Forget the Fear




With sedation dentistry, there's no need to be afraid.

Twenty- twenty- twenty-four hours ago,

I wanna be sedated.

Nothin' to do and nowhere to go,

I wanna be sedated.

Just get me to the airport and put me on a plane.

Hurry, hurry, hurry, before I go insane.

I can't control my fingers, I can't control my brain,

Oh no, no, no, no.

- "I Wanna Be Sedated," The Ramones

The smooth, fresh feeling of professionally cleaned teeth is one to savor and possibly one of the best potential weight-loss methods around (admit it: you do hesitate, at least a little, before eating after a cleaning, not wanting to tarnish your gleaming choppers). But most of us find dental visits unpleasant and feel a sense of relief when we are dismissed from the dental chair, snazzy new toothbrush in hand.

While it's not uncommon for dental procedures to trigger a mild case of the jitters, sometimes the anxiety blossoms into a full-blown phobia, complete with trembling and debilitating panic.

Avoiding the dentist is bound to make matters worse, though, often leading to much scarier dental visits than a routine cleaning or cavity fix. If you are one of the very afraid, you might feel stuck. But dentists today offer sedation methods that can calm even the most fretful, leaving patients with nothing to fear but cavities themselves.

The fear factorRegardless of the reason - whether it be bad memories of a long-ago dental visit or lingering persuasion from a relative who set the stage for dentist anxiety - uneasy patients have been known to avoid dental appointments for years or even decades. "Some people are just petrified of working with a dentist. It becomes a challenge for them just to step within our doors," says Paul E. Thompson, D.D.S., of Thompson Smiles by Design in Manchester. "It's a fear of the whole process. We violate people's space; we're right in their face."

Indeed, the fear of needles, the dentist's drill or the procedures in general can make patients so nervous they break down at the mere thought of receiving treatment, says Paul Connolly, D.M.D., a prosthodontist at Bedford Dental Care. "Sometimes as soon as I walk into the room for the initial consultation, the patient starts crying, or even before I get into the room and they're talking with the assistant, they're crying," he says.

Knowing that patients are not always eager to open wide, some dentists try to create a serene atmosphere in their office, offering soft music, calming paint colors on the walls and even warm blankets. Others provide distractions like televisions and video glasses that allow patients to watch a video or noise-canceling headphones that block the sound of the drill and fill patient ears with music instead. Not as commonly, some dentists also offer hypnosis therapy to soothe frayed nerves and redirect patients' thoughts, Connolly says.

Regardless, the overall goal for most dentists is the same: to make patients as comfortable as possible while giving them the care they need - without the use of medication, if possible. "We certainly don't, at least in my practice, promote sedation," says Thompson. "We offer it if we can't get a patient comfortable by other means."

The road to relaxationFor patients who do need help getting through their appointments, there are three main "conscious sedation" options (with general anesthesia a possibility for those who need the ultimate form of sedation - a state of unconsciousness). Not all dentists offer all types of sedation.

Nitrous oxideFor apprehensive patients who feel too edgy to go it alone at the dentist's office, nitrous oxide, commonly known as laughing gas, is often all that is needed to bring about a better sense of calm and comfort during the appointment. It is the mildest form of sedation.

Oral sedationOral sedation, in which the patient ingests medication such as Valium, provides a deeper level of relaxation than nitrous oxide. It makes the patient less aware of what is going on during the dental visit, says Vicktor Senat, D.M.D., a general dentist at Amerident Dental Associates in Amherst.

Intravenous sedationThe most intense level of conscious sedation is delivered intravenously, and, depending on the patient's medical history, might require that the dental procedure be performed in a hospital setting. Intravenous sedation, like oral sedation, requires that a driver escort the patient because of the lasting effects of the medication. It is the most expensive sedation technique; "the Mercedes of sedation," Senat says.

Administering sedation medication intravenously allows the doctor to sedate the patient more quickly and in a more precise, controlled manner, Thompson says. "You can't do that with pills or with nitrous oxide," he says. And because the medicine is delivered via the veins, it can also be reversed more quickly, if need be, than the other sedation methods.

All three types of sedation are likely to have an amnesia effect, making it tough to recall procedure details and leaving the impression that the time spent in the dental chair was much shorter than it actually was. A patient trying to remember a three-hour stretch in the dental chair, for example, might guess that it was a 10-minute visit, Connolly says.

Sedation settingsSome patients request sedation specifically because of its ability to warp time; they're not necessarily afraid, but they can't bear the thought of enduring an hours-long session in the dental chair. "Sedation dentistry is not just for the fearful patient or the patient who has a lot of anxiety just sitting in one place for so long," says Senat. "If the procedure is going to take upwards of three or four hours, they would much rather be someplace else than to be aware," he says.

But sedation works for shorter appointments, too. In fact, it can be used during just about any treatment, from a cleaning or filling to a crown, extraction or even an elective cosmetic procedure. It is an option for patients of all ages who truly need it, including children if necessary - even kids as young as, say, 4 who have a lot of decay, Thompson says. "With the very young, we're very careful because of the age and the body weight of the patient. At the other end of the spectrum, as folks get older, they develop more medical conditions, which restrict the use of [sedation methods]. But usually, we can find a modality that will allow us to go ahead" and allay the patient's fears while taking care of their oral health, Thompson says.

Over time, some patients find that they can rely less on sedation for at least some dental visits, as they grow more at ease with the doctor and the procedures, Connolly says. "They start to get a comfort level with us," he says. Especially if it's a patient's third or fourth visit for the same type of treatment, "sometimes we can back off and be a little less aggressive with the sedation," he says. NH

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