, simply discussing the planned procedure is all that is necessary to alleviate the patient's dental anxiety.

When this is not enough, other highly effective and safe sedation techniques can be used to alleviate dental anxiety. If the technique involves the administration of a drug, it is termed conscious sedation dentistry.

The most readily available routes of conscious sedation are: oral, inhalation, intravenous and intramuscular. For extremely fearful dental patients, general anesthesia may be required.

Oral Conscious Sedation Dentistry

Many dentists will prescribe a sedative drug to be taken by mouth prior to the planned treatment. If the individual has an even greater degree of dental anxiety, the doctor may prescribe an oral conscious sedative to be taken at home one hour prior to going to sleep on the evening before the appointment.

If the drug is administered at home, it is IMPERATIVE that the patient NOT DRIVE A CAR to the appointment. Patients receiving oral conscious sedation are not permitted to drive a car or operate a motor vehicle for 24 hours following their appointment.

Commonly administered oral conscious sedatives include: Valium, Halcion, Dalmane, and Versed. Oral conscious sedation dentistry is most effective in the management of milder degrees of dental fear.

Inhalation Conscious Sedation Dentistry

The use of inhalation conscious sedation (nitrous oxide and oxygen) has been a mainstay of sedation techniques in dentistry for generations and still represents the most frequently employed technique. Commonly known as laughing gas, nitrous oxide-oxygen is used by more than 35% of all U.S. dentists.

An advantage of this technique of inhalation conscious sedation is that most people receiving it recover promptly and may be permitted to leave the dental office unescorted and resume normal activities immediately.

Inhalation conscious sedation is most effective with mild to moderate degrees of dental anxiety.

Intravenous Conscious Sedation Dentistry

Though not as readily available as other conscious sedation techniques, intravenous (IV) conscious sedation is a safe and highly effective technique for management of moderate to more severe levels of dental anxiety.

Sedation dentists who employ IV conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners.

Drugs administered intravenously are more effective than the same drugs taken orally. A major benefit of some of these IV drugs is amnesia.

The patient will have no memory of some, or even all, of the dental treatment. This will lead the patient to think they were asleep during the treatment when, in reality, they were awake, but comfortable, at all times.

During the procedure, monitoring devices will be attached to the patient. These devices monitor the effectiveness of one's breathing (pulse oximeter), blood pressure and heart rate, increasing the safety of the procedure.

Patients receiving IV conscious sedation are not permitted to leave the dental office unescorted at the conclusion of the procedure.

Intramuscular Conscious Sedation Dentistry

Less commonly employed for adult patients, intramuscular (IM) conscious sedation is a relatively effective technique for management of moderate levels of dental anxiety and fear.

IM conscious sedation is more often employed in the management of fearful children. Sedative drugs are injected into the muscle of the upper arm or the thigh, producing sedation in approximately 20 to 30 minutes.

Dentists using IM conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners and will employ the same monitors described in the IV conscious sedation section.

General Anesthesia

Though the techniques of conscious sedation described above effectively manage more than 90% of all fearful dental patients, some may require general anesthesia in order to relieve their dental anxiety during their dental treatment.

When general anesthesia is used, the sedation dentist will employ a person who is trained and certified in general anesthesia to manage the patient while the dentist carries out the dental treatment.

This person will be a dentist anesthesiologist, a medical anesthesiologist, or, in some cases, a nurse anesthetist, whose sole responsibility is to ensure the safety of the sleeping (unconscious) patient while the dentistry is being done.

Sleep dentists using general anesthesia have received a minimum of two years of specialized advanced training and have been certified by their state Board of Dental Examiners. Monitors will be employed to help ensure the safety of the procedure.

Not all dentists employ conscious sedation techniques to relieve dental anxiety. It is important for patients to voice concerns and dental fears with their dentist during their first visit to the office.

The dentist will seek to work out a treatment plan that will best accommodate the patients needs. In some situations it may be necessary to refer a patient to a doctor who has these techniques available.

By Stanley F. Malamed, DDS

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.

Anxiety Free Dentistry - Questions on Reducing Dental Anxiety

Q. Why do you need to have regular dental care check-ups?

A. Regular check-ups are needed to monitor your overall oral health. In addition to checking for cavities, your dentist examines the health of your entire mouth and surrounding soft tissues, checking for pre-cancerous or cancerous lesions, oral sores, and gum disease.

Your oral health is connected with your general health. Dental care check-ups can alert the dentist to other medical conditions that have symptoms in the mouth such as diabetes, nutritional deficiencies, and hormonal irregularities. Regular dental care visits are vital to prevent tooth decay, gum disease, and other conditions affecting your mouth.

Q. What can you do to feel more relaxed during a dental care appointment?

A. With the combination of modern anesthetics and new conscious sedation dentistry technology and techniques, many procedures only have minimal discomfort or are now entirely painless. Dental care providers want their patients to have maximum comfort and approach their treatments with a relaxed attitude and less dental anxiety.

There are a number of ways to decrease dental anxiety:

• Tell the dental care staff your concerns. Studies have shown that talking about your fears of possible discomfort actually reduces pain.
• Use visualization to picture yourself relaxed, or repeat messages that have a calming effect.
• Play your favorite music on a Walkman you bring with you (some dental offices are equipped with walkmans, too.)
• Arrange a signal with the dental care staff, such as raising your hand, if you need a break or feel discomfort.

Some dental care offices are now offering patients new options for stress-relief: hypnosis, self-hypnosis instructions, relaxation tapes, soft lighting, warm gel-filled eye masks, scented candles, and massaging pillows. These are helpful in reducing stress in patients that suffer from dental anxiety. Be sure to avoid the use of stimulants such as caffeine prior to your visit.

Q. Aromatherapy has a relaxing effect for many people. Is this effective for patients undergoing dental treatment?

A. Research studies conducted at Case Western Reserve University have noted that the use of aromatherapy has a significant positive effect on dental anxiety patients. Two-thirds of the patients receiving aromatherapy were more calm and relaxed than those patients without exposure to the scented fragrance oils.

Dentists are concerned about your comfort. Ask your dental provider if aromatherapy is available in the office to help reduce dental anxiety, or if you can bring your own for your dental care visit. Essential fragrance oils are available in health food stores, spas, and some grocery and drug store outlets.

Q. Are dental patients who are considered at risk for bacterial infections advised to take antibiotic medication prior to their appointments?

A. Certain medical conditions, such as heart valve problems or a recent total joint replacement, are considered at risk for infection at the site of the cardiac abnormality or joint replacement. This infection results from bacteria from the mouth entering the bloodstream and working its way to these vulnerable areas.

Consequently, dental care procedures likely to result in bleeding from the gums or mucous membranes will require patients to take antibiotics prior to that procedure. Such procedures could include, but are not limited to, extractions, implant surgery, incision and drainage for oral infection, and professional teeth cleaning.

Guidelines have been established by the American Heart Association and the American Dental Association to provide dentists and physicians with information regarding appropriate regimens for antibiotic therapy. It also outlines those situations when antibiotic therapy is or is not indicated.

There also are other medical conditions warranting antibiotic therapy prior to dental procedures. Be sure to update your dentist regarding your medical history. Your dentist and/or physician will advise you of any special needs.

Q. Where can you receive dental services if you do not have the money to cover the related expense?

A. If you do not have either dental insurance or the money to pay for a dental visit, you should inquire about financial aid from various sources within your community.

You may need to make several calls, but the local dental society, the local public health department, or social service agencies may be able to direct you to sources of assistance. Also, check local hospitals, dental schools, and outreach clinics that may be able to provide dental services at a reduced fee.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.