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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.

Relieving Dental Anxiety With Sedation Dentistry

Patient comfort and care is a top priority for a sedation dentist. They recognize that dental anxiety or discomfort can be associated with some dentistry procedures. Fortunately, a variety of dental procedures using dental anesthetics are available to relieve both anxiety and discomfort. Talk with your dentist to find out which is right for you.

Dental Anxiety Relief

Local Anesthetic:

This is the most frequently used type of dental anesthetic for sedation dentistry procedures. Although often referred to as "Novocain," this once popular painkilling drug has actually been replaced by more effective anesthetics such as Lidocaine for a comfortable dental care treatment. It also works very well for temporary relief of a tooth ache.

However, the name has become so much a part of the American vocabulary, it's now used in generic terms. Prior to injecting the local anesthetic, the dentist often swabs a topical anesthetic over the injection site to prevent the patient from even feeling the needle.

Conscious Sedation Dentistry:

Patients seeking comfortable dentistry can consult with their dentists to choose anti-anxiety agents either administered by mouth, inhalation or injection. Nitrous oxide, often referred to as laughing gas, helps to ease patient anxiety. The gas is inhaled by patients, inducing relaxation, so they can approach dental procedures with less stress.

Deep Sedation:

This may be required for complex procedures or for dental patients with special needs. With the administration of general anesthesia, the patient is unconscious; with deep sedation dentistry or sleep dentistry, dental patients are deeply relaxed and not fully aware of their surroundings during their dental treatment.

Consult With Your Dentist

Prior to treatment, your dentist will need to know a few things regarding your health history such as:

• allergies
• your current health condition
• any medications you may be taking.

Some medicines may interfere with the efficiency of an anesthetic requiring an adjustment in your medication schedule. Your health history is very important information for the dentist. During the consultation, you can ask questions about any dental procedures that may be of concern during your dental procedure.

A Concern for Safety

The drugs used as dental anesthetics are approved by the Food and Drug Administration and are safe. Anesthetic providers are professionals with a commitment to patient safety and comfort.

A dental anesthetic can be administered by a general dentist, a dental anesthesiologist or an M.D. Certification is required and is regulated on a state-by-state basis. Discuss sedation with your dentist at your next visit.

By Brian J. Gray, DDS, MAGD, FICO

+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.