Knocking out Dental Fear with Sedation Dentistry
Pain. It’s just a simple four letter word, but it’s surprising the number of people who don’t like to visit their dentist because of it. In fact, according to recent statistics published by the Dental Organization for Conscious Sedation, the problem affects 30 percent of Americans. Think about it. That’s three out of ten people. They could be people you work with, your neighbor…or maybe it’s you.
It’s not that these people don’t want dental treatment. I’m sure they want healthy teeth that last them a lifetime, but it’s their anxiety of suffering excruciating pain, needle pricks and post treatment discomfort that keep them from getting the work done. For some people the problem can be even deeper – especially if they have a fear of the unknown or a phobia of unseen complications during or after treatment. But what they may not realize is their fear may lead to even greater and longer-lasting pain later on.
That’s right. The longer you wait to receive the necessary dental care; the more chance your dental fears and phobias can compromise the well being and functionality of your teeth and oral tissues. If you have dental fear and are reading this, you are probably already weighing your options: Should you go with a little pain now or a lot of pain later? I bet neither choice has you wanting to jump into a dental chair any time soon. But what if I was to tell you there was a way you can get your dental treatment while experiencing little to no pain at all?
The Wonders of Sedation Dentistry
Sedation dentistry (also known as sleep dentistry) is a technique where patients can receive dental treatments in a relaxed and anxiety-free state through the administration of anesthesia and sedative drugs during the treatment. Yes, it sounds clinical, but it’s really quite simple – and it can greatly improve your dental experience as you’ll be relaxed and won’t have to worry about the pain. Plus, because you’ll be less stressed, it could help your dentist get the necessary work done quicker.
Reduced or no pain is good, but what if you’re afraid of not waking up after? Or have a controllable gag-reflect? Or can’t swallow pills? Don’t worry. The modern medical world has thought of everything and there are many different ways for you to be sedated that are commonly used in dental practices today.
The type and degree of dental sedation used by your dentist will depend on the complexity of the dental treatment being performed and your level of anxiety and panic. The two most used techniques of sedation dentistry are intravenous sedation and general anesthesia. They can be used for all types of dental procedures from routine dental cleanings to complex surgeries.
Intravenous Sedation to Reduce Dental Anxiety
Intravenous sedation is a technique where sedative and anti-anxiety drugs are injected into your blood stream using a thin needle. The needle is inserted into a vein on your hand or arm. With this type of sedation, you won’t be knocked out, but will retain consciousness. This is why you’ll hear this method of sedation sometimes called “conscious sedation.”
One of the advantages of being awake during your surgery is you’ll be able to understand and comply with any instructions your dentist gives you during the treatment. Don’t worry. Even though you’re awake, you’ll be so deeply relaxed and in an anxiety-free state you won’t feel concerned about the treatment. You probably won’t even remember how long the dental surgery lasted or what happened during the procedure. I know you’re thinking, “If I’m awake, then how come I won’t remember?”. Sleep dentistry affects everyone differently, but it’s perfectly normal for the drugs used in intravenous sedation to produce either partial or full memory loss during the time they are circulating in your blood stream. So, if you can’t remember what happened, don’t worry.
Benzodiazepines are the most commonly used anti-anxiety sedative drugs in intravenous sedation. The most popular of these is Midazolam because it has a relatively shorter duration of action. This means that after your dental treatment, you’ll return to your normal conscious state faster. It also doesn’t produce a burning sensation on your arm or hand when the drug is entering the body, unlike other benzodiazepines such as Diazepam so there is little discomfort.
How Does Intravenous Sedation Work?
I know you’re wondering how being in a relaxed state is going to help with your fear of getting dental surgery, but believe me it does.
Once the intravenous sedation is administered, you’ll be so mellow you will forget about your fear of needle pricks, surgical incisions or even stitches in the mouth. Your dentist can then administer local anesthesia safely through local injections in oral tissues without evoking any anxiety or restless movements from you. This will numb your mouth enough to make your surgery virtually pain-free.
The intravenous sedation technique doesn’t just deal with pain, but it works wonders if you happen to be one of those people who have an instinctive gag reflex – even if it is a chronic problem that can’t be controlled by psychological behavior training methods. It also can help your dentist get the work done if you have a low tolerance for certain types of surgery. For example, let’s say, you need to get an impacted tooth fragment removed in the back part of your jaw. This type of dental work would involve bone cutting by a machine — which in your normal state would probably evoke fear, trigger your gag reflex and perhaps other problems. But under intravenous sedation, you’ll be able to handle this situation without a problem.
Plus, if the surgery is painful, your dentist can also easily administer additional pain killing drugs into bloodstream using the same intravenous being used to sedate you. This means no additional needle pricks are needed and you’ll feel little or no pain at all during the procedure.
How Safe is Intravenous Sedation?
Intravenous sedation is effective and safe when administered by a trained anesthesiologist so if you are concerned, make sure your dentist has one in the office or that your dentist has been specially trained in this area. The reason it’s good to have a professional around is because the onset of the sedative is rapid and your recovery back to your normal state is also fast. In other words, your dental fear is going to disappear quickly, but then it’s all going to come back. And while you want to be relaxed, you don’t want to be so relaxed that your blood pressure or pulse drop too much.
