|
Dental Anxiety and its Management By Brian
J. Gray, DDS, MAGD, FICOI It is important that a patient tell the doctor if they have any 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 dentist is aware of the patient's 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 concerns. When this is not enough, other highly effective and safe sedation techniques can be used. If the technique involves the administration of a drug, it is termed conscious sedation. 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 Many dentists will prescribe a sedative drug to be taken by mouth prior to the planned treatment. Most oral sedative drugs must be taken one hour prior to the planned appointment in order to be effective. The dentist may prescribe the drug to be taken by the patient at home prior to coming to the office or may request that the patient arrive at the office one hour early to take the drug in the office. If the drug is administered at home, it is IMPERATIVE that the patient NOT DRIVE A CAR to the appointment. If the individual has a greater degree of dental fear, the doctor may prescribe an oral sedative to be taken at home one hour prior to going to sleep on the evening before the appointment. Patients receiving oral sedation are not permitted to drive a car or operate a motor vehicle for 24 hours following their appointment. Commonly administered oral sedatives include: Valium, Halcion, Dalmane, and Versed. Oral conscious sedation is most effective in the management of milder degrees of anxiety. Inhalation Conscious Sedation The use of 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 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 anxiety. For additional information regarding inhalation conscious sedation, please see the article on Nitrous oxide-oxygen inhalation sedation. Intravenous Conscious Sedation 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 fear. Dentists who employ IV conscious sedation have received specialized advanced training and certification by their state Board of Dental Examiners. Commonly used drugs include Valium, Versed, Fentanyl, and Demerol, either alone or in combinations selected by a doctor. 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 Less commonly employed for adult patients, intramuscular (IM) conscious sedation is a relatively effective technique for management of moderate levels of dental fear and anxiety. IM conscious sedation is more often employed in the management of fearful children (see article " Sedation and Pain Control in 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 tolerate their dental treatment. When general anesthesia is used, the 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. 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. It is important for patients to voice concerns and dental fears with their doctor at their first visit to the office. The doctor will seek to work out a treatment plan that will best accommodate their needs. In some situations it may be necessary to refer a patient to a doctor who has these techniques available.
|