Sedation Options for Dental Anxiety
by Martin Miron
Dr. Steven Gray, a general dentist at Ann Arbor Smiles, says, “Studies show that more than a third of Americans experience dental anxiety or phobia, with a third of those being an extreme form. For some, anxiety can be as simple as a feeling of unease about their next appointment. For others, this anxiety can lead to decades of avoiding preventive dental care and sometimes major damage to their dental health. The reasons for the anxiety are varied, but often include traumatic experiences, experiencing trauma through other’s stories and other internal psychological factors. Dentists can come alongside patients who are experiencing dental anxiety by offering varying degrees of sedation services. Other useful applications for sedation methods are for patients with a strong gag reflex and patients who need full reconstruction which requires lengthy appointments.”
Ann Arbor Smiles has helped hundreds of patients receive needed dental care using three forms of sedation: nitrous oxide, oral conscious and intravenous. “The generic term sedation covers a wide range of therapies. A medication like nitrous oxide gas (laughing gas) can be used as an entry attempt at sedation for mild to moderate anxiety. Patients simply breathe a combination of nitrous oxide gas and oxygen during their appointment. The gas likely affects several neurotransmitters and modulators in the brain to offer a level of anxiety and pain control during dental procedures,” informs Gray. “This service has a low cost, doesn’t require a separate driver and is offered by many dental offices. For some patients this method is sufficient, but for others, their anxiety requires a deeper level of sedation. There are two additional methods that are safely practiced in dental offices for those patients: oral conscious sedation and intravenous sedation.”
Oral conscious sedation refers to taking medications prior to the dental treatment under the careful monitoring of the dental team. Benzodiazepines such as Valium, Halcion, Xanax and Ativan are the most commonly used class of medications for this purpose. “These common medications are used in low doses on a daily basis by many individuals for generalized anxiety. However, when given in higher doses under supervision, they can help patients achieve a very comfortable mental state for receiving dental treatment. Dentists are required to take special training in order to administer these medications and patients are required to have a friend or family member drive the patient to and from the appointment. This type of sedation is considered very safe for the majority of patients,” explains Gray.
“Typically, a patient will arrive roughly one hour prior to the start of their dental treatment, and be brought into the treatment room. Procedures are reviewed and instructions for the caretaker will be given. Monitoring equipment for breathing and heart functions are placed and baseline readings will be recorded. The treating dentist will then determine the adequate dosage of medication based on the patient's anxiety and the length of the appointment. The medication typically takes 45 to 80 minutes to reach the desired level of sedation. Breathing and heart functions are monitored by the dental team throughout the appointment and patients are only released with the caretaker once the patient has recovered to a safe level of consciousness,” according to Gray.
Intravenous (IV) sedation provides an even deeper level of sedation. “The dental team places a catheter into a vein and administers medications which place the patient into a moderate level of sedation in a matter of seconds. This method offers the benefit of being able to quickly titrate the level of sedation for the patient and can be reversed if needed. It is typically a more expensive form of sedation and requires an even higher level of training for the dentist and the staff. Similar to conscious sedation, the patient is still able to breathe without assistance. Deep sedation and general anesthesia typically require a hospital setting and an anesthesiologist or certified registered nurse anesthetist on-site. This is typically reserved for only the most extreme medically compromised cases,” says Gray.
“While the exact effects of sedation can range from person to person, we have found these methods tremendously beneficial for patients who have not been able to receive the care they needed due to their anxiety,” counsels Gray. “Many patients can undergo several hours of dental work with little to no memory of the whole experience. If anxiety is something that has kept you from receiving the dental care that you need, finding a dentist who offers sedation can be life changing. Delaying dental care further typically ends up costing more in the long run and involves more advanced treatments. Many times, a free consultation in person or on the phone is a great way to start a conversation with a sedation dentist.”
Ann Arbor Smiles has three locations in Ann Arbor. For appointments, visit AnnArborSmiles.com/services/sedation-dentistry.