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Articles
John C. Chao, D.D.S., F.A.G.D
Anxiety Management,
Behavior Science,
Faculty, USC School of Dentistry
For The Dental Phobic: Sedation Dentistry
Good news for dental "chickens!" Although 40 million Americans do not visit the dentist due to fear of treatment (according to the American Dental Association), deeper understanding of the dental anxiety syndrome by the dental profession and the emergence of new technology can make the dental visit relaxing and comfortable for even the worst cases. The vast majority of these patients can be helped in the various non-pharmaceutical ways, as discussed in a previous article. But for those who for various reasons are still extremely anxious about dental treatment, conscious sedation is a safe and effective option. This technique predictably relieves anxiety associated with dental treatment and allows the patient to remain deeply relaxed for long periods of time, while remaining awake. There are two ways by which a patient, while maintaining consciousness, can be "sedated" for dental treatment. They are: oral conscious sedation, and intravenous (I.V.) conscious sedation
The easier and more popular choice is oral conscious sedation. Oral pre-medication is used before and sometimes during the appointment. It is a safe and relatively affordable means of relieving high anxiety in patients who prefer an effortless and comfortable way of having all the treatment done in a few appointments. This technique generally calls for the patient to take an oral sedative the evening before the appointment. In the morning the patient is escorted to the office by someone else and is given another sedative before the start of the procedure. For a small number of patients an additional dose of sedative may be needed. Some times nitrous oxide ("laughing gas") is also used to augment and control the depth of sedation.
Although sedated and deeply relaxed, the patient is awake during the entire appointment. In most cases only one or two appointments would be necessary to have all the treatment completed. Where the treatment is highly complex or where complicated laboratory work is involved, more appointments may be necessary. Generally used are monitoring devices that continuously measure oxygen saturation, and regularly measure blood pressure and pulse rate. After treatment is finished, the patient is required to be escorted back home.
In most cases patients will recall a pleasant experience of short duration, even though the appointment had been for two hours or more. This is because of the amnesiac quality of the sedatives used. The most common class of sedatives used in dentistry are the benzodiazepines, which includes Triazolam, Versed and Valium. In minimal doses, such as those used for oral sedation, Triazelam and Versed can be mildly amnesic. Incidentally, another advantage of benzodiazepines is that sedative effects of this kind of drugs can be readily reversed by an antagonist, called Flumazenil
.Where the patient suffers from moderate or severe anxieties and prefers a deeper form of sedation, intravenous (I.V.) route of sedation may be used. The patient is placed in a deeper sedated state through the intravenous route, but is conscious enough to respond to verbal instructions. Partial or complete amnesia is common. I.V. sedation requires a higher degree of monitoring. Devices such as the electrocardiogram (EKG) are employed. Special training and certification is required for the administration of intravenous sedation. Unless the dentist is qualified for I.V. sedation, a dental anesthesiologist administers I.V. anesthesia while the treating dentist performs the dental procedures. For these reasons the cost of I.V. sedation may be somewhat higher.
For the medically compromised patient, the very young or the severely phobic adult, general anesthesia is also an option. Dental treatment is done in the hospital setting or specially equipped out-patient surgical centers. Some medical insurance plans provide some benefits under specific circumstances for general anesthesia.
So if you are "chicken" when it comes to dentistry, remember you are in good company. Even some of the strongest, biggest men are in this category. Dentists are specialists when it comes to caring for anxious, fearful patients. They are welcome. So don't hesitate to openly announce that you have anxieties and fears regarding dental treatment and let your dentist explain to you the new, exciting ways you can be helped, including conscious sedation. Then get the smile you always wanted. It's that easy.
