Sedation Dentistry
Sedation dentistry is a generalized term for several techniques used to calm hyper nervous dental phobic patients, those with a psychological fear of dentists and dental treatment, so they can comfortably receive the oral care and treatment they need without undue stress. Most patients who are dental phobic do not even seek the care they need even when they are in pain because their fear of the dentist and dental treatment out weighs their rational understanding that they need treatment and their condition will only get worse without treatment.
Sedation dentistry can give hope to this type of patient allowing them to over come their fear in seeking the oral health care that they need. This can allow them to feel more comfortable in seeking treatment before something catastrophic occurs that causes them pain, loss time form work and extensive and therefore expensive treatment.
There are three basic levels of sedation that can be offered to patients in the dental office and the first two can even be used in combination to attain a synergistic effect that is greater than the sum of the individual methods.
The first is mood alteration and is achieved by creating a pleasant non-threatening environment with calming music, soothing sounds (such as rain fall, gentile steams flowing, rolling waves on the sea shore etc.), dimmed lights, wearing sunglasses and stereo headphones. This allows the patient go be in their own world without the fearful sites and sounds that they associate with the dental office and dental treatment that trigger their phobia and anxiety.
They can avoid the sound of the dental high speed hand piece, what most patients refer to as the dental drill, they don’t have to see the dental instruments the doctor is using, which often seem sharp and pointed and implements of torture to the patients rather than the instruments of healing that they truly are. There are many benefits to these methods and they are capable of assisting many patients in getting the oral care and treatment they need while they have no adverse risk factors for patients. This makes these techniques universally available to all patients regardless of their health and medication they may be taking. They are also very inexpensive for both the doctor’s office and the patient.
The next level of sedation is pharmaceutical induced conscious sedation that makes the patient unaware of their surrounding so they don‘t have to be exposed to all the triggers of their phobia and anxiety in the dental office. In the dental office the doctor can administer nitrous oxide, more commonly known as laughing gas, to help the patient relax and become less aware of their surrounding that they find so intimidating and nerve racking. This is done by placing a nose hood over the patients nose and having them breathe deeply through their nose without talking during the dental procedure.
The doctor can adjust the concentration of nitrous oxide that the patient is receiving so it can be tailored to the particular patient and the specific type of treatment the patient is receiving. This method can be very effective for most patients and has low risks factors and the patient recovers in just a few minutes after termination of it being administered. It is contraindicated in claustrophobic patients who cannot tolerate the closed in feeling of the nose hood, mouth breathers who can not breath through their nose without consciously trying, patients with sinus infections or other sinus problems that preclude them from breathing through their nose and for patients who do not tolerate the feeling of loss of control.
The dentist may also prescribe a pharmaceutical that the patient can get a pharmacy that will help the patient relax and not remember what occurred to them while they were under the influence of the drug. The class of drugs that has these qualities is the benzodiazepines, and example of which is Valium (diazepam). The amnesic qualities of this class of compounds make them ideal for this application of treating dental phobic patients with high levels of anxiety.
They are relatively safe and have few adverse side effects so they can be used for a wide range of patients and are extremely effective in controlling anxiety, however transportation arrangements have to be made for the patient because they cannot drive while under the influence of the drug and it takes several hours to wear off. They can even be use in combination with nitrous oxide adding to the desired hypnotic effects and allowing the management of all but the most severely phobic patients to be treated with only moderate cost to the patient.
The final level of sedation is IV, or intravenous, sedation in which the doctor has to establish an intravenous line though which the medications can be delivered. With this technique anybody no matter how phobic or anxious they are can be treated because they are completely under the influence of the medications and are totally unaware of what is happing to them. However, this method has the highest risk factors associated with it so it should only be employed for the most sever cases of dental phobia. This method also has the highest cost to the patient and is seldom covered by insurance benefits. This type of dentistry can also be done in a hospital setting.
