Dental Care for the Apprehensive Patient

The fear of dental treatment is neither unusual nor abnormal. Today, it is possible to avoid the pain and anxiety of dental treatment and have pain free dental care through the use of oral sedatives and intravenous or general anesthesia.

The need for sedation is not restricted to any particular group of people. The apprehension or sensitivity that some people associate with dental treatment is prevalent in every walk of life, in both men and women, and in every social and economic group. Your dentist wants to make sure that your visit is as free from discomfort and anxiety as possible. Here are some of the options that are available.

The Numbing Effect: The Role of Local Anesthetics

Local anesthesia numbs the teeth and gums to prevent you from feeling discomfort during dental treatment. There are two types of oral anesthetics: topical and local.

  • Topical anesthetics help numb the surfaces of the gums. They may be used to help eliminate the slight discomfort that some patients may feel from the anesthetic solution. The topical anesthetic is applied with a swab, spray, or an adhesive patch.
  • Local anesthetics (Novocain®) work to prevent pain in the mouth where treatment will take place. They are generally administered near the treatment site to help block nerve endings and temporarily numb mouth tissues. These medications are used for procedures such as restoring teeth, dental crowns, and tooth extractions. A topical anesthetic is generally applied prior to receiving the local anesthetic.

A Calming Feeling: Anxiety and Pain Relief through Conscious Sedation

Anti-anxiety agents or sedatives can help you relax during dental procedures. They may be given before or during the dental visit and can be administered as pills, liquids, or intravenously. Some can be inhaled, such as nitrous oxide (laughing gas). The only form of sedation we offer is in pill form.

Anti-anxiety agents or sedatives may be used with local anesthetics and pain medicines during procedures. Some of these agents provide what is called “conscious sedation”. This means that when they are administered, you should feel drowsy but still remain responsive to voice commands.

Your dental visit will be very comfortable and you should feel no discomfort or anxiety during treatment.

Oral conscious sedation involves taking an oral medication prescribed by your dentist or physician such as a Valium® or other anti-anxiety medicine.

  • You should feel at ease with your surroundings and planned procedures, although you will be awake. The dentist or physician will review your medical history to discuss the prescribed medication, its dosage, and its expected results.
  • You will generally take the prescription to the pharmacy to be filled and may possibly begin taking the medication the night prior to the dental visit. Detailed instructions will be given to you on your consultation day. Remember, you will not be able to drive yourself to or from the treatment appointment if you have taken the oral sedatives.

Intravenous sedation involves the introduction of medication intravenously, usually in a vein in the arm, to achieve a relaxed, sedated state in which you are less aware of what is taking place.

  • You are generally treated in a dental room where you are consciously sedated. You will be breathing and swallowing on your own, without a breathing tube. You will have monitors placed to watch your heart’s activity, your blood pressure, and your breathing and your treatment will be completed in a comfortable fashion. An adult friend or family member must be available to drive you home.

General Anesthesia

General anesthesia, unlike conscious sedation causes a loss of consciousness and produces deep sleep.

  • General anesthesia may be used for patients with uncontrollable anxiety or patients who are unable to control their movements, such as young children or patients with disabilities. It may also be used for long or complicated procedures such as surgical tooth extraction.
  • All states require dentists who provide general anesthesia to have a special permit from the state (based on advanced training). Other trained dental personnel are usually on hand during the procedure.
  • General anesthesia is usually administered in a hospital operating room where you will be fully asleep with a breathing tube.