Can you guess the #1 question patients ask us daily? We are sure you know. That’s right, they always ask, “Is the treatment going to hurt?” It is an important yet very easy question to answer. Our answer is always a resounding “NO.” We can say this with confidence because of the many advancements the profession has made in sedation dentistry.
Do you fear going to the dentist? Rest assured, you are not alone. Some 75 to 80 percent of Americans experience feelings of anxiety about dental visits. In fact, roughly 25 million to 30 million Americans are deathly afraid of going to the dentist. But after you read this chapter that describes the different sedation options available, you will see that fear is really no reason to put off the dentistry treatment you may need.
The difference between anxiety, fear, and phobia
A distinction has been made between dental anxiety, dental fear, and dental phobia.
- Dental anxiety is a reaction to an UNKNOWN danger. Anxiety is extremely common, and most people experience some degree of dental anxiety, especially if they are about to have something done that they have never experienced before. Basically it is a fear of the unknown.
- Dental fear is a reaction to a KNOWN danger. “I know what the dentist is going to do, been there, done that—I’m scared!” This fear elicits a fight-or- flight response when the patient is confronted with the threatening stimulus.
- Dental phobia is basically the same as fear, only much stronger. “I know what happens when I go to the dentist—there is no way I am going back if I can help it. I am so terrified that I feel sick.” This patient experiences the fight-or-flight response when just thinking about or being reminded of the threatening situation. Someone with a dental phobia will avoid dental care at all costs until either a physical problem or the psychological burden of the phobia becomes overwhelming.
What are the most common causes of dental anxiety, fear, and phobia?
- Previous bad experience. In our opinion, this is by far the main reason for dental fear, ranging from anxiety all the way to a true phobia. We routinely ask our patients who have a severe form of dental phobia about when their problems started, and it usually stems from a bad past experience.
- Occasionally we hear about dentists, hygienists, or staff members who may have made insensitive remarks to patients. This can contribute to a dental fear.
- Uncaring dentist. You might think that fear of physical pain is the main problem, but for some people it is actually emotional pain inflicted by a dentist who is perceived as cold and controlling. This can have a huge psychological impact.
What can help ease dental anxiety?
Dental professionals can use many things to help put a patient at ease, such as:
- Relaxing environment;
- Calming music;
- Communication—the way your dentist and his or her staff interacts with patients; and/or
Local anesthesia, also known as an “injection.” Local anesthesia is needed for all dental surgery, whether or not sedation is used. The site to be treated must be “numbed” in order for a patient not to experience pain during and after the surgery is completed. The majority of the drugs used with IV sedation are not painkillers (although some are added occasionally). Most of the sedation medications are antianxiety drugs, which relax you.
Inhalation sedation, also known as “laughing gas.” Nitrous oxide is a gas that is breathed during treatment. After five minutes or so of breathing in the gas, patients usually experience a euphoric feeling that spreads throughout the body. Some describe it as a “happy drunk” feeling. Some people find there are auditory or visual effects as well. Patients will feel a bit lightheaded, and often people get “the giggles” (hence the name laughing gas). The main side effect is it can sometimes cause nausea. Patients can safely drive themselves to and from our office after receiving this form of sedation.
IV (intravenous) sedation. With IV sedation, a drug to decrease anxiety is administered intravenously into the bloodstream during dental treatment. Different types of drugs can be used, with effects ranging from a state of total relaxation to deep sedation where the patient is actually asleep. Most of the drugs administered through the IV route cause amnesia (memory loss), which makes the treatment time seem to pass quickly.
How is IV sedation given?
“Intravenous” means that the drug is put into a vein. An extremely thin needle is put into a vein close to the surface of the skin in either the arm or the back of your hand. This needle is then replaced by a soft plastic flexible tubing through which the drugs are administered. The tubing is taped to your arm and stays in place throughout the procedure.
During the procedure, 100 percent oxygen is administered, and your pulse, heart rhythm, blood pressure, and oxygen levels are measured using a pulse oximeter and ECG. The pulse oximeter gadget clips onto a finger and measures your pulse and oxygen saturation. It provides a useful early warning sign if you are getting too low on oxygen. ECG leads are placed on the chest to register heart rhythm, and blood pressure is monitored automatically every 10 minutes throughout the sedation with a blood pressure measuring machine. The patient’s vital sign monitoring is documented and is included after treatment in the medical chart.
How safe is IV sedation? Are there any contraindications?
IV sedation is one of the safest types of sedation when carried out under the supervision of a dentist who has been properly trained. Each state dental board has specific regulations to which a dentist must adhere in order to perform sedation in his or her office. In Connecticut, certain education requirements are needed to obtain a sedation permit. A dentist must have a personal sedation permit (unless a medical doctor or a nurse anesthetist is administering the sedation) and an office sedation permit. The board will perform an on-site office inspection to make sure the appropriate emergency and monitoring drugs and equipment are present and that the dentist knows how to use them. Additionally, the dentist must successfully complete two sedation cases and successfully pass an oral examination encompassing 12 of the most common medical emergencies before receiving certification. At this writing, Drs. Evans and Weiss are two of only three periodontists in the state of Connecticut licensed to administer IV sedation.
In addition to the above requirements, dentists seeking to use sedation must provide proof to the dental board of current certification in cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS). These requirements help to ensure the safety of patients who are to be sedated.
In addition to the safety afforded by proper training and regulatory oversight, the IV sedation process itself has certain “built-in” safety benefits. Due to the administration route (into a vein), drugs can be given in a precise manner to give the desired level of sedation for each patient. Several factors, such as drug tolerance and a patient’s weight, determine the amount of medication needed. If problems arise, such as a patient’s oxygen level becomes low or an allergic reaction is noted, the drugs can be reversed using reversal agents.
There are contraindications to sedation; some examples are:
- Known allergy to sedation medications; and
- Some instances of glaucoma.
Are there disadvantages?
- IV sedation is more expensive than other sedation options.
- Recovery from IV sedation requires several hours after the dental procedure is completed. Drugs can “linger” in a person’s system afterward, so a responsible escort is always recommended.
- A hematoma (bruise) may develop at the site where the needle enters the vein.