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By Lee R. Cohen, D.D.S., M.S., M.S.
Many of us, dentists included, have a fear of going to the dentist. In reality, almost all dental procedures do not hurt due to the use of local anesthetics (often referred to as Novocaine). Typically this anxiety is primarily related to fear of having a procedure performed, fear of possible pain during the procedure or flat out phobia of getting numb (“the dreaded injection”). Fortunately, there are a variety of ways in which these fears can be addressed so that the visit is not only pain free, but non-anxiety producing. Different forms of sedation can be provided to the patient based on their needs and of the level of training / certification of the doctor. In addition, more advanced levels of sedation require state permitting of the treatment facility. Below is a list of commonly used modalities to help manage dental anxiety.
Nitrous Oxide (“Laughing Gas”)
This form of therapy is administered in the office and usually has a fairly rapid onset. A combination of oxygen and nitrous oxide are delivered as the patient breathes in and out. The gas is delivered through a small mask placed over the nose. Typically this treatment allows the patient to relax as the procedure is performed. When the procedure is completed, oxygen alone is delivered in the mask to flush out the “laughing gas” and return you to a normal state. In most cases, you may drive yourself to and from the appointment when nitrous oxide is utilized.
Oral Sedation (Prescription Medications)
Another form of therapy is the use of prescription medications taken prior to and during the appointment. Typically medications such as benzodiazepines (i.e. – Valium, Xanax, Ativan), antihistamines (i.e. – Benadryl, Vistaril) and narcotics (i.e. – Demerol) are prescribed based on the needs of the patient. Using these medications in combination requires special training and permitting by the doctor. In the majority of the cases, this form of sedation is used to provide minimal sedation or the relief of anxiety. Depending on the dosing, needs of the patient and doctor’s training, this form of treatment can be used to provide a deeper level of sedation than simply a reduction of anxiety. The sedation in this case is provided to relax the patient and local anesthetics (“Novocaine”) are also used so the procedure is pain free. A driver is typically needed when oral sedation is provided due to the effect of the medications on your reflexes (similar to alcohol).
Conscious Sedation (Prescription Medications or “Twilight Sleep”)
Conscious Sedation is a form of sedation that relaxes a patient beyond simple relief of anxiety. As the name implies, you are still conscious, but are typically more drowsy and forgetful of your surroundings. The level of relaxation can range from mild to moderate based on the dosing of the medication. In many cases, this type of sedation is provided via an IV similar to “twilight sleep” provided for other types of procedures. Special training and permitting is required to provide patients this safe and effective method of sedation. Often patients do not remember much of the procedure after it has been completed. A benefit of this type of therapy is that when administered by IV, the medications can be given drip by drip so that the sedation can be titrated to each patient’s exact needs. Conscious Sedation can be achieved by the use of prescription pills alone, but the exact control as seen with the IV is not possible as each patient digests and absorbs oral medications differently. A driver is needed when this type of sedation is utilized and local anesthetics (“Novocaine”) are used to provide a pain free procedure.
Deep Sedation / General Anesthesia
This form is sedation allows for a depressed state of consciousness and can be achieved with the use of IV, inhalation gases or prescription pills. In this situation, your reflexes are diminished. This type of treatment is typically used in specific situations and not for the majority of dental procedures. Special permitting is required to perform Deep Sedation and a driver is needed.
The fear of seeing the dentist can become paralyzing and causes many not to seek the treatment they truly need. Unfortunately, what may be a simple problem can become much more involved, painful and costly if left untreated. Sedation techniques which are safe and effective can make seeking the treatment you need not only bearable, but possibly even pleasant (I know it seems impossible, but it is true).
Lee R. Cohen, D.D.S., M.S., M.S.
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