Taking the Pain Out of Dentistry

By Joseph P. Thomas, DDS

When its time to go to the dentist, is your first thought, “Oh no, I hate going to the dentist?” There is no doubt about it; the mere thought of discomfort during and after a dental procedure can result in some uneasiness. Your mind runs rampant with real and imagined scenarios that convince you to do just about anything else than make the trip to the dentist office. The truth about dental anxiety and fear in this thought process is that individuals delay scheduling appointments for needed treatment or if they do make the appointment, they cancel or fail to show up when scheduled. Because of this self-neglect, more extensive and invasive procedures are needed. Of course, this causes more worry and fear. Now, the vicious cycle has been set in motion.

Unfortunately, pain from dental procedures is often greater than comparable injury outside of the mouth area. The greater density of sensory nerves in the mouth needed for taste, speech and chewing accounts for a higher degree of pain during dental procedures. For individuals who don't get numb from local anesthesia, are needle phobic, have a high gag reflex, have had traumatic dental experiences or simply are short on time, a solution is available. Conscious Sedation is the perfect answer for dental patients who are nervous or in some cases, terrified about receiving dental treatment.

Now, that you know there is a less angst-ridden way to keep your dental appointments and not lie awake all night worrying, let's explore Conscious Sedation.

Conscious Sedation

Conscious Sedation is a minimally depressed level of consciousness that retains the patients' ability to breathe independently and to respond appropriately to physical stimulation and verbal commands. Conscious sedation may be accomplished by employing many different methods of administration including oral, inhalation, intravenous (IV), sublingual, rectal, intranasal or sub-muscular. Depending on the individual patient and the dose of drug or combination of drugs, any of these methods have the potential to induce any level of sedation. The patient recovers physically and psychologically within 12 hours after conscious sedation.

Goals

The goals of conscious sedation are to minimize pain and anxiety, minimize negative psychological responses to treatment, control disruptive behavior, guard safety and welfare and return the patient to a state that is safe for discharge.

Safety

As with the use of any drug in dentistry, the dentist must have a clear understanding of the drugs clinical pharmacology and the ability to manage potential adverse events. It is prudent to select one drug and use it well, as opposed to using multiple drugs. The use of combinations of sedatives is more likely to lead to deeper levels of sedation or other adverse events.

Once the decision is made to proceed with conscious sedation, patients must be properly assessed to determine any risk. Patients are categorized, based on the American Society of Anesthesiology (ASA) physical status classification system. This categorization can act as a guide to assess the patient's ability to tolerate the planned procedure or the need for further medical assessment.

A drug used to induce conscious sedation should be administered to the patient in the dental office. This setting has the benefit of allowing for prompt treatment of any adverse reactions by a well-trained dental team in a well-stocked, emergency-prepared dental office. Administration of the drug in the dental office offers two important elements; a relaxed setting to help induce sedation and determining the exact time the drug was given.

The patient should take the drug approximately one hour before the planned dental procedure. If there is a clear indication that the patient's anxiety regarding the dental appointment will prevent him or her from sleeping, one dose to facilitate a restful sleep the night before the procedure maybe considered.

Monitoring

Good monitoring equipment is a must when sedating a patient. Today compact computerized pulse oximeter and blood pressure monitors exist that closely scrutinize the vital signs of the sedated patient.

Ideally, heart rate and blood pressure should be determined before, during and after the procedure. Clinical observations of the level of consciousness and adequacy of respiration are critical during the procedure.

Pharmacology

Most prescribed doses of sedation drugs assume the patient is a healthy 150 lb. adult. There are factors that lead to the adjustment of the dosage above or below those suggested.

Significant increases or decreases in body weight may require adjustment of the amount of drug administered for conscious sedation. Elderly patients are more susceptible to central nervous system depressants with respect to depth and duration. The weight of the pediatric patient is a major determinant of the size of dose. The medically compromised patient may require reduction of the dose. Patients taking other drugs affecting the central nervous system may have drug interactions that can effect the oral sedation. Other reasons a dose might be adjusted are, a patients' unusual response to alcohol, patients who are chemically dependent, and finally, patients with increased anxiety.

Oral Administration

Taking a sedative drug by mouth is a convenient and economical way to induce conscious sedation. The incidence of adverse reaction is greatly minimized by oral sedation. The disadvantage of oral sedation is the erratic and incomplete drug absorption from the stomach. Not eating for a certain length of time before orally taking the drug can improve absorption. The onset of the effects begins approximately in 30 minutes after taking the drug, reaches peak effectiveness in 60 minutes and then starts to wane.

You'll never have to be nervous, worried or terrified to go to the dentist again. Stop worrying and start planning your new smile! Please call us today at 406-256-5165.

Back to News Index