by P. Vernon Erwin, DDS
There’s an old joke that goes: What are the six most frightening words in the world? “The dentist will see you now.”
Fear of the dentist seems to be a sort of cultural norm. If you say you’re going to see the dentist, most people will grimace, groan or give their sympathies. Now, back in the day before effective anesthetics, when “painless dentistry” was just a pipe dream, this would have been an appropriate response. But today’s dentists provide a wide variety of methods to minimize pain and help the patient stay calm and relaxed – ideal for both patient and dental team alike!
Whether you experience dental anxiety, fear or all out phobia; whether your feelings are rooted in bad experiences or fear of the unknown; a good dentist will listen to you and work with you to discover the best way to deal with it so you can take good care of your teeth and get the healthy, attractive smile you want.
So what are your options for dealing with dental anxiety, fear or phobia?
In the most extreme cases – or in situations where the work to be done is extensive – we can use a procedure known as oral conscious sedation. As the name suggests, this consists of taking medication by mouth at such a dose that you will stay awake but very calm.
In my practice, we follow the DOCS protocols. Typically, the medication will consist of one or more of several drugs: Valium, Halcion, Ativan, Versed, Sonata and Vistaril. The first four are benzodiazepines, which reduce anxiety and relax the muscles. Sonata is from a related class of drugs called pyrazolopyrimidines, which cause sleepiness and thus are often used to treat insomnia. Vistaril is an antihistamine which also reduces anxiety and has mild pain-reducing properties. We determine the precise kind and amounts of medication on a case by case basis, depending on your needs, situation and biochemistry.
Typically, when you opt for oral conscious sedation, you take a dose of a single medication the night before your appointment. Once you’re at our office, you take additional medication and are monitored at all times for safety. As soon as you’re fully relaxed, we proceed with treatment.
Because of the types of medications used, patients who opt for oral conscious sedation must have someone drive them to and from their appointment, for the effects of the drugs take some time to wear off.
Who is oral conscious sedation appropriate for?
Not all people want the drug “cocktail” that oral conscious sedation involves, nor do all who experience dental anxiety need so much sedation. In such cases, we can provide nitrous oxide, commonly known as “laughing gas”. Once the patient is seated, we place a small rubber or plastic nosepiece through which the gas is administered. Within just a few minutes, the patient is very calm and relaxed, and when the treatment is over, it generally takes just about five to ten minutes for them to return to full alertness. Consequently, they are able to drive themselves to and from their appointments as they wish. Also, nitrous oxide has analgesic properties, meaning it helps reduce or prevent pain. Along with the local anesthetic, nitrous oxide is generally sufficient sedation for most people undergoing common dental procedures. The only people for whom it would not be appropriate are those with breathing or other respiratory problems and those who can’t tolerate having their nose covered due to claustrophobic feelings.
There is a vast array of herbs that can help reduce anxiety, relax muscles and block pain. Among the most potent is valerian root, which can be bought as an extract and taken as drops in water. Along with other calming herbs such as hops, passionflower, chamomile, lemon balm, hyssop, mugwort, St. John’s wort and lavender, valerian can also be found in many herbal teas sold as “bedtime”, “sleep” or “calming” teas. Herbs can be taken both the night before and day of treatment for full effect. But as with oral conscious sedation, you will need to have someone drive you to and from your appointment, due to the grogginess that these botanicals cause.
Other natural means of relaxation include simple deep, controlled breathing from the belly; progressive relaxation techniques; and listening to soothing music through headphones or earbuds. These can be done alone or in combination with each other.
But above all, the number one thing you can do to cope with dental anxiety, fear or phobia is to talk with your dentist, letting him or her know of your fears, worries and concerns about treatment. Your dentist can then work with you to come up with a great game plan to allay them so you can get the quality dental care you need and deserve.