When it comes to things that we don’t like doing, going to the dentist often ranks very highly on the list. However, for some people, even the thought of visiting a dentist is enough to send them into a tailspin of fear and anxiety. Dental anxiety is no longer a joke but a very real condition, and it is estimated that up to 15% of Americans completely avoid visiting the dentist due to fear or anxiety.
Patients that suffer with dental anxiety are often stressed and uneasy when they visit for an appointment. They experience high levels of worry and concern, and may question everything that their dentist says or does. However, patients with dental phobia are panicked, may make themselves sick or hyperventilate, and are often unable to be reasoned with – and that is if they make it through the door to their appointment at all!
The main issues with dental anxiety and phobia is the lack of care that they receive. Sufferers have a far greater risk of tooth decay, gum disease and tooth loss, which can impact on their appearance and as such, their confidence and ability to function day to day. Poor oral health has also been found to have links to some life-threatening illnesses such as heart disease, and as such, sufferers of dental anxiety and phobia can also be at risk from poorer general health and a lower life expectancy rate.
Thankfully, sedation dentistry is making serious inroads into improving dental anxiety in phobia in a number of patients, reducing their risk of oral health problems.
What is sedation dentistry?
Sedation dentistry is the practice of using medication to assist patients to relax during dental procedures. There are multiple levels of sedation used, and the type you are given depends on the level of anxiety that you are feeling and the dental procedures that you need to be carried out. These include:
Minimal sedation – you are fully awake, but relaxed
Moderate sedation – you will have a slight awareness of the procedure, but may remember very little after. You may also slur your words for a short while after the sedation has occurred.
Deep sedation – for procedures performed on the precipice of unconsciousness
General anesthetic – you are completely unconscious and will remember nothing of the procedure at all
Who is sedation dentistry suitable for?
As well as people with a serious anxiety or phobia of the dentist, sedation dentistry may also be a practical solution for people who:
Have particularly sensitive teeth
Have a very strong gag reflex
Struggle to hold their mouth open
Are unable to sit still for a procedure
Have a very low pain threshold
Need extensive work completed at one time
Some children are also given sedation for dental procedures, although this is almost always in the form of nitrous oxide or oral sedation, and is carefully planned based on the child’s height, weight and health history.
How is the anesthetic administered?
There are several different types of anesthetic used in sedation dentistry. The type given to you will depend on your personal health, anxiety level and the dental work that needs to be carried out. In addition to the varieties listed below, you may also require a local anesthetic in your mouth, to numb the area that the dentist will be working on.
Sometimes referred to as ‘laughing gas’, nitrous oxide is administered through a mask that is placed over your nose. The gas helps you to feel relaxed, and many people say that they feel slightly ‘tipsy’ and disorientated when they use it. However, it wears off quickly and so your dentist will need to carefully control how much you have. This type of sedation is the only one with which you may be able to drive yourself home after – but this is only with the express permission of your dentist.
A pill may be given to help induce mild to moderate sedation. Usually from the same family of medicines as Valium, the pill is usually taken around an hour before your procedure and will make you feel drowsy, but won’t send you to sleep. For a slightly stronger effect to facilitate moderate sedation, a slightly higher dose may be given. In these cases, the patient can sometimes become unconscious, but can be easily awaken with a gentle shake.Intravenous Sedation
Intravenous or IV drugs are for moderate sedation and are administered via an injection into the vein. This type of sedation works very quickly and can be carefully monitored and adjusted as needed.
There are a number of medicines that will put you into deep sedation that will render you completely unconscious, which is how you will stay until you are woken up either with medicine or because the anesthetic has worn off.
Risks of sedation dentistry
Although dental sedation is perfectly safe in the majority of cases, there are some risks and side-effects you should be aware of before your procedure. These include:
Disorientation – many patients feel disorientated for some time after their procedure and this is why we ask patients to have a friend or family member present to take them home
Hypoxia - where not enough oxygen reaches the blood or bodily tissues
Hyperactivity – some people find they are jittery and unable to stay still
Nausea – you may feel or even be sick
Overdose of sedation drugs – which comes with its own risks
Respiratory depression (hypoventilation) – where the body is not getting enough oxygen
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