Who's Afraid of the Big Bad Dentist?
If you are squeamish about going to the dentist, you are not alone. Fear is one of the biggest reasons a person does not seek necessary dental care. The goal of this column is to raise awareness of anxiety reducing methods currently available to dental patients.
The first defense against dental anxiety is to choose a dentist you trust. Contrary to stereotypical generalizations, dentists come in many personalities and each dentist’s staff and office atmosphere reflects the dentist’s personality. Choose a dentist with whom you have positive rapport. Many dentists are willing to schedule a brief, complimentary “meet and greet” appointment. This appointment gives you the opportunity to visit with the dentist, meet the staff and see the office. This meeting should allow you to assess your comfort level and begin the process of building a trusting relationship with the dentist.
The second line defense against dental anxiety is to communicate your fears and concerns clearly with your dentist. Is it the “the needle” that makes you cringe or is it the noise of the hand piece? Have you had difficulty getting completely numb in the past? Do you want to watch in a mirror and hear about everything that goes on during treatment, or would you rather pretend you are at the beach and see and hear nothing until “All done!” Let your dentist know these things.
Many people need a third line of defense to alleviate dental anxiety. This set of defenses involves medication taken via inhalation, IV or pills taken by mouth.
Nitrous oxide or “laughing gas” has been a common relaxation strategy for many years.
Nitrous oxide was discovered in 1772 by English natural philosopher and chemist Joseph Priestley. Before it was employed for its analgesic effects, it was used as a recreational drug at “laughing gas parties” arranged primarily by the British upper class. Forty-four years elapsed from its discovery to its use as an analgesic in medical practice. The gas actually has a triple effect: analgesia (pain relief), anxiolytic (anxiety reducing), and euphoric (a sense of well-being). Most people under its influence appear lethargic or dreamy, but some erupt in giggles, hence the name “laughing gas.”
Oral premedication with anxiolytics such as Ativan is highly effective in reducing the stress many people experience during dental treatment. This method is nice because the patient is communicative, though often quite sleepy, during treatment, and there is no cumbersome nose piece or hoses to work around as with nitrous oxide. When oral pre-medications like Ativan are used, the patient is not allowed to drive while under the influence. They will need someone to bring them to their appointment and someone to pick them up after their appointment.
For patients who need even more relaxation, deeper sedation is available. This deeper level of sedation is often delivered via an intravenous (IV) line. These types of services are not as readily available in general dental offices as are nitrous oxide and oral premedication. However, an internet search for “sedation dentist” should be helpful. Just remember that “Sedation” can mean a number of things, so look into the details. Specialists such as oral surgeons, periodontists (gum disease specialists) or endodontists (root canal specialists) are most likely to provide these services.
Most dental patients find that being cared for by a dental team they trust, communicating clearly and, if needed, using oral pre-medication transforms the dental treatment experience from nerve wracking to relaxing. Be sure to communicate with your dentist about what helps you to feel most comfortable while being treated. In addition, do not hesitate to ask your dentist what further relaxation options are available for you. With clear and open communication the scary nursery rhymes can be left in our childhood with a smile.