But don’t worry. Intravenous sedation is commonly used in dental offices and is considered safe. Plus, it’s not a “one drug for everyone” process. The drug dose required to produce your required level of sedation will be tailored to your needs and will be constantly monitored by a trained anesthesiologist. The same concept holds true for the pain medicine. It will be administered based on how much you need.
You will be under continuous surveillance. A trained anesthesiologist will monitor the drug’s effect on you with each passing minute, and will also monitor your pulse, blood pressure and oxygen levels constantly.
General Anesthesia for Complex Dental Surgeries
Sometimes intravenous sedation is not enough and you will want to be completely knocked out. For times like this, general anesthesia may be your answer. I’m not talking about dental visits such as a routine teeth cleaning, but complex dental surgical procedures.
How complex? Well…let’s say you need dental implant surgery or have an impacted tooth that has to be removed from your jaw bone. These are big surgeries that require a long time in the dental chair and could be painful if no anesthesia is used. Other examples would be a surgical operation involving a fracture of your jaw bones or if you have oral cancer and need treatment. In all of these cases, you may not want to be awake during the procedure and you definitely want the pain to be as minor as possible – especially if you already dread the thought of being at your dental office or have a pain phobia.
How Does General Anesthesia Work?
General anesthesia produces a state of controlled and reversible unconsciousness. In other words, you won’t be awake during the surgery. Instead, your consciousness will be controlled through a combination of intravenous drugs and gasses that you’ll inhale to put you into deep sedation. Your muscles will also completely relax and no longer respond, and you’ll no longer respond to pain.
Just like intravenous sedation, you will experience loss of memory during the time you are under the general anesthesia. But the good news is that you will be put into a physical and mental state where you’ll be able to undergo complex dental and surgical procedures a conscious person would find unable to tolerate due to excruciating pain or horrific memories.
How Will I Be Sedated?
Keep in mind, general anesthesia is not used for all dental surgeries. Instead, it’s used in cases where you may have to undergo surgical procedures for an unpredictable or long duration of time or for surgeries where proper muscle relaxation is required for a prolonged period.
The most commonly used induction drug for general anesthesia is Propofol. It is given by intravenous injection and is the drug of choice as it doesn’t cause as much nausea after the surgery as other drugs. Plus, it allows you to become clear-headed faster when you regain consciousness. A pain reliever drug like fentanyl is also given intravenously with the induction drug. This will help decrease your reaction to pain and increase your pain tolerance so you will feel no pain at all during the surgery.
In addition to the intravenous, you’ll also inhale gas. The gasses (called gaseous anesthetics) used for general anesthesia are usually chlorofluorocarbons. You’ll inhale the gas stream using vaporizers that control the dose with extreme accuracy.
Medical Risks Involved with General Anesthesia
Like intravenous sedation, if you undergo dental treatment using general anesthesia, you will not feel anything and won’t remember the treatment when it is over . While this may be a good thing, you will also not be able to respond to any verbal instructions your dentist gives you during the treatment, breathe independently without a machine or maintain adequate airway protection as your muscles will be paralyzed.
As you’ve probably guessed from the amount of drugs and effort involved, general anesthesia is more expensive compared to intravenous sedation and it requires special preparation. Before undergoing general anesthesia, you’ll undergo various laboratory tests like chest X-rays and an ECG. This is because the medical risks involved in general anesthetic sedation are higher than intravenous sedation.
You also can’t eat or drink anything for six hours before starting the procedure as it could result in vomiting during the treatment. Because you are so relaxed and are unconscious, the vomit could enter into your respiratory tract.
But nausea is only one of the risks. As general anesthesia causes your cardiovascular and respiratory systems to be depressed, the chances of complications are higher compared to intravenous sedation and should only be administered in a hospital setting well-equipped with the necessary critical care facilities. It should also only be administered by a trained anesthesiologist.
The hospital providing general anesthesia should be equipped with the necessary machines and devices such as anesthesiologists monitors to monitor oxygen levels, heart rate, blood pressure, ECG, pulse, temperature and the level of anesthetic drugs being administered. Make sure they will have a trained anesthesiologist present at all times during general anesthetic procedure to manage the airway equipment, cardiac defibrillator and any emergency situation which may arise during this procedure.
The hospital isn’t the only part of the treatment that needs to be prepared in advance. To perform dental surgeries under general anesthesia, your dentist also needs to be prepared and should have an advanced level of training as general anesthesia brings about some special challenges during treatment. For example, because you’ll have an endotracheal tube down your throat while under general anesthesia, your tongue will be brought forward which could obstruct your dentist’s working area.
Another challenge is that when your dentist is operating on you after you’ve been sedated by general anesthesia, he or she will be forced to work against the dead weight of all your paralyzed muscles for the entire time. You will also remain immobile in a single posture and position.
You would think it would be easier to work on someone who couldn’t move, but think about it –you’re not going to be able to move your head into position to help your dentist see or reach a certain area. You also won’t be able to move your jaw to assist or even swallow. Only highly skilled and well-trained dentists can effectively meet such challenges. So if you think you’ll need general anesthesia, choose your dentist and anesthesiologist wisely.