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Treating Dental Fear
Millions of people unnecessarily avoid dental care due to fear. Unfortunately, dental decay and gum disease do not simply disappear. As a consequence, many people suffer from dental maladies that could easily be avoided.
Bad Dental Experiences
People commonly blame bad childhood experiences at the dentist for their present anxiety about dental care. Psychologists have observed that it may take nine or more positive experiences to overcome one negative incident. But it can be done.
The first step in managing dental fear is familiarization. The more you learn about a forthcoming experience, the less likely you will be anxious about it. Be frank with the dental staff. Talk about your concerns. Communications such as “I’m afraid of the drill,” “I’m a dental coward,“ or “Please, I need extra TLC,” will clear a pathway for an exchange of ideas.
Most dentists are caring, empathetic people -- not the sadistic demons portrayed in Hollywood. They will listen to your fears. There are several options available for a tranquil dental appointment.
For some patients, a comfortable setting, reassurance by the dentist or stereo headphones may be all that is required for relaxed dental treatment. Others may require more pronounced treatment modalities.
Hypnosis
Hypnosis is a suggestive technique that may produce a state of altered consciousness, opening the subject to the therapist’s behavioral or perceptive suggestions. This approach can easily include a state of relaxation. Once properly trained, individuals may later reproduce the relaxed state without the presence of the therapist.
Nitrous Oxide and Conscious Sedation
The American Dental Association defines conscious sedation as “a minimally depressed level of consciousness that retains the patient's ability to independently and continuously maintain an airway and respond appropriately to physical stimulation or verbal command.” This may be accomplished with the use of a pre-treatment oral sedative, the inhalation of nitrous oxide, or a combination of both. The technique requires the use of a local anesthetic for most dental procedures.
Some patients tolerate dentistry more easily by taking an oral pre-medication 30-60 minutes before the dental visit. The choice of a sedative depends upon the patient’s general health and other medications taken. The drawback to oral sedatives is that the level of sedation is difficult to manage and an escort is usually required.
Nitrous oxide, or relative analgesia, is a safe, convenient agent for dental care in comfort. Also known as laughing gas, nitrous oxide is effective in producing a state of deep relaxation without the loss of consciousness. It wears off in a few minutes and the patient may drive home. Used by properly trained dental personnel, nitrous oxide is ideal for the dental environment.
Some dentists prefer to prescribe anti-anxiety or sedative medications in combination with nitrous oxide.
Intravenous (IV) Sedation
Comprehensive control of pain and anxiety in dentistry is sometimes achieved by the intravenous introduction of anti-anxiety or sedative drugs. This technique produces a profound state of relaxation, without the loss of consciousness or compromising respiration. The technique is recommended for excessively anxious dental patients and an escort is always required. A local anesthetic is still needed for most dental procedures.
While less convenient than conscious sedation, IV sedation’s predictable effects make it the method of choice for the highly fearful dental patient.
General Anesthesia
Outpatient oral surgery procedures or general dentistry for extremely apprehensive or handicapped dental patients may require the use of a general anesthetic. Oral and maxillofacial surgeon Dr. Ken Templeton states, “Modern technology now makes it possible to perform complex surgery in the office with little or no discomfort.”
In an oral surgery or dental setting, general anesthesia characteristically produces a state of unconsciousness, short of impairing respiration. Special monitoring, supportive and resuscitative techniques are mandatory for patient safety. A local anesthetic is commonly used in conjunction with the administration of intravenous drugs. Recovery time is usually 20-40 minutes and an escort is necessary.
Safety and Training
The use of conscious or intravenous sedation and general anesthesia requires special university training and clinical experience. The 50 state boards of dentistry carefully regulate and license dental practitioners within their jurisdictions. Training requirements do vary. Offices must be specially equipped with emergency equipment and drugs, and in-office inspections are necessary for each dentist issued a permit.
Dr. Stanley Malamed, Professor of Anesthesia and Medicine at the University of Southern California School of Dentistry, reports that dental IV sedation is a safe technique. "While any sedative technique carries a degree of risk, the drugs used and their slow delivery, accompanied by modern monitoring equipment, make IV sedation extremely safe.”
Don’t Delay Necessary Dental Care
Dr. Richard Gagne, who provides IV sedation for his patients, observes:
“Comprehensive dentistry can save your teeth, improve your smile, and keep you looking youthful. However, the problems must be caught early and treated promptly. IV sedation can get you back to wonderfully healthy, attractive and pain-free teeth -- teeth of which you can be proud and will serve you for a lifetime.”
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