Your Local Area - Cosmetic Dental Treatment

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 Can Help Control Dental Fears

Many patients face their dental appointment with a degree of anxiety. Research has shown that the largest cause of this fear is the fear of pain ... the fear that at some time during their dental care treatment they are going to be hurt.

Sedation dentists have information available about a variety of drugs known as local anesthetics, which are the safest and most effective drugs in all of medicine. Local anesthetics are a resource used in anxiety-free dentistry for the prevention and management of dental anxiety resulting from dental and surgical procedures, not to put the patient to sleep.

Local anesthetics, commonly called Novocain by patients (Novocain is no longer used, having been replaced by newer, safer, and more effective drugs), are drugs which, when injected near a nerve, prevent stimulation from reaching the brain where it would be interpreted by a person as pain. Sedation dentists interested in practicing anxiety-free dentistry know these also work very well as temporary relief of a tooth ache.

The injectable local anesthetics, used today by sedation dentists provide complete relief about 100% of the time. The duration of the numbness varies from drug to drug -- some providing short durations, while others remain effective for up to 12 hours. A doctor will select a drug for a patient that is appropriate for the type of dental care procedure they are having done.

In order to be effective during dental treatment, local anesthetics usually need to be injected. For many people, this is the most uncomfortable part of the entire dental appointment.

Local anesthetics can be administered quite comfortably. Sedation dentists and dental hygienists take pride in their ability to administer local anesthesia easily and comfortably.

The following are some of the procedures sedation dentists practicing anxiety-free dentistry might use to make this procedure more comfortable:

• Place the patient in a reclined position during the injection.
• Place a topical anesthetic (a gel or spray) on the patient's gums where the injection is to be given. This should remain in contact with tissues for at least one minute.
• Use of a distraction technique, such as pulling or shaking the lip as the needle is slowly inserted.
• Injecting the local anesthetic drug slowly. This is critical to a comfortable injection.
• Permitting the local anesthetic drug time to work. Most local anesthetics will become completely effective within approximately five minutes after their injection.

If an individual is fearful of receiving a local anesthetic injection, they should tell the assistant or the sedation dentist BEFORE the procedure starts. The use of conscious sedation such as laughing gas, as part of anxiety-free dentistry, can work wonders to make this procedure more comfortable for the patient.

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.