Thursday, September 20, 2007

Do Anxious Dental Patients Really Need Oral Sedation?

by Hisham S. Ayoub, DMD

"Did I really Have a Root Canal?" was the title of the article that ran in Tuesday's (June 19th) edition of the Wall Street Journal. It is a remark made by a dental patient who underwent a root canal treatment under oral sedation.

More and more patients these days are asking for oral sedation as a way of circumventing their anxiety during dental treatment, and dentists are happily obliging. Why? Well, some dentists charge as much as $800 for the oral sedation in addition to the treatment, and usually that is not covered by insurance companies.

I personally think that the majority of anxious dental patients out there do not need oral sedation, which is typically the insomina drug Halcion (Triazolam) used by dentists as an "off label". Halcion is made by Pfizer.

What Halcion does is place the patient in a sedated state of mind which typically includes mild amnesia, helping the patient forget most of the treatment. The patient is usually prescribed a dosage the night before, and another in the morning right before the treatment. A designated driver must be at hand at the end of the procedure as the effects can last several hours.

But Nitrous Oxide, better known as laughing gas, can be just fine in allevaiting anxiety. It can be less of a concern in terms of overdosing and side effects, and does not last as long. Patients usually need no more than 10-15 minutes following the procedure to be fully recovered. Nitrous Oxide is also covered by insurance in most cases.

People do not like dentists. I know; my own wife is, as Kramer from Seinfeld termed it, an anti-dentite. Yet, usually with a slow and comforting treatment environment she does not even need nitrous, let alone oral sedation. Now, of course, I am not sure if that would be the case if another dentist is treating her, but my point is there are methods of circumventing a patient's anxiety levels without the use of pills and oral drugs.

Most of the anxiety and fear that patients feel towards the dentist in their adult years is usually the cause of a fearful event early in their childhood, and is usually precipitated by their parents.

I am not saying that dentists did not have a role either. Some dentists do need to pay extra attention to the comfort needs of their patients, but more and more of the younger dentists these days are properly trained and honestly concerned about the comfort of their patients. An unhappy patient, no matter how unwarranted, is a non-returning patient.

But I do feel that parents can and should aid in the comfort of their children with their early dental needs. I remmember a mother who brought in her 4 kids to the clinic. Her eldest son, in his mid-teens, had a pretty deep cavity on one of his teeth and did need a root canal. His attitude and his eyes clearly stated the obvious; he was not looking forward to any treatment.

After he was locally anesthetized, which in itself took a lot of patient comforting, his eyes began to tear, and ask a lot of questions, a common tactic by younger patients to delay the work.

Now, his mother never explained that he usually needs nitrous oxide, nor did she warn me about his extreme anxiety, and as I turned on my dental drill, and having heard the noise, he gives out a loud yell of surprise. His mother starts yelling out loud from the patient waiting room. I walk over to her and she begans to shoot questions at me hysterically; "what's going on?", "why is he crying?", "I just came over for an exam, and you talked me into a root canal?, "I don't even know what's going on?" and on and on...

I spent the better of 20 minutes trying to calm the mother down knowing that it is now too late for her boy, he has heard everything and is now even more hysterical just like his mother. I wasn't even going to try the Nitrous on him. I promptly referred her to a local pedodontist.

Talking to her I learned that she was terrified of the dentist, and that her parents and herself, did not have great teeth and hated to go to the dentist. This is typical of anxious dental patients who sometimes do not know why they are scared, rather they know that their parents, their siblings, or friends had a horrible experience and did not want to go through the same. What worries me the most of this experience is the fear and anxiety instilled in her other three younger children who have now witnessed their older brother's, and mother's dental fear.

While some patients with extreme fear and phobia do need oral sedation, I firmly believe that with proper comfort, Nitrous Oxide, and a good warning in advance of possible anxiety should be more than adequate for most fearful adult patients.

As for the young patients whose dental experience is just beginning, parents please, do your kids' a favor and try your best not to motivate further fear in them. Your dentist is on your side in making sure your children have the very best experience possible.

This article represents Dr.Ayoub's opinion only and should not be considered as medical nor dental advice. Please seek the advice of your local dentist or visit the American Dental Association ( for further information.

Dr.A's Dental Journal________________



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